Homelessness and Health

To be vulnerable means you are at an increased risk of being harmed. Vulnerable populations, such as persons living in poverty or homeless, are at an increased risk of health problems and face significant barriers when accessing health care services.

For this blog, I will look at who the homeless are in Canada, some of the health challenges they face, and how we can better serve this vulnerable population.

Who are the homeless in Canada?

Homelessness encompasses all individuals without stable, permanent or acceptable housing (Pottie et al., 2020). It is estimated that approximately 35 000 Canadians experience homelessness on a given night, and at least 235 000 experience homelessness in a year (Gaetz et al., 2016). The demographic characteristics of the homeless population vary across the country affects a wide range of people (see Figure 1)

• Single men make up the largest percentage of homeless people (60%), and while they typically only stay in the shelter system for a few nights, the account for 75% of the chronically homeless (Hwang, 2001)

• Single women account for approximately 25% of the homeless population (Hwang, 2001)

• Indigenous people account for 5-35% of the homeless population, and a disproportionate number sleep on the street rather than in a shelter (Hwang, 2001)

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Figure 1 – Homelessness in Canada By the Numbers (Gaetz et al., 2016)

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Homelessness and Health

Individuals who are homeless are at an increased risk of dying prematurely and suffer from a wide range of chronic health challenges, including chronic obstructive pulmonary disease, tuberculosis, seizures, skin and foot problems, and smoking. Chronic conditions such as hypertension and diabetes often go undetected for an extended period and are poorly controlled. Disease severity can be high due to delays in seeking care, noncompliance, and cognitive impairment. Sadly, unintentional injuries from falls or being struck by a motor vehicle are the leading cause of morbidity and mortality. Deaths due to an overdose of drugs and alcohol are also common (Hwang, 2001).

In addition to the many health challenges the homeless population already faces, this year, COVID-19 has been hard on Canada’s homeless population. Many shelters have had to reduce capacity to facilitate physical distancing, making it harder for many to find a safe place to sleep (Fenn, 2020). Individuals experiencing homelessness often find it challenging to adhere to public health directives such as social distancing and self-isolation and are at an increased risk of severe COVID-19 due to the high prevalence of chronic health challenges (Perri et al., 2020).

Homelessness and Health Care

Homeless adults are high health care users, and the emergency department is often their primary care provider. Homeless people are admitted to a hospital five times more often than the general population with a prolonged hospital stay. (Hwang, 2001). In many cases, once a homeless patient is ready for discharge, they are discharged either back to the street or a shelter for their ongoing recovery. It is difficult for people without permanent housing to recover from hospitalization or cope with chronic illness.

Homelessness can also make it difficult to access health care; while we are fortunate in Canada to have universal health care, this does not cover all medical expenses. Provincial health plans do not cover medical equipment such as crutches, cast boots, and prescriptions. Also, it can be challenging to arrange a follow-up appointment without access to a phone or address. For example, programs that offer mobile health care registered nurses and outreach workers who meet the homeless where they are – shelters, the park they live in, etc. go a long way in providing ongoing care.

Conclusion

Improving health care services for the homeless, while needed, is only a band-aid solution to a much larger problem. Homelessness affects a large number of Canadians and is associated with a variety of health challenges. Unfortunately, the health care system is not adequately designed to meet the needs of this vulnerable population. The main barriers to health among the homeless are the lack of adequate, safe, and accessible housing. Therefore, to improve the health of the homeless, we need to find a solution to end homelessness.

References

Gaetz, S., Dej, E., Richter, T., & Redman, M. (2016). The State of Homelessness in Canada in 2016. www.homelesshub.ca

Hwang, S. W. (2001). Homelessness and health. In CMAJ (Vol. 164, Issue 2, pp. 229–233). Canadian Medical Association. https://doi.org/10.1177/1359105307080576

Perri, M., Dosani, N., & Hwang, S. W. (2020). COVID-19 and people experiencing homelessness: challenges and mitigation strategies. In CMAJ (Vol. 192, Issue 26, pp. E716–E719). Canadian Medical Association. https://doi.org/10.1503/cmaj.200834

Pottie, K., Kendall, C. E., Aubry, T., Magwood, O., Andermann, A., Salvalaggio, G., Ponka, D., Bloch, G., Brcic, V., Agbata, E., Thavorn, K., Hannigan, T., Bond, A., Crouse, S., Goel, R., Shoemaker, E., Wang, J. Z. J., Mott, S., Kaur, H., … Tugwell, P. (2020). Clinical guideline for homeless and vulnerably housed people and people with lived homelessness experience. In CMAJ (Vol. 192, Issue 10, pp. E240–E254). Canadian Medical Association. https://doi.org/10.1503/cmaj.190777