Homeless Population and Health Disparities

Health Disparities and Homeless Population
The causes of homelessness are complex but its tragic consequences are very clear. Homelessness is a huge problem in many rural areas, towns, and cities across the world. It is also a public health problem. The homeless are a vulnerable population. They not only live a poor quality of life on the streets but they also face hunger and are at a high risk of getting preventable diseases, getting co-occurring diseases, and dying premature deaths. In developed countries like the United States and United Kingdom, the phenomenon of homelessness is closely interlinked with that of poverty. Most of the time, the working poor have to work so hard or to work multiple jobs or they will become homeless. Sometimes just one missed pay check results people being evicted and sent to the streets. Other times illnesses, unexpected retrenchments, accidents, lead to lack of money at the end of the month and then evictions (Plumb, 2000).
There are certain subgroups in poverty that are more likely to become homeless. They include those with mental conditions, those suffering from post-traumatic stress disorder, those who are victims of abuse, those who are victims of family violence, those who are suffering from substance abuse, and those who have no social support. Healthy People 2020 puts emphasis on the significance of dealing social determinants of health to promote great health for everyone. One of the ways of dealing with social determinants is building physical and social environments that bring about good health (Fajardo-Bullón et al, 2019).
Identifying Health Disparities in Homeless Population
Homelessness is linked to great health disparities including higher morbidity, reduced life expectancy, and greater use of emergency hospital services. When viewed via the perspective of social determinants, the phenomenon of homelessness can be regarded a main driver of poor health for the homeless. However, the phenomenon itself is the result of adverse economic and social conditions. Undeniably, in the homeless, the social determinants of health disparities and homelessness are interlinked. And continued homelessness usually leads to further poor health. The number of health issues that the homeless have to deal with are made worse by other social health determinants including social disconnection, domestic violence, unemployment, poverty, and psychological trauma (Fajardo-Bullón et al, 2019).
Addressing social determinants of health is the preferred way of dealing with the health inequities in Healthy People 2020. It is also the preferred way according to the WHO (World Health Organization). The organization released a report that was titled Health Equity through Action on the Social Determinants of Health. Several health programs in the United States including the National Prevention and Health Promotion Strategy and the National Partnership For Action to End Health Disparities also emphasize addressing health inequities via addressing social health determinants. Social health determinants is a collection of social issues that affect health. Focusing on them challenges conventional clinical boundaries as they are regarded as non-medical issues even though they play a role in determining the health status of the homeless. Nevertheless, understanding the underlying determinants of health is also important for promotion of great health as addressing them will almost automatically lead to better health (Fajardo-Bullón et al, 2019).
In addition to poor social determinants of health, the homeless also face several external and internal barriers to healthcare. Internal barriers entail downplaying health problems, and great pressure to satisfy competing needs such as food, water, clothing, and shelter instead of healthcare. While external barriers entail unavailable primary care services, and prejudices and misconceptions by healthcare professionals. With poverty, several barriers to care, and complex comorbidities, it is not a surprise that the homeless have very high death rates (Fajardo-Bullón et al, 2019).
In the city of Philadelphia, the age –adjusted death rate of the homeless is nearly four times higher than that of Philadelphia’s general population. While in the city of New York, it is about two to three times higher than that of the city’s general population. However, a new study of the city of Toronto’s homeless population found that although its mortality rate was higher than that of the city’s general population, it was much lower than those of the homeless populations in Philadelphia, Boston, and New York. The significant difference between the mortality rates between the Canadian homeless population and the American homeless populations is explained by the fact that Canada has a universal health insurance program, has lower barriers to accessing healthcare, and has got lower homicide rates. Moreover, in Canada, homeless is usually more short-term hence unlikely to be linked to death. Although Canada is doing better than the US, the death rates of its homeless populations compared to its general populations are still quite high (Andaya, 2016).
Another barrier that has traditionally been cited as a cause of health inequity is the lack of compassionate treatment and care for the homeless. Many healthcare professionals have prejudices and misconceptions about the homeless hence they do not treat them or dealing with them compassionately. This often results in the homeless not seeking care unless it is very necessary. So understanding the need for compassion in the care of the homeless and ensuring medical professionals understand it could help improve the health outcomes for the homeless (Andaya, 2016).
Lastly, another major barrier is mental illness and the comorbidity of drug abuse. Both mental illness and substance abuse among the homeless can be barriers to health care and prevent the utilization of care services that could improve quality of life and overall health status (Andaya, 2016).
