Homelessness and Health Disparities: A Health Equity Lens
In this chapter, we describe a variety of health disparities experienced by homeless people, outline the pathways that link housing and health, and point to promising solutions for enhancing health equity. Whether living in shelters, on the street, or couch-surfing, homeless people exhibit high rates of disease and disability, reduced access to treatment, and poorer prognoses relative to their housed counterparts. Many of the health conditions common among people experiencing homelessness, such as tuberculosis, are comparatively rare within the general population. Mental health conditions and substance use disorders are also strongly associated with homelessness and poor physical health. Disparities widen as homeless individuals struggle to satisfy basic needs, such as accessing adequate food. People experiencing homelessness are also subject to high degrees of victimization and physical and sexual violence, both precipitating and during periods of homelessness. Taken together, the cyclical and successive magnification of risk factors that contribute to health disparities for people experiencing homelessness is termed cumulative disadvantage. Permanent supportive housing and especially Housing First models, medical-legal partnerships, and mobile health outreach programs are among the promising policy and programming interventions to reduce health disparities for homeless populations. In sum, given that housing and health are so closely linked, achieving health equity for homeless populations is closely tied to strategies to improve housing stability and address the most upstream social determinants of health.
KeywordsCumulative disadvantage Health care Health disparities Health equity Social determinants of health Couch-surfing Health care for the homeless HIV/AIDS Infectious disease Food insecurity Violence Permanent supportive housing Mental illness Substance use disorder Trauma Multi-morbidity Homeless women Homeless youth Chronic homelessness Dual diagnoses Violence
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