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health and homelessness: understanding the stats, barriers to care and solutions

people experiencing homelessness are subject to higher rates of health declines due to lack of access to care.

as many as 300,000 canadians live without homes, making access to healthcare near impossible. getty images
homelessness can drive the onset or worsening of many health disorders, and when people without set addresses try to seek care, it can be challenging to get it.
roughly 150,000 to 300,000 canadians are currently living without a set address or home in the country. it’s difficult to pinpoint an exact number because many are considered to be what is called “hidden homeless” in that they do not have a permanent residence but tend to live with family or friends temporarily.
males are more likely to be found within this group, and those belonging to the indigenous community make up 33.1 per cent of all of canada’s people without homes. of the total number of people living without a set address, roughly 23 per cent are between the ages of 13 and 24.
toronto is the most notable location for people without homes, and 40 per cent of all homeless shelters in the country are found in ontario.

barriers to care for people without set addresses

people without homes experience near-impossible barriers when seeking healthcare because being without a set address is linked to employability, community support, and personal healthcare measures.
for example, people must have a set address to apply for a health card. without a health card, accessing even basic healthcare services requires out-of-pocket payment. when a person without a home cannot secure employment, they lack the money necessary to pay for services that would otherwise be covered under a provincial health plan.
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even if a person without a home has a health card or is employed, it’s also difficult to make appointments with various providers without a set address or have a place to recover after or during treatment.
in some cases, prioritizing basic needs, such as obtaining food, becomes a priority for people who are homeless, putting other less pressing matters, such as health complaints, on the back burner.
while there are some programs available to help lessen these challenges for people living without homes, such as the uhn foundation’s peer support program, there is no denying that optimal health and homelessness do not go hand in hand.

the negative health effects of homelessness are vast

people living without set addresses are subject to a higher risk of early death, musculoskeletal disorders and chronic pain, hunger and nutrition-driven illness, skin and foot problems, infectious diseases, dental problems, respiratory illness, chronic diseases and disorders, and mental health issues. according to research, as many as 85 per cent of people who are experiencing homelessness have a chronic health condition.
in the case of early death, people living without set addresses are often exposed to the elements, such as extreme hot or cold temperatures, which can lead to freezing, hypothermia, and frostbite if they are cold, and severe sunburn and heatstroke if they are hot.
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violence causing bodily injury or death is also a factor in early mortality in the homeless population, with roughly 40 per cent being assaulted at some point and 21 per cent of women without homes being raped. data shows that men who are homeless are approximately nine times more likely to be murdered as well.
poor nutrition and diet can contribute to the onset of various chronic diseases. as more research is released on the connection between diet and health, further understanding of its importance sheds an even brighter light on the negative impacts food scarcity can have on a person’s health.
chronic diseases are also common in homeless populations, with one study showing that a significant number of people without set addresses have one or more seizure disorders that could be driven by sleep deprivation, anxiety, stress, or alcohol and drug-related addiction.
mental health disorders are a significant issue among the homeless population as well, with up to 35 per cent of people in that group being previously diagnosed with a mental health disorder. women who are without homes are diagnosed with a mental health disorder at a rate of 75 per cent, and 20 to 25 per cent of people in that group have severe mental illness along with a concurrent disorder, such as addiction.
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depression is also highly prevalent, with up to 46 per cent of the homeless population having attempted suicide and up to 61 per cent experiencing suicidal thoughts or ideations.

implemented solutions that can foster positive change

easier access to healthcare services for those living with homelessness is required to help address this widespread issue.
uhn’s peer support worker’s program, launched in 2020 by the gattuso centre for social medicine and the neighbourhood group community services, has begun to make it easier for people without homes to seek care. the program involves working within emergency departments and speaking to patients directly to determine their current state of health and care needs.
these peer support workers also help them locate available shelter beds, advocate for their care needs in the overcrowded emergency rooms and assist in finding them a meal.
regarding healthcare alone, “peer’s input helps us understand a patient’s history and realities, including recognizing vulnerabilities that often go unnoticed in the chaotic emergency department environment,” dr. kathryn chan, uhn emergency medicine and addictions physician and health equity co-lead within the emergency department, said in a press release.
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by giving these patients trust in the healthcare system’s ability to care for them through support programs such as the one at uhn, they are more likely to feel as though they can turn to emergency departments.
when there, they will also gain better access to care because their current situation and health will be considered equitably after speaking to someone who can relate and show empathy for those living without homes—all peer support workers are people with lived experience of homelessness and substance use.
the peer support workers program has provided a solution to a severe problem faced by canadians living without set addresses, a move that could potentially pave the way for others to follow suit.
angelica bottaro
angelica bottaro

angelica bottaro is the lead editor at healthing.ca, and has been content writing for over a decade, specializing in all things health. her goal as a health journalist is to bring awareness and information to people that they can use as an additional tool toward their own optimal health.

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