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Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants

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  • Amanda Stafford

    (Royal Perth Hospital, Perth, WA 6000, Australia)

  • Lisa Wood

    (School of Population and Global Health and Centre for Social Impact, The University of Western Australia, Crawley, WA 6009, Australia)

Abstract

Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homelessness further exacerbates poor health. Aggregated health service data can mask this, and case histories thus provide important insights. Methods: This paper presents three case histories of homeless patients seen at an inner city public hospital in Perth, Western Australia. The case histories draw on several data sources: hospital data, information collected from rough sleepers and clinical observations. Estimates of the cost to the health system of the observed hospital usage by the three patients are included. Findings: The case histories illustrate the interplay of social determinants of health in homelessness that help explain the high level of hospital usage by rough sleepers. The cumulative healthcare costs for the three individuals over a 33 months period were substantial. Hospital attendance plummeted even in the short term when housing needs were addressed. Conclusions: Treating homelessness as a combined health and social issue is critical to improving the abysmal health outcomes of people experiencing homelessness. In addition, the enormous economic costs of hospital care for people who are homeless can be reduced when housing and other social determinants are taken into account.

Suggested Citation

  • Amanda Stafford & Lisa Wood, 2017. "Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants," IJERPH, MDPI, vol. 14(12), pages 1-12, December.
  • Handle: RePEc:gam:jijerp:v:14:y:2017:i:12:p:1535-:d:122176
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    1. Kushel, M.B. & Perry, S. & Bangsberg, D. & Clark, R. & Moss, A.R., 2002. "Emergency department use among the homeless and marginally housed: Results from a community-based study," American Journal of Public Health, American Public Health Association, vol. 92(5), pages 778-784.
    2. Fowler, P.J. & Toro, P.A. & Miles, B.W., 2009. "Pathways to and from homelessness and associated psychosocial outcomes among adolescents leaving the foster care system," American Journal of Public Health, American Public Health Association, vol. 99(8), pages 1453-1458.
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    1. Vanessa Heaslip & Stephen Richer & Bibha Simkhada & Huseyin Dogan & Sue Green, 2021. "Use of Technology to Promote Health and Wellbeing of People Who Are Homeless: A Systematic Review," IJERPH, MDPI, vol. 18(13), pages 1-18, June.
    2. Tobias Schiffler & Ali Kapan & Alina Gansterer & Thomas Pass & Lisa Lehner & Alejandro Gil-Salmeron & Daragh T. McDermott & Igor Grabovac, 2023. "Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review," IJERPH, MDPI, vol. 20(1), pages 1-14, January.
    3. Jane Currie & Amanda Stafford & Jennie Hutton & Lisa Wood, 2023. "Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments," IJERPH, MDPI, vol. 20(3), pages 1-8, January.
    4. Grace Bennett-Daly & Hazel Maxwell & Heather Bridgman, 2022. "The Health Needs of Regionally Based Individuals Who Experience Homelessness: Perspectives of Service Providers," IJERPH, MDPI, vol. 19(14), pages 1-18, July.
    5. Shannen Vallesi & Matthew Tuson & Andrew Davies & Lisa Wood, 2021. "Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data," IJERPH, MDPI, vol. 18(12), pages 1-16, June.
    6. Barton Hamilton & Andrés Hincapié & Emma C. Kalish & Nicholas W. Papageorge, 2021. "Medical Innovation and Health Disparities," NBER Working Papers 28864, National Bureau of Economic Research, Inc.
    7. Kritika Rana & Andrew Page & Jennifer L. Kent & Amit Arora, 2022. "Pathways Linking Housing Inequalities and Health Outcomes among Migrant and Refugee Populations in High-Income Countries: A Protocol for a Mixed-Methods Systematic Review," IJERPH, MDPI, vol. 19(24), pages 1-12, December.
    8. Emilia Aiello & Ainhoa Flecha & Olga Serradell, 2018. "Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System," IJERPH, MDPI, vol. 15(2), pages 1-19, February.
    9. Christina M. Pollard & Sue Booth & Jonine Jancey & Bruce Mackintosh & Claire E. Pulker & Janine L. Wright & Andrea Begley & Sabrah Imtiaz & Claire Silic & S. Aqif Mukhtar & Martin Caraher & Joel Berg , 2019. "Long-Term Food Insecurity, Hunger and Risky Food Acquisition Practices: A Cross-Sectional Study of Food Charity Recipients in an Australian Capital City," IJERPH, MDPI, vol. 16(15), pages 1-16, August.
    10. Coline van Everdingen & Peter Bob Peerenboom & Koos van der Velden & Philippe Delespaul, 2023. "Vital Needs of Dutch Homeless Service Users: Responsiveness of Local Services in the Light of Health Equity," IJERPH, MDPI, vol. 20(3), pages 1-16, January.
    11. Federica Leone & Ala Hasan & Francesco Reda & Hassam ur Rehman & Fausto Carmelo Nigrelli & Francesco Nocera & Vincenzo Costanzo, 2023. "Supporting Cities towards Carbon Neutral Transition through Territorial Acupuncture," Sustainability, MDPI, vol. 15(5), pages 1-31, February.
    12. Paul Batchelor & James Kingsland, 2020. "Improving the Health of the Homeless and How to Achieve It within the New NHS Architecture," IJERPH, MDPI, vol. 17(11), pages 1-7, June.
    13. Lin-Yun Wang & Lan-Ping Lin & Yun-Cheng Chen & Tai-Wen Wang & Jin-Ding Lin, 2020. "Correlates of Depressive Symptoms among Middle-Aged and Older Homeless Adults Using the 9-Item Patient Health Questionnaire," IJERPH, MDPI, vol. 17(13), pages 1-14, July.
    14. Derrien, Monika M. & Bratman, Gregory N. & Cerveny, Lee K. & Levy, Chaja & Blahna, Dale J. & Frank, Paulo & Serio, Naomi, 2024. "Public nature and health for homeless populations: Professionals’ perceptions of contingent human benefits and harms," Social Science & Medicine, Elsevier, vol. 347(C).
    15. Gemma Crawford & Elizabeth Connor & Kahlia McCausland & Karina Reeves & Krysten Blackford, 2022. "Public Health Interventions to Address Housing and Mental Health amongst Migrants from Culturally and Linguistically Diverse Backgrounds Living in High-Income Countries: A Scoping Review," IJERPH, MDPI, vol. 19(24), pages 1-22, December.

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