How to Remove Health Disparities
To address health disparities between the homeless and those who have shelter, it is important to first understand the underlying social issues. The traditional healthcare model does not take into account the realities of homelessness. For example, it does not consider that homeless people will choose food and shelter over seeing a doctor unless a situation is life threatening. Therefore, to address health disparities adequately, there is a need to consider priorities of the homeless. Because what the traditional healthcare model and health officials may view as carelessness on the part of the homeless is often, in fact, a difficult choice driven by the need to survive (Andaya, 2016).
Apart from understanding the priorities of the homeless, there is also a need to find out how to properly engage the homeless because they are often challenging to engage. This is because they have experienced many negative experiences especially with care providers who do not understand them or want to take into account their special needs. For example, many homeless people often only seek treatment when they are suffering a life-threatening condition or when their injury or illness is exacerbated and more expensive to treat. The conditions are usually also made worse by social disconnection, domestic violence, unemployment, poverty, and psychological trauma (Andaya, 2016). To remove their disparities, there is a need to take into account all these things and to address them for better outcomes. While social of these problems are social and not medical, they play a significant role in determining the health status of homeless people, and, therefore, effective healthcare is not possible without addressing them (Plumb, 2000).
Some of the strategies that can definitely help in addressing the health disparities of the homeless include shelter modifications, care management, effective disease prevention, and prevention of homelessness. With millions of dollars being dedicated to shelters by cities across the country, there is a need to become creative and come up with homeless prevention programs that actually prevent people from becoming homeless rather than house them after the fact (Plumb, 2000).
Similar innovative programs have been tried out in New York and Philadelphia with much success. The programs first identify neighbourhoods where most homeless people say they come from and then engage in revitalizing them, providing free job training, providing public housing, improving health care services, and rolling out drug abuse treatment programs. Such programs can help to reduce homelessness and reduce health disparities. Shelter modification and focused care management can also help to reduce the high morbidity and death rates among the homeless (Plumb, 2000).
Strategies
Many efforts that have been proposed to deal with homelessness in the U.S. have repeatedly stressed on the significance of housing as a cost effective and important solution to both the problem of homelessness and the health inequities faced by the homeless. Tackling homelessness and providing shelter is a fight for a basic human right. Many cities are fighting hard to provide more permanent shelter to their homeless instead of temporary shelter. This is because it is believed that more permanent house and better quality houses will improve both the health and the wellbeing of the formerly homeless people (Andaya, 2016). So for the health disparities to be removed, there is a need to deal with the big problem itself and that is homelessness.
In European states, the development of housing solutions for the homeless have resulted in the development of social and welfare states with affordable social housing quarters. Many British and Spanish cities have been implementing a house-first approach to help the homeless and the results have shown significant improvement in health status, in health visits, in following medical guidelines, in accepting medical visits, and in earlier visits to care providers in case of medical problems or issues (Koh, & O’Connell, 2016).
Even though it is a frequently analysed variable in epidemiological studies self-perceived health or self-assessed health is not very frequently utilized in studies about homelessness and health. Self-assessed health is often based on directly asking individuals to assess their health using a scale and it utilized to evaluate related risk factors. Quite a number of studies have evaluated the link between self-assessed health and physical health within general populations (Koh, & O’Connell, 2016). In some of the studies, no link was found between self-assessed health and health factors including consumption of medicines, occupational accidents, and hospital morbidity. However, recent studies especially in the Spanish population have revealed a strong link between self-assessed health and social activity, mental health, physical health, and functional performance. Due to the fact that the link between self-assessed health and mortality has been supported by studies and surveys, the use of self-assessed health has been recommended by various studies as a convenient tool for surveys (Koh, & O’Connell, 2016).
The tool has been used and can be utilized to measure health inequalities and characteristics. The measure is very reliable and especially useful in the prediction of current health and future health issues. Studies have concluded that the measure is more effective in predicting death rates among males than among females and differences within people of the same socio economic and ethnic groups. However, among older groups the measure is not as reliable because of different self-evaluation at older ages (Koh, & O’Connell, 2016).
References
Andaya, A. (2016). Understanding the Causes Health Disparities among the Homeless. UC Merced Undergraduate Research Journal, 9(1).
Fajardo-Bullón, F., Esnaola, I., Anderson, I., & Benjaminsen, L. (2019). Homelessness and self-rated health: evidence from a national survey of homeless people in Spain. BMC public health, 19(1), 1081.
Koh, H. K., & O’Connell, J. J. (2016). Improving health care for homeless people. Jama, 316(24), 2586-2587.
Plumb J. D. (2000). Homelessness: reducing health disparities. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 163(2), 172–173.