14 Simon Communities of Ireland 2.7 The relationship between homelessness and health Health is defined by the WHO as ‘a state of complete physical, mental and social well being and not merely the absence of disease or infirmity’.21 A person’s home (or the absence of it) clearly plays a central role in shaping their physical health and their feelings of wellbeing and general ability to cope with everyday life. 33% of the individuals identified as homeless in the CSO special report on homelessness indicated that their health was ‘fair’, ‘bad’ or ‘very bad’ (compared with 10% for the wider general population). The relationship between health and homelessness is however a complex one. What is clear is that people who are homeless have higher than average mortality rates linked to higher levels of physical and mental illness and problematic drug and/or alcohol use, inadequate access to health care and often severe poverty. Holohan22 (1997) found that 66% of the people he studied who were homeless experienced at least one physical or psychiatric problem. Further research conducted in 2005 by O’Reilly & O’Carroll (2005), which compared the health status of the people who are homeless with the findings of the 1997 Holohan study, found that the physical and mental health of people who are homeless had not improved; in fact, levels of illicit drug use and blood borne diseases, including HIV and hepatitis, had risen significantly23. O’Connell et al 2004 identified older people who are homeless as a ‘particularly vulnerable group who have both high mortality rates and high levels of cognitive impairment and mental illness’ (Pp.124) than the general population. It is interesting in this context that the London based homeless charity St. Mungos has developed its first Health Strategy (2008-2011)24 for its hostel dwellers that seeks to facilitate health delivery in its hostels; integrate into a single document its vision of service delivery across physical health, mental health, drugs and alcohol; and address priority areas for promoting positive health and well-being. Physical Health Issues The links between homelessness and poor physical health are well established and often linked to exposure to the elements and lack of a safe protected shelter. Rough sleepers, for example, tend to suffer injury and fall victim to violence, while exposure and inadequate conditions in night shelters and hostels can lead to high levels of certain infectious diseases, such as tuberculosis and hepatitis. “People who are homeless have higher morbidity from physical conditions that are common as well as conditions that are rarely found in the general population such as HIV, Hepatitis and Tuberculosis” 25. The on-going University of Sheffield study26 found that whilst disease is the cause of the vast majority of deaths amongst the general population, people who are homeless are more likely to die from external causes with higher incidences of deaths as a result of traffic accidents, infections and falls. Holohan et al27 identified that people who are homeless are more likely than their housed counterparts to suffer from arthritis, leg ulcers, oedema, problems with bones and joints (caused by long hours standing in public places or walking around the streets), heart disease, tuberculosis, eye & ear complaints, epilepsy, skin problems as well as injuries from accidents and assaults. Condon also found that 98% of the people who were homeless that she examined needed dental treatment suggesting that this type of care is particularly difficult to access for people who are homeless. These findings are reinforced by the 21 Preamble to the Constitution of the World Health Organization adopted by the International Health Conference June, 1946, 22 Holohan, T. (1997) Health Status, Health Service Utilisation and Barriers to Health Service Utilisation among the Adult Homeless Population of Dublin. Eastern Health Board 23 Pp. 124 24 St Mungos (2008) St Mungo’s Health Strategy for Homeless People (2008 – 2011) 25 SafetyNet (2009) Service Activity Report, SafetyNet: Primary Care Network for Homeless Health Services, Pp. 5 26 Crisis (2011) Homelessness: A silent killer: A research briefing on mortality amongst homeless people 27 Feeney, A., H. McGee, T. Holohan, & Shannon W. (2000) Health of Hostel-Dwelling Men in Dublin. Dublin: Royal College of Surgeons in Ireland and Eastern Health Board. Condon, M. (ed.) (2001) The Health and Dental Needs of Homeless People in Dublin. Northern Area Health Board Lawless, M & C. Corr (2005) Drug Use Amongst the Homeless Population in Ireland. National Advisory Committee on Drugs Merchants Quay Ireland (2009) Older People’s Experiences of Housing Exclusion: An Exploratory Study on behalf of NCAOP
Homelessness, Ageing and Dying
To see the actual publication please follow the link above