The issue of homelessness is becoming increasingly widespread and has serious consequences for people’s health. Those who are homeless are at a greater risk of dying prematurely and suffering from a range of health problems, including HIV and skin conditions. However, they face numerous obstacles when it comes to accessing healthcare services, such as not having health cards or encountering discrimination when seeking assistance in public facilities.
Whatever the cause may be for the increasing number of individuals experiencing homelessness, it is imperative that it is addressed promptly to prevent our society from descending into chaos and despair (Raphael, Dennis (ed.). 2004. Social Determinants of Health: Canadian Perspectives. Toronto: Canadian Scholars’ Press). Toba Bryant comprehensively examines the distressful impact of homelessness on health in her article “Housing and Health.” The Ottawa Charter for Health Promotion recognizes the significance of having adequate shelter as a fundamental requirement for maintaining good health.
Having a home is crucial for both physical and mental well-being. It provides warmth, protection, safety, belonging, and ownership. According to Bryant’s article cited by Dunn (2000: 220), the homeless face numerous challenges such as higher rates of mental illness, HIV infection, and physical violence. However, having shelter can potentially alleviate these problems. In Toronto, Canada, Ambrosio et al.’s (1992) survey found that homelessness increases susceptibility to diseases like asthma, epilepsy, arthritis, and chronic respiratory diseases. Homelessness is also known to increase the risk of premature death; Kushner (1998) suggests it reduces life expectancy by 20 years. Additionally, a study conducted on 9000 homeless men in Toronto in 1995 further supports these findings.
Hwang (2000) found that young homeless men were eight times more likely to die compared to men of the same age in the general population. Keyes and Kennedy’s study on suicide rates revealed that homeless individuals in the UK are 34 times more likely to commit suicide. These alarming statistics highlight the urgent need for governments worldwide, including Canada, to address the ongoing suffering of people living on the streets. The implementation of a housing plan is crucial and must be given proper attention.
In her article titled “Homelessness and Mental Disorder: Policy Considerations,” Gupta (1995) argues that a significant number of homeless individuals lack homes due to untreated mental disorders. Brown (1985) adds that the misconception of mental patients being able to survive in society solely with psychotropic drugs has contributed to this issue, as they often lack proper supervision or comprehensive treatment for their illness.
After being released, these patients did not receive any follow-up from mental health institutions. Upon leaving the treatment facility, many found themselves without shelter (Russel, 1984). I commend Gupta for highlighting the significance of following up on these individuals, as it is an often overlooked problem. When people are admitted to mental institutions, they must leave their jobs, families, and way of life behind. Consequently, they face a lack of financial support and assistance.
Consequently, individuals lacking funds are confronted with a dilemma after leaving their residency institution: where to find shelter and how to improve health without adequate housing or monetary means for sustenance. It is crucial that these patients are afforded the chance to regain autonomy before being left on their own. For instance, allowing them to stay at the facility for an extra month following treatment completion would permit them to search for employment and ideally generate income they can rely on upon discharge.
The lack of financial resources presents challenges for individuals undergoing treatment to improve their circumstances. Consequently, they may find themselves in the same predicament or even hospitalized due to unmet essential needs such as food and shelter. Gupta raises an intriguing point about the relationship between mental illnesses and homelessness: are these conditions a cause or consequence? While they can be either, I believe that mental disabilities contribute more to homelessness rather than being a result of it. This is because certain mental impairments carry social stigma and can hinder employment prospects, ultimately leading to homelessness.
The information supporting this viewpoint is cited from Kalichman, Seth C., Lisa Belcher, Charsey Cherry, Ernestine A. Williams, Christopher T. Allers’ study conducted in 1997 titled “Human Immunodeficiency Virus (HIV) Seropositive Homeless Men” published in the Journal of Social Distress and the Homeless (6(4): 303-318).
Research consistently shows that homelessness is strongly associated with HIV infection. In their article “Human Immunodeficiency Disorder (HIV) Seropositive Homeless Men,” authors Kalichman, Belcher, Cherry, Williams, and Allers investigate the ongoing high-risk behaviors among homeless men living with HIV, including injection drug use, involvement in commercial sex, and sexual behaviors.
Why are homeless individuals at higher risk of HIV infection? The majority of homeless people tend to gather in urban areas with high rates of HIV infection, where they often engage in unprotected sexual intercourse with multiple partners (El-Bassel & Schilling, 1991). Additionally, HIV transmission can also occur through drug injection. Research has shown that 25% of HIV-positive men use inject drugs. However, the more prevalent behaviors among the homeless population are cocaine use, unprotected sex, and involvement in sexual commerce.
These drugs provide relief from the feeling of poverty and homelessness and offer a quick solution to their problems. However, they are unaware that this immediate fix has now become a long-term problem with no solution. In my view, the only way to address the spread of HIV is to continue with existing programs and hope that they eventually realize their problem. We cannot prevent them from engaging in unprotected sex or drug use because we are not there to intervene when it happens. Our only option is to strive to minimize the harm and understand that this epidemic may never be fully resolved.
In a related article by Jo Ensign, she focuses on the specific issues faced by homeless youth regarding their health. The paper explores challenges related to access to healthcare, risk-taking behaviors, and overall health status. Ensign begins by clearly defining certain terms to ensure all readers are on the same page. She addresses the confusion surrounding the age range of “adolescence,” stating that according to the World Health Organization, an adolescent can be between 10-24 years old.
