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Homelessness and The Social Determinants of Health

Social determinants of health are the conditions in which individuals are born, grow up, work, and live. These conditions of daily life are significant dictators of why some people are healthy and others are not, in addition to a wider set of economic and social systems that drive income, access to food, housing, and healthcare. Homelessness or unstable housing itself is a significant social determinant of health [1] and homeless individuals themselves may be predisposed to adverse health outcomes due to poor living conditions and limited access to food. As such, for people who are homeless, social determinants and homelessness are often intertwined. [2]


Being homeless has grave effects on a person’s health and human dignity. Devastating mortality data in Toronto shows that an alarming two individuals/week die while homeless.[3] Over 5, 400 people use Toronto’s emergency shelter system on average every night. [4] However, due to overcrowding, people are being turned away from these shelters which further highlights the desperate need for increased shelter capacity and availability. Those who are visibly homeless and seeking immediate shelter are only at the tip of the iceberg. Beneath is an even larger group staying with friends or “couch surfing”, or simply living in unstable housing. Not having access to adequate and affordable housing is associated with enormous health inequalities, including shorter life expectancy, higher morbidity, and greater use of hospital services.


As previously mentioned, lack of access to housing and income has a significant impact on mental health as well. Community-based initiatives have worked to address access to housing and assist people who are homeless with mental health problems. [5] The use of social enterprises is a promising practice to address these issues regarding poverty, employment, and social inclusion. However, we are far from reaching a concrete solution to this problem and large steps still need to be taken to ensure the success of these outreach programs.


Unemployment, another social determinant, tends to go hand-in-hand with homelessness and carries its own health disadvantages. While unemployment is not exclusive to homeless individuals, it leads to problems associated with food insecurity and unstable housing. Unemployed individuals are more likely to self-report diminishing health status and are at a higher risk for mortality.p1] Ensuring stable employment will help these individuals live better and healthier lives by allowing them to reside in safe neighbourhoods, afford better health care, access nutritious food, and provide education for the young. Thus, addressing unemployment can be a big step in treating other significant social determinants of health, especially for the homeless.


Housing is a significant social determinant of health and is often intertwined with other social determinants for homeless individuals. Their situation is often exacerbated due to their poor living conditions leading to both physical and mental illnesses. Contrary to popular belief, in most cases, living conditions - for better or worse - are imposed upon us by the quality of housing situations, communities, work settings, and health service agencies with which we interact. Raising awareness regarding these issues and problems is the first step in helping these individuals come out of their poor and unfortunate situations.


 

References


  1. The Social Determinants of Health: Homelessness and Unemployment. Retrieved from https://essentialhospitals.org/quality/the-social-determinants-of-health-homelessness-and-unemployment/

  2. Stafford, A., & Wood, L. (2017). Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants. International Journal of Environmental Research and Public Health, 14(12), 1535. doi:10.3390/ijerph14121535

  3. Rider, D. (2017, October 30). Homeless death toll hits 70 and rattles public health committee members. Toronto Star. Retrieved from https://www.thestar.com/news/city_hall/2017/10/30/homeless-death-toll-hits-70-and-rattlespublic-health-committee-members.html.

  4. Source: City of Toronto. (2018, January 23). Daily shelter and overnight service usage. Retrieved from https://www.toronto.ca/citygovernment/data-research-maps/research-reports/housing/housing-and-homelessness-research-and-reports/sheltercensus/.

C. F. (2016). Social determinants of health: Housing and income. Retrieved from https://www.homelesshub.ca/resource/social-determinants-health-housing-and-income

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