Health Impact of Homelessness
Homelessness
The
phenomenon of homelessness is multidimensional with macro (health policy), meso
(health care systems), and micro (individual) structural mechanisms.
Homelessness is not a random event that occurs to families and individuals
outside the context of their lives and personal history.
Epidemiological
medicine and social researchers continue to amass a body of literature whose
focus is the identification and description of individual risk factors that are
correlated with homelessness. These studies have documented the rates of mental
illness, substance abuse, experiences of childhood physical and sexual
violence, and experiences of abuse and neglect (Bauman, 1993).
This work has
promoted the humanization of homeless people through its descriptive
distinctions between the various subgroups within this population. However,
focusing on individual-level risk factors, in describing who is at risk for
becoming or remaining homeless is only part of the picture.
Factors Contributes to Homelessness
Contemporary
analyzes have looked at the interaction of individual and structural factors
that contribute to homelessness. This approach continues to be informed by a
simple, sequential causal relationship.
What needs to be considered at this
point in time is a model that stresses the myriad ways in which factors on the
macro, meso, and micro levels interact in the formation of various pathways
into homelessness. Researchers have pointed out that structural factors are
heightened when there are fewer housing subsidies and the gap between median
rents and median income is relatively wide.
These structural factors in
conjunction with individual factors such as gender, race, history of childhood
or adult abuse, substance abuse, and the level of social support, contribute to
a complex interplay exerting a dominant effect on homelessness (Ringwald,
Greene, Robertson, & Mc-Pheetes, 1998).
Homelessness Vs Poverty
The
life of a homeless person holds more uncertainty than its poverty. Homeless
people are marginalized within the marginalization of poverty (Hall, JM,
Stevens, & Melleis, 1994). There are more labels for homeless people than
for segments of mainstream America.
There is fringe homeless, long-term
homeless, temporary homeless, emergency homeless, visibly homeless, and
invisibly homeless.
Within all of these categories there are different groups
of homeless: single women never married without children, single women who are
pregnant and underage, divorced women with children, single unmarried women
with children, single men, divorced men with children, divorced men without
children , families with children, run-aways (minor children), adolescents,
throw aways (children whose parents have told them to leave home and never
return), lesbian and gay youth, transgender youth and adults, elderly,
disabled, handicapped, veterans homeless, impoverished, immigrants, and illegal
aliens.
In addition to the aforementioned categories, there are homeless who
have been evicted or those who are addicted to substances; there are homeless
who are mentally ill; those who are homeless because of domestic violence
and/or abusive family situations; and those who are homeless the cause of
release from incarceration without transitional support mechanisms in place.
When considering all of the above categories of homelessness, how then does a
generally accepted definition of “homeless” result? The National
Coalition for the Homeless (2002) reports a definition according to the Stewart
B. McKinney Act, 42 USC § 11301, et seq. (1994), a person is considered
homeless who “lacks a fixed, regular, and adequate night- time residence,
and has a primary nighttime residency that is:
(a) a supervised publicly or
privately operated shelter designed to provide temporary living
accommodations
(b) an institution that provides a temporary residence for
individuals in-tended to be institutionalized
(c) a public or private place
not designed for, or ordinarily used as, a regular sleeping accommodation for
human beings. 42 USC S 11302(a) The term “homeless individual does not
include any individual imprisoned or otherwise detained pursuant to an Act of
Congress or a state law. 42 U.S.C. 5 11302(c).
Where the Homeless Likely to Found
People
experiencing homelessness in rural areas are less likely to live on the street
or in shelters, and more likely to be “couch surfing,” living with
relatives or friends in over-crowded or substandard housing.
Although homeless
people are heterogeneous, while experiencing homelessness they do have certain
shared basic biopsychosocial needs, such as affordable housing, adequate
incomes, mental and physical health care, and possible substance abuse
treatment. All of these needs must be met to prevent and end homelessness.
Census of Homeless
An
ongoing dilemma is estimating how many people are homeless. There are several
national estimates, many of which are based on dated information. No one
estimate is a definitive representation of an accurate count but only the best
approximation.
In 2000, the Urban Institute found that there were approximately
3.5 million people, 1.35 million of them children, who probably have or will
experience homelessness in any given year (O’Sullivan, 2003).
Level or Categorization of Homelessness
Baumann
(1993) reported that the research on homelessness could be divided into three
levels of analysis. The first focus was on the individual with numerous
biopsychosocial issues, disaffiliated, disabled, mentally ill and addicted, and
living in a shelter.
The second level focused on homelessness in the context of
the person’s environment and the third level of inquiry defined homelessness as
economic dislocation related to housing shortages. A significant amount of
research focused on specific homeless populations such as those with mental
illnesses and disaffiliated by society (McCarthy, D., Argerion, Huebner, &
Lubran, 1991).
Within the rise of the trajectory into homelessness there is a
rapidly growing increase in the number of homeless elders. This can be
attributed to their vulnerability to poverty and undertreated mental illness,
accelerating a course of nursing home placement and/or early death.
Women have
become a major segment of the homeless population, with access to health care a
major issue. Lim and colleagues (2001) conducted a study inter-viewing 974
homeless women in 78 homeless shelters and soup lines in Los Angeles County.
Using multivariate analyses, the key enabling factors associated with improved
health care access were having health insurance and a regular source of health
care.
Marital Status and Homelessness
Families
are the fastest growing segment of the homeless population representing diverse
backgrounds. Most are female-headed single-parent households with mounting
incidences of violence, abuse, and neglect.
Numerous researchers reported the
intense stress and adverse effects that homelessness has on a child’s
development, health, behavior, and academic success.
Problems Invited By Homelessness
Research
pertaining to homeless adolescents incorporated biopsychosocial, cultural, and
spiritual health problems in addition to the homeless adolescent’s propensity
for engaging in delinquent or maladaptive social and health behaviors.
Concepts
such as risk, resiliency, and connectedness were found to be critical for
survival, supported by the creation of peer communities or street families
(Ensign & Gittelsohn, 1998; Jezewski, 1995; O’Sullivan, 2003; Rew,
Taylor-Seehafter, Thomas, & Yockey, 2001).
Nursing Role As An Advocate for Homeless
Nursing
research, education, and practice have philosophical foundations in advocating
and facilitating health care for marginalized and vulnerable populations.
In
light of the increasing number of groups of homeless people and the known
biopsychosocial outcomes of homelessness, intervention research is needed not
only to prevent the trajectory of homelessness but also to develop programs and
educate health care providers to the spe scific concerns of the homeless.
Nursing research and advocacy as a course of action is essential on the macro,
meso, and micro levels.