Health Issues of Homeless Population

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Health Issues of Homeless Population

Health Issues of Homeless Population

Introduction: The unfortunate vulnerable homeless

A typical physical examination at your family doctor may seem insignificant to your long-term health care, but not every individual has this prosperity in regards to access to public health care. A common under serviced group of individuals are homeless people.  As stated in the Encyclopedia Homelessness is a condition of detachment from society characterized by the absence or attenuation of the affiliate bonds that link settled persons to a network of interconnected social structures. Homeless people have many faces: male, female, adult, child, and elderly. It has been very prominent that there is a fine line between homeless people and their so-called “universal” health care. Homelessness is a social problem that has been on the rise since the early 1980s (Gelberg et al., 2002).Homelessness is one of the many problems that prevail here in Canada; it will continue to rise unless we can find a solution to fix it. People need to take into consideration that people who are homeless did not choose to be homeless; they came across many barriers throughout their life that conveyed them to where they are today. They face many barriers, which stop them from getting the health care treatment they need, while other individuals who are human just like them can easily access it whenever they want and they seem to be the ones who take it for granted the most. “Many homeless people face barriers to primary healthcare and frequently have unmet health needs” (Khandor et al, 2011, p.94).Individuals who are homeless face numerous issues everyday when they need medical attention, they will never get better if they don’t see a doctor. Therefore barriers that stand in the way of homeless individuals accessing primary care are discrimination/inequality in the emergency department, not having a family doctor to treat their needs so they face long wait times in the ER and either having a lost or stolen health card. Health Issues of Homeless Population Sample Essay


Background on the homeless

Homelessness began around the 1960s, and according to around Kusmer sometime around mid eighteenth century homeless people were regarded as “Sturdy beggars “ and they were found around every corner of colonial towns (Kusmer, 2003).  Through generation-to-generation homelessness never seemed to stop it only seemed to increase. Poverty is considering one of the main contributions to homelessness, not being able to keep up with rent, bills, and essential commodities of life. What people do not take into consideration is people could also become homeless from natural disasters or a house fire. They lose everything and are sent to live on the streets; most people are not fortunate enough to have insurance.  Homeless people lost everything, including their home, family, friends and their access to primary healthcare.  A study conducted in July 2010 by Travis P. Baggett shows the unmet health needs for homeless adults, 73% of the homeless population had unmet health needs, and those who had a job within that past year got medical attention first over those who did not (Baggett, 2010, p.1326-1333). This proves that certain physicians have a certain preference of patients to attend to. They may be this way because from the past homeless people have a stereotype built up and defined. When you look at a homeless person it is evident that you think dirty, drug addict, helpless and lazy. There are also different types of homeless one being “ ‘Absolute homelessness’ describes the condition ofpeople without physical shelter who sleep outdoors, in vehicles, abandoned buildings or other places not intended for human habitation” (Hwang, 2001, p. 229). The other being “  ‘Relative homelessness’ describes the condition of those who have a physical shelter, but one that does not meet basic standards of health and safety; these include protection from the elements, access to safe water and sanitation, security of tenure, personal safety and affordability” (Hwang, 2001, p. 229).  Both are consider homeless and both are treated the same way, if they get sick and show up at the hospital’s emergency department they are seen as last priority, no one wants to help the homeless which is demeaning and sad. People take one look at them and discriminate because of what society has shown us what homeless people are.Health Issues of Homeless Population Sample Essay

Discrimination against the poor defensiveness Homeless

Homeless people face inequality when accessing health care; they are looked at as last priority.  It is shown by Khandor that people who are homeless “face barriers to primary health care and frequently have unmet health needs” (Khandor et al., p.94). Why you might ask do they have unmet needs?  Well when a homeless person gets sick they go to the emergency department to get treated. Upon entering attention is usually on them because of how they look. Their wait time could be extremely long; they could be last on the waiting list. Homelessness increases the use of emergency health services, which is the most expensive health service. Homeless people living on the street suffer from all kinds of mental illnesses. Healthcare workers would treat the homeless person with bare minimum treatment.  In an article written by Mary Dawood health care staff made some comments about homeless people, “Homeless people stay in the department as long as possible to stay warm, Homeless patients on the whole aren’t abusive, I sympathize with the patient’s overwhelming need to seek drugs to maintain their addiction” (Dawood, 2011, pg. 257-8). These are just some comments made from some of the nurses that work at one hospital. Health Issues of Homeless Population Sample Essay

