Homelessness and Health – A Primer

In spite of the variation in causes and experiences of homelessness, for all who experience it, homelessness is an experience that compromises one’s health.  And, as suggested by the Ottawa Charter, this has to do with more than physical illness, and includes the social determinants of health (e.g. income and social status, social support networks, education and literacy, employment/working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender, and culture).

For most individuals, homelessness is a transitional state rather than a permanent situation (Buck, Rochon, Davidson & McCurdy, 2004), and during this time much can occur that exacerbates existing health concerns, or creates new ones.  Understanding the health impacts of homelessness is somewhat complicated in that many of the conditions faced (such as mental illness, substance use and chronic health conditions) can be both causes of and results of homelessness, but the case of negative health impacts of homelessness is well established (Daiski, 2007).  Most striking in terms of the negative health effects of homelessness is the high mortality rates of homeless persons, with mean age of death ranging from 35-47 years (Podymow, Turnbull & Coyle, 2006).

Statistics on acute and chronic conditions and homeless persons are striking.  Street Health in Toronto, Canada found that 55% of homeless persons have a serious physical health condition, and 63% of these have more than one (Street Health, 2005).  In Western nations, psychiatric conditions such as psychosis, major depression, personality disorders and addictions are higher amongst homeless persons than the general public (Fazel, Khosla, Doll & Geddes, 2008).  These conditions can in part be caused by and exacerbated by the challenges that homeless persons face in taking medications as prescribed, risk of injury , lack of access to good hygiene, poor nutrition and exposure to the elements, social isolation, and exposure to physical and sexual violence.  In one study, when asked about their health concerns, homeless men focused on broader health and safety needs and acute conditions, rather than chronic illnesses (Lafuente, 2003), an important consideration for the structuring of health care services for homeless persons.

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  1. Pingback: Homelessness and Health: Chicken or the Egg? | Abe Oudshoorn's Blog

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