Written by: Varleen kaur
Edited by: Jacqueline Cheung
Welcome back, CCP readers,
Two weeks back, we discussed Social Determinants of Health (SDOH), the types of SDOH and their role in public health. This week we are focusing on the relationship between SDOH and homelessness.
If you would like to learn more about the current state of homelessness in Canada and the Greater Toronto and Hamilton Area (GTHA), welcome! If you are returning for more information about the challenges faced by youth experiencing homelessness and those with animal companions, welcome back! If you are new to our blog, welcome to the community and thank you for your interest in learning more about issues regarding the homelessness crisis in Canada and beyond - you are one step closer to becoming a changemaker in your community, and you are in great company.
The state of homelessness is a major contributor to poor health when seen through the lens of social determinants. Simultaneously, homelessness is the outcome of a combination of unfavourable social and economic circumstances. Housing is frequently mentioned as a significant SDOH, given that poor quality or lack of housing can cause negative impacts on overall health and well-being. As with many social determinants of health, the causal paths from housing to health are intrinsically complicated. Therefore, many of these pathways are neither completely conceptualized nor empirically understood.
As articulated by Wise and Phillips in their paper on narratives of healthcare and homelessness:
“Until a health care problem becomes life-threatening, a homeless individual will likely choose shelter or food before going to the doctor. These priorities must be considered when dealing with the homeless population. What might, at first, seem like carelessness or noncompliance is, in reality, simply a struggle to survive”.
Hospital readmissions due to the same problem could be a nightmare for individuals experiencing homelessness. To better understand it, consider this example - you went to the emergency department yesterday because of a severe stomach ache and underwent an urgent appendectomy after being hospitalized for appendicitis. When you were ready to go home, you were given a bag of painkillers, instructions on how to keep your incision dry and clean, and a warning to stay away from vigorous activity. Simple, yes? Unfortunately, this situation is anything from straightforward for most patients facing homelessness. What could appear to be a routine outpatient procedure could be the beginning of a protracted battle with pain management, infections, and nearly certain readmissions. Assisting patients attain stability through housing and employment, interfering in care transitions, and providing individualized primary care could be a solution to break this vicious cycle.
The situation of homelessness is a health hazard in itself and an important SDOH. Being in a state of homelessness may have worse health outcomes due to subpar living conditions and lack of access to food. These patients also typically have few resources available to them for self-care. For example, a diabetic patient who is homeless may struggle to control their condition without access to nourishing food and a suitable location to store medication for insulin. Patients who are facing homeless may also live in remote locations (such as densely forested areas) or be very mobile and have limited or no access to transportation. These access problems make it difficult for healthcare professionals to connect with patients facing homelessness and build the patient-provider bonds required for successful treatment.
Here are some of the problems associated with homelessness that can impact accessing healthcare when needed:
Poor communication
Stigma
Social exclusion
No transportation
Mental Health
Justice Involved
Poor life skills
Lack of life support
Treatment Must Go Beyond Medical Care
Housing and employment are two social factors that affect health and greatly impact people’s lives. It is insufficient to address the medical requirements of people who are homeless or unemployed. Providers must address the issue’s root by assisting patients in finding dependable housing and employment.
Steve Rolfe et al., in their research on developing an empirically-informed realist theoretical framework for housing as a social determinant of health and well-being, provided three potential causal pathways through which housing may affect health and well-being.
1- Regardless of demographic traits or background, a pleasant tenancy experience, influenced at least in part by connections with the housing provider, is substantially connected with the health and well-being of all tenants.
2- Some tenants appear to value aspects of home quality beyond the fundamentals of weatherproofing in ways that are probably impacted by past housing experiences and present expectations.
3- Although there may be significant heterogeneity among different tenant groups, neighbourhood characteristics and social support in the area may impact health and well-being.
These Context-Mechanism-Outcome Configurations’ (CMOCs) developed by Steve Rolfe et al. attempt to identify how causal mechanisms may operate to generate outcomes within particular contexts. Additionally, the paradigm provides a foundation for additional studies to improve and test these causal pathways. These improved CMOCs give a more balanced view of what works, for whom, and under what conditions. They can be used in practice and serve as the basis for more realist research iterations.
By highlighting how some components of housing service might function as a public health intervention in renters' lives, this framework offers a lens through which to assess and possibly improve practice within housing organizations and housing policy.
CCP is Canada's first non-profit organization to support youth facing homelessness and their animal companions. We strive to promote youth's mental well-being and health in the Greater Toronto Area. On our website, you can support us in our various initiatives like wellness departure packages, art & mindfulness workshop, community pantries, and animal stations. There is also an option of a tax receipt for donations of $25 or more.
Thank you for reading our blog! Feel free to leave a comment with your feedback and/or insights to help us enrich the quality of future posts and cater to the interests of our community of changemakers.
References:
1- Stafford A, Wood L. Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants. Int J Environ Res Public Health. 2017 Dec 8;14(12):1535. doi: 10.3390/ijerph14121535. PMID: 29292758; PMCID: PMC5750953.
2- Rolfe, S., Garnham, L., Godwin, J. et al. Housing as a social determinant of health and wellbeing: developing an empirically-informed realist theoretical framework. BMC Public Health 20, 1138 (2020). https://doi.org/10.1186/s12889-020-09224-0