The Downtown Eastside (DTES) is a neighbourhood in Vancouver, British Columbia, Canada. The area, one of the city’s oldest, is notorious for its levels of drug use, poverty, mental illness, sex work, homelessness, and crime. It is also known for its strong community resilience and history of social activism.

Around the beginning 20th century, the DTES was the political, cultural, and retail centre of the city. Over several decades, the city centre gradually shifted westwards and the DTES became a poor, although relatively stable, neighbourhood. In the 1980s, the area began a rapid decline due to several factors including an influx of hard drugs, the de-institutionalization of mentally ill individuals, policies that pushed prostitution and drug-related activity out of nearby areas, and the cessation of federal funding for social housing. By 1997, an epidemic of HIV infection and drug overdoses in the DTES led to the declaration of a public health emergency. As of 2017, critical issues are an epidemic of opioid overdoses, especially those involving the drug fentanyl, decrepit and squalid housing and a shortage of low-cost rental housing, and a high prevalence of severe mental illness which often co-occurs with addiction.

The population of the DTES is estimated at around 6,000 to 8,000. Compared with the city as a whole, the DTES has a higher proportion of males, and of adults who live alone. It also has significantly more First Nation Canadians, who are further disproportionately affected by the neighbourhood’s social problems. The neighbourhood has a history of attracting individuals with mental health and addiction issues, both from around British Columbia and across Canada, many of whom are drawn by its drug market, low-barrier services. Law enforcement policies are among the most progressive in Canada, however many vulnerable members of the community have low trust in police.

Gentrification of the area began in the 1980s, when Vancouver was preparing to host the Expo 86 world’s fair, a trend that some see as a force for revitalization, but that others believe has led to displacement and homelessness. Numerous efforts have been made to improve the DTES, at an estimated cost of over $1.4 billion as of 2009. Services in the greater DTES area are estimated to cost $360 million per year. Commentators from across the political spectrum have said that little progress has been made in resolving the issues of the neighbourhood as a whole, although there are individual success stories. Proposals for addressing the issues of the area include increasing investment in social housing, increasing capacity for treating people with addictions and mental illness, making services more distributed across the city and region instead of concentrated in the DTES, and improving co-ordination of services. However, little agreement exists between the municipal, provincial, and federal governments regarding long-term plans for the area.