|dc.description.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