Poor health has a close link with homelessness and the vice versa. For most of the families that are still struggling to meet their housing rent, a serious disability or illness can initiate a ripple into homelessness, which can start with loss of a job, depletion of family’s savings to cover up for medical expenses ultimately leading to eviction (Cheung & Hwang, 2004).
The rates of acute and chronic health problems are incredibly high among the homeless people. With the exclusion of cancer, strokes, and obesity, homeless individuals are more likely to be plagued by every category of most of the chronic health issues. Conditions that dictate uninterrupted and regular treatment such as mental disorders, tuberculosis, addictive disorders, HVV/AIDs, hypertension and diabetes are tremendously hard to manage or treat among the homeless population (Kushel, Vittinghoff, & Haas, 2001).
A large number of homeless people often suffer from multiple health problems. For instance, upper respiratory tract infections, leg ulcers, and frostbites are common, often as a result of homelessness (Schanzer, Dominguez, Shrout, & Caton, 2007). Homeless persons are also much predisposed to trauma as a result of rape, beatings and muggings. Homelessness precludes adequate nutrition, basic first aid, and even personal hygiene, adding to the already complex health care needs of the homeless population. Again, a number of homeless people, especially those with mental disorders, may result to self-medicate using alcohol or drugs and a proportionate with addictive disorders are more exposed to contracting HIV alongside other infectious diseases (Larimer et al., 2009).
Homelessness amplifies poor health while at the same time exposes residents who are often crowded in shelters to infectious illnesses such as influenza and tuberculosis. Concurrently, homelessness complicates the management of those suffering from chronic illnesses such as asthma and diabetes making harder the access to healthcare and presents adamant barriers that confound healthcare delivery systems and exasperate the healthcare team (Badiaga, Raoult, & Brouqui, 2008).
The burden imposed by substance abuse and mental illness are well recorded in homeless people. In addition, chronic diseases are common as many homeless persons have peripheral vascular disease, diabetes, renal disease, hypertension, liver disease, and respiratory problems. Skin diseases are also not left out and are extraordinarily frequent leading to costly hospitalization due to cellulitis. Frostbites and hypothermia are feared life hazards in the streets and have been implied as risk factors for the premature demise. Other conditions, such as lice infestations, pellagra, and diphtheria may ultimately lead to endocarditis from the toxins produced by Bartonella Quintana (Badiaga et al., 2008). The persons caring for this cohort of individuals must marry medicine with aspects of public health since HIV/AIDS and Tuberculosis are endemic, communicable diseases outbreaks such as influenza, violence and trauma are somewhat implied in homeless people and infestations common in shelter.
Cheung and Hwang (2004) investigated on elevated mortality rates in the United States, England, Denmark, and Canada. A peculiar and disturbing observation made was the apparent absence of notable inputs of health insurance on the predisposition of premature mortality. Incredibly, in the US, there remains 40 million plus citizens without a coverage of health insurance. The rest of the countries had had for a long time universal health insurance. Even with the necessity for a universal coverage, the initiative appears to fall short in preventing early deaths in the homeless population (Cheung & Hwang, 2004). Fundamental improvement in health care delivery is crucial to address the existing health care disparities for such population at risk.
The health care of homeless families and individuals poses a distressing challenge to our traditional models of health care delivery. The undying urgency of striving daily for warm meals and safe shelter relegates health care to a less-immediate priority (Wright & Tompkins, 2006). Injuries fester and common illnesses progress resulting to increased cases of emergency unit visit and acute care hospitalization.
Treatment plans that are sensible to those with family and home support are often inapplicable to difficult, impossible to have bed rest, he homeless people; simple changes of dressing, hard to secure medication and properly store them and adherence to therapy especially those that require multiple daily administrations is flattering. For instance, adequate dietary control and regular exercise, the diabetes mainstays, provide unavoidable challenges to individuals subsisting on kitchen soups meals and living in shelters (Schanzer et al., 2007). To complicate further the troubles faced by diabetic homeless people, the safe medication storage presents many challenges and possessing syringes and needles for injections is not allowed in many shelters.
