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Vancouver accepts Canada's poorest people with open arms and they just so happen to live there. The dtes is the only place in north america where we treat drug addicts like human beings and offer support for them. The fact it's so bad is a symptom of a Canada wide problem, not Vancouver specific. Other cities don't have an equivalent since most of the poor come here rather than stay in Toronto or Calgary.
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This has to be emphasized. The DTES is a national problem, not a provincial one, and certainly not a civic one.
A lot of people were not raised here. I know weather is such a controversial topic here (why, I have no idea) but a lot moved here because of the climate. It's easier to be homeless here in the winter than out east. Yes, it rains, just find a roof.
But also a lot were pushed here. It's cheaper for, say, Calgary to buy its drug-addicted residents a bus ticket to Vancouver than to actually treat them.
I'm sure there are a lot of people who were raised in, say, Richmond, lost a job because of a bike lane being built or whatever awful civic decision, and now live their life in the DTES, but I don't think that's the norm.