We need to focus on housing people experiencing homelessness – families, single adults, and youth. With only a few exceptions (obesity, cancer, stroke), people experiencing homelessness are more likely to experience every other category of chronic health condition. When you consider that some conditions like TB, HIV, diabetes, mental illness, etc. are extremely difficult to control, treat or cure without adequate housing, the impetus to focus on housing should be even greater.
Charity – feeding people on the street, handing out clothes, casual handouts – will not provide an environment where these health conditions can be satisfactorily addressed. Sheltering will not provide an environment to address these health conditions satisfactorily. Housing is required. And then intensive supports and health care. Sometimes there are, what are called “innovations”, really intensive health supports in shelter settings, but these do not create the necessary environment for ongoing wellness.
Certain illnesses while homeless are almost a death sentence. Chronic issues with liver, kidneys, heart, lungs or stomach pretty much make it game over. HIV status is also more terrible to experience as a homeless person than a housed person, and is more likely to result in AIDS.
Unlike the general population with a major health issue, people experiencing homelessness are more likely to have more than one health issue (a 1989 JAMA article showed 8-9 co-occurring health issues within homeless persons was average), and are more likely to deal with co-occurring issues such as a mental health disorder with a physical health issue, or a physical health issue while also having a substance use disorder. As if that was not bad enough, homelessness increases risks for trauma as a result of assault or rape (especially within women experiencing homelessness). It also makes people more reluctant to access care, or believe that they are going to get suitable care when sick.
At the same time, the provision of services in most communities does not focus on health, nutritious feeding. The lack of nutritious food security is a huge issue. This doesn’t meant food is scarce. On the contrary, food can be plentiful. BUT (and this is important) it is rarely prepared to the same standards and inspection controls as you would find in a restaurant, and it is rarely prepared with the perspective of safe food handler guidelines or public health seal of approval.
Then there are other matters like suicide, which should be considered a health issue. Did you know that rates of suicide are higher within the homeless population than the general population? Did you know that between a quarter and half of most homeless populations have made attempts at suicide or experience suicide ideation? The longer you are homeless (beyond six months) the greater the risks for suicide.
Dermatological conditions such as scabies, lice and allergic reactions are way more common in the homeless population than the general population. Imaging the irritations experienced as a result of these. Then imagine what it must feel like to cope with stress, other health issues, and a housing search at the same time.
Then there are women-specific health issues that MUST be considered. Rates of mental illness amongst homeless women are higher than homeless men – by a landslide. STIs within homeless women – most often as a result of prostitution or survival sex – are very high. Most women experiencing homelessness do not receive “routine” scanning and preparatory health access, from breast screening to appropriate gynaecological screening.
I could go on. The matter at hand though, begs the question – so what?
Good housing policy is actually good health policy. Policy that focuses on ending homelessness essentially is health promotion policy. Health promotion saves lives. It also saves money. We need to end homelessness if we want to promote health. And the healthier people that have experienced homelessness are, the healthier all of our society will be. Not a bad thing at all.