Homelessness has become an evolving epidemic of our time, and the health implications associated with being homeless makes it that much worse. Homeless people are at major risk for premature death and a wide range of health problems such as HIV, skin blemishes, and much more. It is very difficult for homeless people to fix their health issues due to the difficulty of accessing health care possibly because of missing health cards, or simply because of the stigma placed on them when they enter a public facility.
Whatever the problem may be that is forcing more people to become homeless, it must be solved, and quickly before our world turns into a travesty. Raphael, Dennis (ed. ). 2004. Social Determinants of Health: Canadian Perspectives. Toronto: Canadian Scholars’ Press. In the article titled Housing and Health by Toba Bryant, the always alarming issue about the effect of homelessness on health is thoroughly discussed. According to the Ottawa Charter for Health promotion, shelter is considered a prerequisite for health.
Not only does having a home provide physical health in terms of warmth and protection from the environment, but it creates a sense of care towards one`s mental health as well. Having a home provides the feeling of being safe, and having a sense of belonging and ownership. Bryant`s article suggests that there are many conditions and ailments the homeless crowd must face. Some of these include “greater incidence of mental illness, HIV infection, and physical violence” (Dunn, 2000: 220), many of which the degree may be lessened with the presence of shelter. More specifically to Canada, a survey done by Ambrosio et al. 1992) in Toronto showed that the homeless are at higher risk for diseases such as asthma, epilepsy, arthritis, or chronic respiratory diseases. Many people already know that homelessness puts you at greater risk for premature death, and Kushner (1998) says that it shortens life expectancy by 20 years. In 1995 a study was done on 9000 homeless men who used shelters in Toronto.
The results of the study were published in a report by Hwang (2000), and it was found that “young homeless men were eight times more likely to die than men of the same age in the general population. Other studies such as the one done by Keyes and Kennedy on suicide rates showed that in the UK, homeless people are 34 times more likely to commit suicide. Unless our governments decide to act upon the alarming numbers, the people on the streets in Canada, and around the world, will continue to suffer. Some sort of housing plan must be put into place and more importantly, followed up. Gupta, Giri Raj. 1995. “Homelessness and Mental Disorder: Policy Considerations. Journal of Social Distress and the Homeless 4(1): 33-42. According to Gupta in her article entitled Homelessness and Mental Disorder: Policy Considerations, she believes a large number of the homeless are without homes due to untreated mental disorders. Brown (1985) suggests that the introduction of psychotropic drugs have lead to this false belief that mental patients in institutions can be released with these drugs and survive in the outside world without any supervision or complete treatment of their illness.
Upon release, these patients were never followed up by any of the mental health institutions, and once assuming position outside of the walls where they were treated, many are left with little or no shelter at all (Russel, 1984). I like how Gupta brings up the situation of following up on patients, because it is an alarming issue that many do not pay attention to. Once emitted into these mental institutions, these people must leave their jobs, their families, and their lifestyle. This ultimately means no money, and no support.
Therefore when they leave the institution where they have been staying, what are they to do for shelter if they have no money? How is their health suppose to get better if they have no shelter and no money to buy food? These patients deserve a chance to get on track with their lives before they are forgotten about. For instance, allow them to stay an extra month in the institution after their illness is treated, to let them go out and find a job, and hopefully bring in some money that they can build off of when they are released.
How do they expect these individuals who are being treated to get on the right track when they have no money? Sooner than later they will be right back in that same place, or possibly the hospital because their bodies cannot function without food and shelter. One last interesting point made my Gupta is the question she ponders about whether these mental patients and the disorders associated with each, are consequences or are they causes of homelessness? Despite the fact that they can be either or, I arguably believe that they cause homelessness more than they are a onsequence of homelessness. Sure homelessness is a tough psychological battle as much as it is a physical and emotional one, but certain mental disabilities are stigmatized, and some even prevent you from getting a job and without employment, homelessness is often the product. Kalichman, Seth C. , Lisa Belcher, Charsey Cherry, Ernestine A. Williams, Christopher T. Allers. 1997. “Human Immunodeficiency Virus (HIV) Seropositive Homeless Men. ” Journal of Social Distress and the Homeless. 6(4): 303-318.
Most studies that are completed about homeless people and their health statuses usually have an end result that states HIV is one of the most significant problems relating to homeless people. This article entitled “Human Immunodeficiency Disorder (HIV) Seropositive Homeless Men” written by Kalichman, Belcher, Cherry, Williams, and Allers looks specifically into the continued risk behaviours of HIV positive homeless men through injection drug use, commercial sex, and their sexual behaviours.
Many wonder why homeless are at such great risk for HIV infection? Unfortunately the majority of homeless people cluster in urban areas that have high rates of HIV infection, and they often participate in sexual intercourse with multiple partners, with no condom use (El-Bassel & Schilling, 1991). Besides sexual intercourse, another area where HIV infection is spread is through injection of drugs. A study was conducted and it showed that 25% of HIV infected men inject drugs. However the use of cocaine, unprotected sex, and sexual commerce are more common.
These drugs offer relief from the feeling of being in poverty/homeless and are a quick fix for their problems, but little do they know that this quick fix has now turned into a long term problem that has no fix. In my opinion, the only way to fix the spread of HIV is to keep going with the programs out there and hope they realize their problem one day. We can’t stop them from having unprotected sex or drug use because we are not there when it happens to stop it. We can continue to hope to minimize the damage, but we must understand that this epidemic will probably never be solved. Ensign, J. 1998. “Health Issues of Homeless Youth. Journal of Social Distress and the Homeless 7(3): 159-174. Another article relating to homelessness and health was written by Jo Ensign, and Ensign focuses on the issues pertaining mainly to the homeless youth. The paper addresses the difficulties youth face in access to health care, risk-taking behaviours, and there overall health status. To begin the author does well to clearly state the meanings of certain words to ensure the readers are all on the same path. She discusses the confusion between the exact age levels of “adolescence”, but according to the World Health Organization, an adolescent can be between the ages of 10-24.
