Homelessness and Poor Health: it’s Time to Break the Link

By Dalma Fabian, Policy Officer FEANTSA

Housing is a social determinant of health that impacts on a person’s opportunity to live a healthy life.  Poor quality, or lack of accommodation is the cause of many of the health issues homeless people face, and often complicates treatment and recovery.  There are clear causal and consequential links between homelessness and poor health outcomes. Ill-health can cause, contribute to and exacerbate homelessness and homelessness can cause, contribute to and exacerbate ill-health.

There is no easy answer to the cause and consequence debate but what we do know is that homeless people are the sickest in society, experiencing health inequalities as well as high prevalence of mental illness, substance misuse and a range of infectious diseases and early death.  The statistics are shocking: rates of tuberculosis infection are at least 20 times higher than in the homeless population than the general population; rates of depression are up to seven times higher, while premature mortality, statistics show, shortens the lifespan of the homeless population by 20 years in Denmark, and by up to 30 years in England.

Despite this excess burden of illness, people who are homeless often experience barriers in accessing and using health services.  Providers of these services often lack the resources and flexibility to promote timely responses to the complex healthcare needs of homeless people. This relationship between the need for healthcare and its actual utilisation has been named the ‘inverse care law’ – in other words, those who most need care are the least likely to receive it.

Reducing health inequalities and improving health services for homeless people is one reason why FEANTSA is urging MEPS to support the written declaration calling for an EU Action Plan on Homelessness. Previous resolutions have been ignored, while the number of homeless people has only continued to increase.  The EU can provide significant added value in helping national governments to address homelessness and its causes – any action plan should include the following measures on health:

  • Provide good health services for homeless people, which offer low threshold, high quality, flexible, tolerant and individually tailored responses to meet their health needs.
  • Better coordination between GPs, hospitals, mental health care, drug and alcohol programmes to prevent the situation often experienced by homeless people of being shunted from service to service and being treated only for the most acute health issue.
  • Develop integrated services that bridge the gap between homelessness and health services reducing the organisational barriers between different services allowing homeless people to receive the support they need.

There are already examples of how this can work in practice. ‘Housing First’ projects across Europe provide housing with support for homeless individuals with severe mental illness and/or substance abuse. These projects not only result in sustainable housing and improved life, but also reduction of costs in health care and social services.

Health professionals and the health care sector also have a role to play in preventing homelessness: join the call for changes to social and housing policies which foster homelessness and highlight homelessness’ excessive toll on health.

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