Ensign (1998) provides a comprehensive definition of “homeless” which encompasses individuals residing on the streets or in emergency shelters and actively seeking housing. Homeless youth can be classified as “runaways”, “throwaways”, or “system kids” who are involved in foster care. Termed as “street youth”, they can be further divided into children of the streets and children on the streets. Children on the streets maintain connection with their families and have a higher likelihood of returning home, while children of the streets are described as “youth who live, work, and sleep on the streets”.
The impact of homelessness on health can be explored by looking at the different health issues that homeless people experience, the psychological effects on homeless children (such as engaging in risky behavior), and the difficulties they encounter in obtaining healthcare. Homeless youth who live on the streets are at a heightened risk of acquiring HIV and other sexually transmitted diseases, which research has shown to be the main cause of death among this group. Moreover, Sherman (1992) has found that substance abuse, depression, and suicide rates are alarmingly high among homeless individuals, while Farrow (1991) emphasizes that unintended pregnancy is a significant concern for homeless youth.
Street youth, particularly children of the streets, are more likely to experience substance abuse, engage in early sexual activity, and receive less social support compared to children who live on the streets. These health issues ultimately impact their mental well-being due to the stigma associated with their situation. Derogatory terms such as “Bui Doi” (dust children) in Vietnam and “Saligoman” (nasty kids) in Rwanda are used to describe homeless youth (Emblach, 1993). As a result, this mental pressure puts these young individuals at a greater risk for behavioral problems.
According to a 1992 Youth Risk Behaviour Survey conducted on youth aged 12-19, out-of-school youth were more likely than in-school youth to engage in smoking, alcohol and marijuana experimentation, involvement in fights within the past year, higher rates of sexual activity, and having more than four sexual partners (CDC, 1992). Homeless children also experience difficulties in accessing healthcare services. Similar to adults, they encounter challenges related to finances, time, or transportation. However, specific issues unique to the homeless population include not having a permanent address (Farrow, 1992) and facing obstacles in being accepted in social places due to poor hygiene (Lukomnik, 1993). This article comprehensively addresses the various health issues faced by homeless individuals, particularly youth. It delves beyond physical diseases or health conditions, exploring the impact on their mental well-being and the difficulties they encounter in obtaining necessary healthcare. Hwang’s (2001) study stands out as the most notable among the five articles reviewed since it thoroughly examines all aspects of health problems experienced by the homeless.
Hwang (year) examines the mortality rates of street youth and finds that male youth living on the streets are 9 times more likely to die, while females are at a distressing 31 times higher risk. In Canada, however, mortality rates are slightly lower due to the availability of accessible healthcare with no associated costs. Homeless individuals also encounter specific health challenges including seizures, chronic obstructive pulmonary disease, arthritis, and other musculoskeletal disorders (Crowe & Hardill, year).
According to Gelberg (1989), some commonly overlooked issues include hypertension, diabetes, and anaemia. What sets this article apart from others is that Hwang also addresses the problem of oral and dental health, which is typically neglected among homeless individuals. Dental health is critical as the lack of dental care leaves them prone to tooth decay and cavities, leading to pain. Unfortunately, these individuals lack both the funds for dental procedures and the means to afford pain relief medications.
Hwang (2000) addresses the elevated risk of HIV transmission among both youth and adults who are homeless. He highlights that young individuals frequently contract the virus through unprotected sexual activity or while under the influence of substances, whereas adults are more prone to infection through drug injection. Moreover, females encounter numerous challenges such as violence and pregnancy. According to Hwang’s research, 21% of women on the streets experienced rape within the past year (Greene & Ringwalt, 1998), and teenage girls aged 14-17 in the United States have a pregnancy rate of 10% (Crowe & Hardill, 1993). Apart from these health concerns, homelessness also exposes individuals to a significantly higher risk of homicide compared to those with stable housing or familial support. Additionally, it is crucial to acknowledge that homeless individuals often coexist with people having HIV infections, mental illnesses, and substance abuse issues. Lastly, an aspect rarely discussed in other articles is the prevalence of foot problems among homeless populations.
Inadequate footwear, prolonged exposure to moist conditions, extensive walking, and repeated minor injuries are responsible for causing many skin diseases and foot disorders (Wrenn, 1990). The homeless population faces all of these diseases; however, their main concern lies in the challenges they face within the healthcare system. Many homeless individuals lack proof of coverage under Canadian Health Care due to lost or stolen identification (Hwang, 2000). Consequently, homeless people encounter various problems encompassing both the diseases they endure and the treatment they need.
Additional research is needed to find a resolution for providing care to homeless individuals. Homelessness greatly affects many Canadians and people worldwide, impacting people of all ages, from children to elderly veterans. These individuals encounter multiple daily obstacles and live with uncertainty about their future. There remains a lack of comprehension regarding their experiences, highlighting the need for heightened public awareness to ensure fair treatment from various social perspectives and within the healthcare system.
The public and homeless individuals must work together to find a solution for improving care for the homeless. Although it is not solely the responsibility of the public, they must also take initiative. While interventions alone cannot solve all the hardships caused by homelessness and social stigma, it is important to urgently seek a balance between assisting and empowering the homeless. This action needs to be taken before homelessness worsens.