She also makes sure we the reader understand what is meant by “homeless” and that is according to Ensign, anyone living on the streets or in emergency shelters, but who is actively trying to find housing. Homeless youth include “runaways”, “throwaways”, and what is called “system kids” (involved in foster care). “Street youth” as they are referred to by many, can be broken down further into children of the streets and children on the streets. Children on the streets maintain contact with family and are more likely to return home, whereas children of the streets are “youth who live, work, and sleep on the streets” (Ensign, 1998).
To relate this to how homelessness affects health, one can look at the health issues they face, the mental affect on these children (risk behaviour), and the access to care these “street youth” are given. The realities of street life place homeless youth at high risk for HIV and other STD’s, in fact studies have proven that it is the number one cause for death of homeless youth. Sherman (1992) also identified high rates of substance abuse, depression, and suicide and Farrow (1991) states unintended pregnancy as a major issue homeless youth face.
Specifically in this group of street youth, children of the streets are more likely than children on the streets to experience substance abuse, earlier sexual activity, and less social support. Eventually, these health issues take a toll on the youth mentally as well, because of the stigma placed on them. Some examples of what people refer to homeless youth as include Bui Doi (dust children) in Vietnam, and Saligoman (nasty kids) in Rwanda (Emblach, 1993). Such mental stress puts these youth in a behavioural risk.
According to a 1992 Youth Risk Behaviour Survey done on youth aged 12-19, out of school youth were more likely than in school youth to smoke, tried alcohol, tried marijuana, been in a fight in the past year, higher rates of sexual activity, and to have had more than 4 partners sexually (CDC, 1992). One final issue homeless children face pertaining to health is the accesses to care these individuals have. In a sense they have similar troubles as adults, whether it is money, time, or transportation, but problems only homeless face are not having a permanent address can be an issue (Farrow, 992), and poor hygiene make it harder to be accepted in social places (Lukomnik, 1993). This article does well in covering all aspects of health issues homeless people face, especially youth. It does not only look at the diseases or health status, but also the ways their status affects them mentally, and how hard it is for them to get access to care for their health problems. Hwang, Stephen W. 2001. “Homelessness and Health. ” Canadian Medical Association Journal 164(1): 229-233. By far the best of the five articles I read, Hwang describes every element of health issues that the homeless face.
To begin, Hwang discusses the mortality rates among street youth and determines that male youth living on the streets are 9 times more likely to die, and an alarming 31 times for females. In Canada however, mortality rates are slightly lower mostly due to the fact that our health care is accessible to anyone without any fees. Furthermore, homeless people face particular health problems such as “seizures, chronic obstructive pulmonary disease, arthritis and other musculoskeletal disorders” (Crowe & Hardill, 1993).
Some issues that often go undetected include “hypertension, diabetes and anaemia” (Gelberg, 1989). What makes this article different from the rest I have covered is Hwang mentions the issue of oral and dental health which is often the poorest among homeless individuals. Dental health can be major, because often tooth decay and cavities inflict pain, but these individuals don`t have a dental plan in which they can help their case. They do not have the money to pay for the dental work, nor do they have the money to pay for pain relieving medication.
Like the other articles, Hwang mentions the always deadly HIV infection. He observes that in youth, HIV is more likely to be caused because of sexual intercourse without condoms, or while under the influence of drugs and alcohol, whereas adults are more likely to receive the infection through drug injection. Females also face adversity on the streets, with violence and pregnancy. Hwang`s article shows that 21% of women on the street have been raped in the last year (Greene & Ringwalt, 1998), and that 10% of females aged 14-17 in the U. S. ere pregnant (Crowe & Hardill, 1993). If the health issues are not enough to make your life rougher on the streets, how about trying to get some decent sleep in; homeless individuals are 9 times more likely to be murdered than people living in homes or with family members (Hwang, 2000). Think about it, and you are basically living with some people that have HIV infections, or that have had mental illnesses and substance abuse problems. One last significant point that is not mentioned in many other articles is the foot problems homeless have.
Many skin diseases and foot disorders are caused by subpar footwear, extended periods of being exposed to moist conditions, long periods of walking, and repetitive minor trauma (Wrenn, 1990). Attracting all of the mentioned diseases above are the least of homeless people’s worries, however when they do become a problem, the health care system does prove to be somewhat of a problem. Many do not have proof of coverage under Canadian Health Care because their identification has either been lost or stolen (Hwang, 2000). Homeless people suffer many problems ranging from the diseases they face all the way to treating these diseases.
More research must be done to find a way to provide care for homeless people. Conclusion Homelessness affects many Canadians and others around the world. It changes the lives of many in a population ranging from youth around 10 years old, all the way to War veterans in their 70’s. They face many challenges daily, and never know what will come next. Many do not understand what they go through, and more public awareness must be done so that these people deserve equal treatment, from a social perspective to the health care system.
The public must find a way to deliver better care to these individuals. However it is not all up to the public to fix the lives of the homeless, they must do things on their own, but interventions alone will not heal all of their hardships from being homeless and carrying that social stigma. The search to find a median between helping the homeless and the homeless helping their own help must be found and dealt with quick before homelessness gets anymore out of hand.