The disparities evident in health outcomes for this group of people put to limelight several inadequacies in our existing health care delivery systems (Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006). Learning from past medicine may be expedient. Effective preventive and primary health care for homeless people is achievable if the health care team is will be willing to reach out from traditional office and hospital settings to provide care directly in shelters and on the streets. These personalized visits to the homeless people will aid in overcoming the vexing obstacles and foster patient-physician relationship. Health care personnel who have ventured into this model of health care delivery have discovered this particular means to be a breakthrough for quality and continuity of care for homeless patients (Schanzer et al., 2007). However, mobility and time required for this approach are rarely valued or funded by our current evolving models of delivery.
Community outreach initiatives, best executed by working or voluntary physicians in a team of multidisciplinary health care professionals, can be integrated fully into our current operational hospitals and emergency units to aid in reducing the necessity of frequent utilization of these quite costly services. Respite piloted care programs in cities such as Washington, Chicago, and Boston, have attempted to make a compensation addressing people with inadequate safe housing by offering twenty-four-hour medical care to people due for discharge from emergency units or hospitals but too vulnerable and ill to go back to the streets (Kilbourne et al., 2006). Over 30 Canadian and United States cities are now conducting a pilot model of this approach to fill the care continuum gaps for the homeless people.
Physicians who are willing to provide care for individuals on societal fringes require that they are not marginalized by their own specialty. Educational, medical centers alongside the poor refuge centers should address these mortality disparities and embrace caring for the homeless and other populations that are vulnerable as a vital constitute of their missions and a crucial component of their curriculum (Larimer et al., 2009).
Caring for homeless persons often brings along vexing ethical dilemma. As we toil to minimize suffering, alleviate symptoms, and prevent diseases, our helplessness is exposed in influencing the basic health determinants, housing included, inevitably outrage and haunt us. As Cheung and Hwang (2004) have intricately shown to us, health and housing are closely coupled. Impoverished men and women who lack homes bear an unacceptable and unfair burden of illness plagued with premature deaths in our streets at the very shadows of our flourishing health care institutions. The ultimate resolution for the problem of homelessness will call for a change in many sectors and institutions (Kushel et al., 2001). This public health need will not be well addressed and resolved until health care and housing become a basic right for all human beings.
In essence, homelessness provides more challenges to the victims than the fact of lack of a safe home. Many health problems are closely implied in homeless persons. Access to health care is also tremendously affected since the homeless people are often poor, and health needs do not top the priority of their needs. In addition, they lack health insurances that may ease the ease of accessing health care services. Willing healthcare personnel often face the challenge of inadequate funding in their attempts to do community outreach programs to the homeless, a key strategy that has shown promising outcomes if well placed. Healthcare sector and the housing institutions will require key changes and revisions to address the issue of homelessness as this will see that the unfair status of the homeless are addressed and that the right to decent housing for all people does not remain a distant outcry notion.
Badiaga, S., Raoult, D., & Brouqui, P. (2008). Preventing and controlling emerging and reemerging transmissible diseases in the homeless. Emerging Infectious Diseases, 14(9), 1353.
Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: a cohort study and review of the literature. Canadian Medical Association Journal, 170(8), 1243–1247.
Kilbourne, A. M., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M. J. (2006). Advancing health disparities research within the health care system: a conceptual framework. American Journal of Public Health, 96(12), 2113.
Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors associated with the health care utilization of homeless persons. Jama, 285(2), 200–206.
Larimer, M. E., Malone, D. K., Garner, M. D., Atkins, D. C., Burlingham, B., Lonczak, H. S., … others. (2009). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. Jama, 301(13), 1349–1357.
Schanzer, B., Dominguez, B., Shrout, P. E., & Caton, C. L. (2007). Homelessness, health status, and health care use. American Journal of Public Health, 97(3), 464–469.
Wright, N. M., & Tompkins, C. N. (2006). How can health services effectively meet the health needs of homeless people? British Journal of General Practice, 56(525), 286–293.