No family doctor, means a trip to the Hospital

When you have a health related issue or when you get sick you will usually go to a walk in clinic or try and get in to see your family doctor, Well for the homeless the process of trying to see a doctor is much more complicated. A study conducted in Toronto in 2011 showed that 57% of homeless people reported not having a family doctor, also the same statistic holds for those with chronic conditions (Khandor et al, 2011). The homeless do not have easy access like other individuals; the term access refers the ability to gain entry to the system and its services. Once a person who is homeless is very sick they will have to go the ER and their wait times can be very long. It is very obvious that people who are homeless have much poorer health than the general population. It is also very hard for a person who is homeless to stay healthy and clean, they have lack control over the food they eat and lack access to healthy food. This make may cause them to have stomach pains. “Homeless people are more likely to be injured or assaulted, which often includes head injuries. Head injuries can lead to seizures. Violence also has a broad range of negative physical and psychological effects” (The Street Health Report, 2007, p.18). “Many homeless people spend a major part of the day outside, exposing them to damp, cold, extreme heat and pollution. This prolonged exposure may put homeless people at higher risk for arthritis, pneumonia, allergies and asthma” (The Street Health Report, 2007,p.19). Homeless people are always more at a risk of always needing to go to the doctor because of their living situations. They get sick more frequently and they do not have a family doctor to treat their needs. So they will always have to go to the ER and even at the ER they are faced with more problems. Some hospitals will not accept a homeless patient if he/she does not have their health card and they creates issues for that homeless person who is unaware of where their health card is.Health Issues of Homeless Population Sample Essay

Health cards are key to receiving primary care

Twenty‐eight percent of all respondents had been refused health care in the past year

because they did not have an Ontario Health Card, and 34 percent did not have such a card (The Street Health Report, 2007,p.26). Several homeless people are without a health card and many of them either lost it or got it stolen. Health cards are key to receiving primary care and with out it you may be out of luck. They could have lost it from moving around, or lost it from going to jail and not having a officers return it, or they could have also lost it from a house fire.  When you’re homeless you have nothing and the little bit you do have you try to salvage, and you always have to be on guard because once you fall asleep a thief is guaranteed to steal something of yours and for some homeless people that could be their health card. This is one of the most difficult barriers they face when accessing their universal health care. Also normally if they do not have a health card they also do not have their social insurance card. “Among our survey respondents, 50 percent did not have a Social Insurance Number6 card and 29 percent did not have identification that provides proof of citizenship, such as a birth certificate, citizenship card, record of landing and passport” (The Street Health Report, 2007,p.27).  A social insurance number is required to work in Canada and receive government benefits and if they are without one then they can not work to make money to get the essentials they need, also they can not receive benefits such as welfare which leaves them homeless on the streets. When on the streets you have a higher risk of getting sick and without the health card they can not receive any help.Health Issues of Homeless Population Sample Essay



There are many barriers homeless individuals face when accessing primary healthcare. It is shown in many studies conducted that physicians and people discriminate against the homeless and they are not treated equally.  People need to take into consideration that the homeless did not ask to be homeless. Many tragedies occur in people lives and their tragedy could have been poverty, house fire, mental illness etc. all things leading to homelessness. Everyone is entitled to the universal care but not everyone can access it, homeless people face many barriers such has discriminate or unequal care, they face troubles getting care because they do not have a family doctor and hospitals ER’s wait times are extremely long and most of homeless people are without their health card and that’s extremely important to get the health care they need. To improve homeless peoples health and health care access would mean to have adequate incomes and proper housing and this may take time homeless people need good access to health care now. Furthermore homeless people will never get the universal access to health care if the barriers are not broken, they need equality, a compassionate helpful reliable family doctor, and either trying to get their health card back or still treating them without it.


A person is contemplated homeless if there is no roof over his head to live. The statistics, which prevail only, relate to masses that are counted as homeless and meet the requirements for local government aid. The quota of households proclaimed in need of urgent housing in United Kingdom increased by about 25% over the last four years. The enormous numbers of people classified have complicated social, health and psychological requirements, and in the past years a great number of centres have been set up to dispense foremost care to people belonging to homeless group.Health Issues of Homeless Population Sample Essay

