Late 19th century
The area was primarily occupied by the working class and families with low incomes as those who could afford to move away had migrated to other areas thanks to the expansion of the streetcar system.
The late 1950s/1960s
Gradual marginalization had occurred due to developments elsewhere and streetcars no longer drove in the area. The main library and department stores were relocated out of the Downtown Eastside. However, the area continued to have 26 beer parlours and two liquor stores in operation. As housing prices spiralled, individuals with low-income had migrated to the Downtown Eastside.
Thousands of psychiatric patients that were deinstitutionalized were confined to the Downtown Eastside, as other communities were unwilling to accept them.
The City of Vancouver established the Four Pillars Coalition. Combined efforts with 20 founding partners, including businesses, government, non-profit organizations, universities, and advocacy groups.
The drug situation in the Downtown Eastside had gotten worse and cocaine had become a favourable choice by substance users, as it was more addictive and less costly than heroin which led many to turn to crime/theft to pay for their drugs. In turn, an excess of illegitimate business had exploded in the area.
The three bodies of government, Federal, Provincial and City of Vancouver signed the Vancouver Agreement.
The city of Vancouver adopted the Four Pillars approach that calls for: harm reduction, prevention, treatment and enforcement.