Health of homeless people : a housing issue

Abstract

Attempts to explain and manage the poor health profile of homeless people have focused on the problems homeless people encounter in accessing and utilising health care. I argue, however, that there are at least two other factors that could impact directly on the health profile of homeless people. First, it is widely acknowledged that living conditions affect health. It therefore follows that the extreme environments in which many homeless people live will contribute to their poor health profile. Secondly, evidence is emerging not only that people with health problems have difficulty in accessing permanent accommodation but also that sick people are disproportionally vulnerable to becoming homeless in the first place. This is despite the theoretical safety-net in the welfare arm of the housing service. It therefore seems plausible to suggest that health selectivity into and out of the housing system is also contributing to the poor health profile of homeless people. In this empirical study, I explore the relationship between housing provision, living space and servicing in order to better explain the health profile of single homeless people. I weigh up the influence of poor services, harsh environments and health selectivity drawing on the evidence provided by a series of qualitative, semi-structured interviews with 40 single homeless people living in Edinburgh. To date, studies of the health of homeless people have been cross-sectional, providing a snapshot in time of factors associated with health and disease but remaining silent on how these links develop through time. In my study the interviews with homeless people were designed to allow a longitudinal analysis of the sequencing, combination and timing of events in health and accommodation histories. Assessment of these histories revealed two key findings. First, the majority of respondents had health problems before becoming homeless. They became and remain homeless because they have not been able to attain or sustain a place in the housing system. Second, the majority of respondents have experienced a deterioration in health that appears to be linked to the physical and servicing environments they have been exposed to since becoming homeless. This study shows that people with health problems are vulnerable to homelessness, and that the health profile of homeless people is a much a reflection of housing inequalities as of inefficiencies in the health service. I argue that by tackling these inequalities, housing policy could go some way to meeting the health as well as accommodation needs of homeless people and so be harnessed to the aims of health and social policy. However, in conclusion, I question whether this theoretical goal is achievable in practice given the recent restructuring of the housing system and the associated separation of housing from other areas of health and social policy.