Importance of public health

Personal medical services regulation body has made this practicable; earlier, the network of general practitioner (GP) fundholding was a hurdle to chief care for vagrant people with complicated and unsolved issues. The nationally increased general practitioner (GP) agreement will in all likelihood put forward inducements for supervision of vagrant people. The existing obstacles for this group can be seen in suc a way that In a report to the Office of the Deputy Prime Minister, they incorporated the appointment procedures, opening times of surgery, financial disincentives, location and discrimination. Causes for differentiation comprise of impressions that they are violent, antisocial, migrant, or ‘undeserving’. Furthermore, the situation was dealt with some vagrant people face even more risk of being excluded due to their gender, age, sexual orientation or ethnic background. In primary safekeeping, demanding conduct can be a matter of question, but classification of an individual as ‘undeserving’ or ‘deserving’ takes no description of the social elements for example poverty and unemployment, which can conduct to homelessness. Doctors are encouraged by the general media council to permit personal views about patients’ gender, culture, race, age or sexuality to preconceive the idea the safekeeping they get. Because of it a challenge is being placed on clinicians not to eliminate people from health centers because of homelessness or possible drug culture. (Anne, 2005).Health Issues of Homeless Population Sample Essay

Common health problems


People without home have a larger proportion of dangerous morbidity and humanity than the other general population. The major health requirement is drug reliance,and the use of illegal drugs, which cause numerous morbidity (including viral hepatitis B and C), septicemia, HIV infection, deep vein thrombosis, abscesses, endocarditis, cellulitis and encephalitis. Adjacent to this, many will be using numerous drugs, mainly heroin and cocaine.Typically for drugs users, principles make these rules. Controlled drugs should be authorized to those patients only who have actually accepted GP, drugs worker and patient. Now there are nations approved results of drug cure,and the policy will rely on those who use drugs independent situations, for example, some drug users will insisted to detoxify from opioids (clearly it is then reasonable to work to an outcome of cessation of drug use).

For disorganized drug users, this outcome is not much sensible at first demonstration and the goal must be to establish health and social obligating’s. This (harm reduction) will involve a reduction in the amount of the drugs used, upgrading in physical health, less sinful action and improved relationships (personal/family). (Phill, 2003). Health Issues of Homeless Population Sample Essay


Many vagrant people have a persistent history of serious alcohol dependence with hepatobiliary, gastrointestinal, cardiovascular, neurological, or metabolic complications. Not to forget that the risk of suicide because of depression is still there.

Frequently the vagrant users of alcohol will come to the extensive practitioner with an appeal for urgent detoxification. This should not be undertaken without sufficient preparatory support and assessment. Particularly, uncontrolled detoxification can conduct to convulsions (mainly in the initial 24 hours), which can cause death. The drug of choice to accomplish removal is chlordiazepoxide. Earlier Clomethiazole (Heminevrin) was taken, but this is more toxic when excessively taken and has larger causing dependency capacity. A treatment of vitamins is used instead which also requires to be recommended large dose of thiamine for a single week followed by prolongation vitamin B blend strong. (Phil, 2003)


In the regular population, smoking have decreases since last 30 years. As stated by the General Household Survey, 27% of adult population smokes. One of the government investigation carried out about smoking (among homeless people) was managed in 1996 by Gill. They found that the levels of the smoking were:

  • 90% of homeless people
  • 85% of public in night shelters
  • 68% of hostel inhabitants
  • 49% of private sector leased residence.

Current research in England (southwest) and Wales noted that 94% of Big Issue vendors reported smoking cigarettes. (Hellen, 2003).Health Issues of Homeless Population Sample Essay

Mental Health

The most common health issue in homeless people is drug-induced, psychosis, schizophrenia, depression and anxiety states.The direction of the link with homelessness is uncertain; mental ill health can be a cause and also can be an effect. As compared with the usual population, mental illness is overrepresented in young people (typically rough sleepers), the principal conditions being schizophrenia, affective disorder, psychoses and substance misuse (including alcohol).Dual diagnosis is common and many of the homeless people who are mentally ill have a history of illegal actions. The crimes mainly consist of acquisitive crime or alcohol habit, damage to property or mischief while drunken.

A very less men have a history of violent crime. Almost less than 1/3 of homeless people.For some old people, mental illness is the excess to homelessness.(Richard & Michael, 2008).

Practice organizations

There has many debates conducted on whether primary care is better provided through specialized general activities working with homeless people than through common activities.It has been talked that a specialized extensive pursuit for vagrant people is best to put on these vagrant drug users in doomsday with an excess of health troubles. And as well as stabilizing the severe medical states such applications can direct the vagrant person in right use of basic care. When these results have been attained the patient is motivated to lodge with a normal practice. This change can be hard not just for patients but also for medical practitioners when there is a powerful personal liability. Consequently, we ponder that a specialized performance requires the assistance of a committed GP liaison worker. Specialized common practices for vagrant people are only possible in large areas of the city. For village vagrant inhabitants, the answer lays in increment of existing normal basic healthcare services.

