Written by Jiejun (Emily) Yang
What is the first thing you notice when you see a person sleeping on the street?
You may feel sorry for that person and drop the change you have left over in your pocket, or you do not have any thoughts at that moment because you are used to seeing people living on the street. These intuitive judgments make you have habitual thinking about what you have seen, and the last thoughts in your mind are not consciously recognized.
When we think about homelessness, we usually recall the people who live on the street because that is what our eyes and ears tell us, but it’s only the surface: there are actually 13 different operational categories of homelessness according to FEANTSA. Perhaps a person’s first experience of people experiencing homelessness is that of a tired face and a blanket covering their unhealthy body on the street. Then you are curious and ask the people next to you, “why are those people sleeping there?” Then, people around you tell you that they are homeless because when people were younger and asked the same question to the adults, they were told the same thing: homeless people live on the street because they do not have a place to live.
““Missing a home/address without one you are basically a ghost citizen, nobody wants to see you so you don’t exist.” In his experiences, everything starts with a home, where everyone can find you and your existence.”
The impression of homeless people sleeping on the street is the most discriminative and profound stereotype toward people experiencing homelessness. Since the most frequent location we meet them is on the street, we have been taught by other adults for a long time that homelessness is synonymous with rooflessness or houselessness. Compared to the previous period, the number of unemployed persons increased by 100,200 in the first quarter of 2022, which lead to unstable living security. Lack of stable housing and income is a common way of becoming homeless, but the variables causing homelessness are many.
A European framework called ETHOS (European Typology of Homelessness and housing exclusion) was created in 2005 to improve the understanding of the diverse conditions of homelessness and define 13 types of homelessness. The factors causing homelessness include, but are not limit to, loss of job (35%), bills higher than earning (15%), evicted by family member (13%), abuse at home (11%), incarcerated (11%), change in family status (10%), sick/disabled/mental issue (10%), and drug/alcohol (9%). Each of these individual variables interact with each other and cause homelessness. The status of homelessness then becomes the consequence of a wider range of determinants. Rough sleeping or people living on the street is the most visible and vocal aspect of homelessness.
Attributing homelessness to a single characteristic alone does not explain why it does not improve after the provision of suitable living conditions. Research on the association of building interpersonal relationships and perceived health services with the improvement of the health condition of 1382 homeless people in the Basque Country of Spain shows the positive relationship between the time of a person becomes homeless and the worsening of one’s health, meaning that prolonged outdoor exposure has an adverse impact on one’s health and life expectancy (Fajardo-Bullón et al., 2021). As well as the result of this association between interpersonal relationships and Self-Rated Health (SRH), the subjective assessment of health status shows that a person's health status improves thanks to interpersonal relationships. However, the disproportionate gender in the sample and the high drop-out rate indicated some limitations in the research. By discussing the impact of gentrification and housing instability on the access to health services in Washington, DC, the housing status of homeless people influenced their access to medical, behavioral health, and other social services (Ruiz et al., 2022). Even though further understanding of the impact of gentrification on marginalized and homeless populations is needed to improve the limitation of the research, the health issues that happened in the homeless community are still considerable.
“I believe that, in many cases, the experience on the streets destroys their self-esteem, sense of value and inhibits self-care. Thus, it is very easy for many to “forget” to take care of their health. They don’t remember how important it is — and they are.”
Therefore, attention to health services for the homeless is warranted. Without stable housing and living security, homeless people are more likely to contract diseases and cannot get effective treatment on time. Even though there are pharmacies on most streets, they are not enough for homeless people who need specific prescription drugs.
“I describe the three ‘A’s for health professionals as awareness, attitude and accountability. Awareness is crucial - understanding the net of care and their role in it, then whether the make a conscious or unconscious decision to support health need by their attitude and lastly - how are they held accountable for that decision? Health needs are so invisible unless commissioners monitor homeless health.”
“To assist people experienced homeless with specific needs, the first thing is to find out the axis of the problem and several levels of inducing factors independent from the consequences. Homeless people are in a total state of vulnerability, in the case of health, they suffer the climatic impact of the place that further aggravates their situation. One of the factors that intervenes in their health is malnutrition and its consequences. Diseases, having to survive in hostile environments in terms of cleanliness and hygiene. Psychological disorders among so many. But one of the main axes that makes them end up in a homeless situation can be due to family, economic problems, drug use, alcohol, problems with the law, etc., which ultimately brings about legal conflicts. In short, it is that vulnerability mentioned at the beginning, called health problems. ”
A survey on support centers for people experiencing homelessness in Spain by Instituto Nacional de Estadistica has shown that among 1,019 shelters for homeless people, 18.5% of the shelters addressed drug addiction. Meanwhile, 12.9% served with mental disorders, and 12.9% provided alcoholism treatment. By providing health services individually for a homeless person with a specific symptom, the efficacy and time-consuming of assisting the homeless community are improved. As these numbers show, the shelters are focusing on providing assistance-based support and the percentage of homeless people receiving support for mental health and substance abuse issues is probably lower than perceived by society.
“I think specialist homelessness services are crucial as they deliver resources directly to homeless people. But if you wanted to improve general health services, so that every individual could get equal access you would have to allow more time for clinicians to consult with their patients (homeless people tend to have multiple health conditions, as do many old and/or poor people); you would need to have highly skilled clinicians in frontline roles; less triage and onward referral as people who struggle to access services – the socially disadvantaged, immigrants and refugees, poor people, people with mental health problems – won’t access hard to access services; you need a redistribution of health resources, so that most are concentrated in areas with the greatest social deprivation; and you need a recognition of the importance of the interplay between poverty, inequality, mental illness and poor health. Finally, Adverse Childhood Events (ACEs) predict all forms of mental illness, social disturbance (criminality, alcoholism, homelessness) and physical illness (including heart disease and cancer rates), so you need huge resources put into early parenting and support for children and parents of young families so as to break the cycle of disadvantage.”
Health problems may become a chronic disease, which will ultimately afflict many of people, which can lead them to homelessness, if they do not receive the timely treatment and support necessary to stay on their feet. We must provide special attention and support for those living in poverty or riches, who suffering from health problems, because no one is too famous to become homeless.
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