Another problem in basic care provision for vagrant people is the tightness between practice-based work and outreach work. The quarrel for outreach is depended mainly on a wrong supposition that vagrant people are short-lived and do not approach basic care.(James, 1994). Health Issues of Homeless Population Sample Essay

  • Working with primary care organizations

Historically the organized multiagency functioning for the advantage of vagrant people has been hard to attain, for causes comprising lack of lucidity about the correct responsibilities and employments given by differing agencies, problems in sharing information, and nonfulfillment to answer in a coordinated manner.

The Royal College of General Practitioners suggests that homelessness problems should be considered as component of the basic primary care organization (PCO) agenda. In a Statement on Homelessness and Primary Care it says that PCOs should give services for in progress homelessness woks, obtain a fine understanding of the numbers of vagrant people in their region and the issues they face, and should encourage multiagency connections and the sharing of conventions and operating ways that make coordinated care and integrated working easier.

  • Working with hospitals

When sick, vagrant people look for the help later than other people. They are over-symbolized in presence at emergency departments and hospital accidents. Whether their lodged complaints would be managed in a better manner in basic care is not evident; the reason behind most of the attendances is intentional self-harm or overdose of medication, so the elevated attendance speed could cast back the high commonness of serious ailment in this category of vagrant people. The GP will wish a vagrant patient with acute disease to stay in the medical care center until fully healthy for discharge, and in vagrant users of drugs this may be assisted by instruction of substitute medication on the hospital rooms. The chief purpose should be to keep the users of drugs in a hospital room and not allow them take their own discharge because of acquiring minimal substitute medication. Because the GP may wish to press on these instructions of doctors even after discharge, practices working with users of drugs require evenly matched connections with services to the inpatients. Present day many users of the drugs taking methadone are liberated out either in the absence of medication or with adequate amount of medicine for just a single day. This puts excessive pressure upon basic care. (Healthy Life, healthy people). Health Issues of Homeless Population Sample Essay

  • Working with other stakeholders

Joint working not only consisted of healthcare associates but also other services providers to vagrant people incorporating social services departments, housing departments, and non-statutory companies. Lastly, and most significantly, GPs should search for to work in association with vagrant people themselves, the ‘consumers.

  • User involvement: active or passive?

In trivialized categories, involvement of patients can be an efficient means to better healthcare. In the case of vagrant people, stigmatization, isolation and absence of choice show large hurdles. By implying these patients we can recognize pauses in the work and alter training correspondingly. Similar efforts go some way to respond to the social exclusion, which subscribes to sick-health. The fundamental principle is that all individuals, regardless of status, must be permitted chances to take part in resolutions influencing them. To this end, advocacy groups and self-help will sometimes be of help in finding out the essential requirements.

An experimental study carried out at the NFA (No Fixed Abode) Health Centre for Homeless People, Leeds, focused to decide the most efficient and suitable ways to facilitate and encourage the involvement of patient. 30 patients attending by random selections, appointments fulfilled a structured questionnaire investigating their behaviors to becoming actively counted in the service. The solutions showed that most of them were keenly interested in impacting the run of the health care center and desired to be a part of the decisions, which could change the recipients of future regarding the service. They depicted interest in making a contrast, to pass on their practical knowledge, or to restore something. Some candidates, specifically the ones who were trying to lower their use of drugs, revealed a feeling that participation in the NFA would dispense a perfect chance to focus their lives again. But the desire for participation was not accepted everywhere: some contemplated no requirement for modification or judged the NFA plainly as a service to provide their medical requirements, and a small number of people said they did not get the time.(Health Development Agency). Health Issues of Homeless Population Sample Essay

Health Promotion And Psychological behavior change

Propaganda of health to vagrant people is feared with problems—not because the masses are so diverse. When asked, sellers of theBig Issue(who themselves are vagrant) gave some prime concern to lessening of uncertainty from the injection of drug. Here are few practical means of promotion of health in primary healthcare:

  • Offer immunization of hepatitis B to that vagrant who inject drug. A speeded up program (0, 7, 21 days) outcomes in immensely better fulfillment charges than the customary (0, 1, 6 month) program. A booster should be given at twelve months
  • Urge vagrant users of drugs to avail needle exchange programs, which may lower the commonness of hepatitis C. Injecting instruments should not be shared.
  • Be alert of death from overdosing of heroin. Recommend the patient not to self-inject when alone and guide in opposition to the use of other drugs, including alcohol or benzodiazepines, with heroin; be alert of deficiency of tolerance after voluntary or enforced sobriety. In the time ahead, courses for vagrant people may consist of peer management of naloxone for excessive drug dose. (Bengt & Monica, 2006)