Public Health and Health Policy - Homelessness and Health - Essay Example

Public Health and Health Policy: Homelessness and Health Public Health and Health Policy: Homelessness and Health Introduction Klein (2013) describes homelessness as an extreme need for housing or shelter. It encompasses more than just sleeping on the city streets. Walker & John (2012) support by suggesting that perhaps there are more individuals in England who lack homes even if they are not rough sleeping. According to Maslow’s model of hierarchy of needs, the provision of shelter is considered as a basic human need. The model considers shelter as an essential need in the order of progress to other needs in the higher order needs such as love and belonging, self-esteem, and self-actualization (Porter & Coles, 2011). Homelessness and health Lack of shelter is regarded as homelessness state. Vostanis, Grattan & Cumella (1998) highlight that many times, homelessness is interchangeably used with the term rooflessness. It is an example of social exclusion that can be incorporated in the equalities in terms of health agendas. Individuals without shelter are often termed as homeless. Baggott (2011) explains that homelessness is not an entity but multiple entities that encompass housing needs. It entails the need for individuals to have short term or temporary accommodation. Sometimes living on the short term or temporary accommodation presents the uncertainty of the future. Wilson & Mabhala (2009) elaborate further by highlighting that the temporary accommodation includes the rough sleepers; individuals sleeping at their friends’ or relatives’ houses; and homeless shelters. Some of them live in accommodations that are supported such as temporary accommodation (bread and breakfast) or in the hostels. It is elaborated in Homeless Link (2010) that that homeless individuals who seek accommodation from friends or relatives are sometimes compelled to either stay on the relatives’ sofas or squat. Moreover, individuals who are driven out of their homes due to factors such as disasters or violence are also faceted as homeless. This is inclusive of the immigrants. Despite the fact that they are the widely known group as illuminated by Baggott, Allsop & Jones (2005), the majority of culprits are of homelessness state are single individuals who live in either insecure or temporary (short term) accommodation. Carr, Unwin & Pless-Mulloli (2007) illuminate that homeless is not a homogeneous group and individuals faceted to be homeless are in most cases families that are young and headed by females who are lonely. They tend to experience general health problems, as well as mental health. However, Douglas (2010).reveals that those who are not officially homeless are usually male persons who are either rough sleepers or residing in hostels. In most cases, there problems are due to psychiatric problems and abuse of substances (Hodgson &Irving, 2007). In reference to Crisis (2005), homelessness is described as a problem or challenge faced by people due to lack of a dwelling or living place that is not only secure and supportive but also decent and affordable. As per Crisis (2005), the possession of a permanent address is more beneficial than the physical nature of the space itself. It not only guarantees security but also an assurance of the well being in the sense that it’s a living practical prerequisite. In the contemporary working society, accommodation is a basic or an essential requirement of the employees besides other services. On the legal grounds or aspects, the legal description of homelessness supports that homelessness is entails more than the state of being roofless besides the determination by the local authority in terms of statutory homelessness. Individuals eligible for the support of the local authority must belong to the narrow group as per the statute. The statute exempts or rather excludes individuals who are considered as hidden homeless such as single persons who lack dependents. The Department for Communities and Local Government (2010) report reveals that due to the nature and circumstances of homelessness, it is quite difficult to ascertain the precise figure of the individuals who are homeless. The Scottish Government (2005) illuminates that the figures that the local authority accepts as homeless in reference to households are available and vary in different countries. The department for Communities and the Local Government (2013) reports that figures of homeless persons as a result of rough sleeping in England has already been published by the local government though there is a new technique that is being employed or implemented to determine the figures for rough sleepers in the cities of England. Wright and Tompkins (2006) believe that there are several reasons why people become homeless or stay homeless. One of the most common reasons is due to the breakdown of relationship with either partners or family members. Crisis (2012) reveals that homelessness due to the breakdown of relationship is more common with the males who are homeless compared to the females. In addition, the homeless males are usually in this predicament as a result of use and abuse of substances such as drugs and alcoholism; and having left institutions such as prisons and hospitals and having nowhere to go to. On the other hand, the homeless females find themselves in the situation due to mental or physical problems related to health and the need to escape relationships that are violent and sexually exploitative. Unfortunately, some of the problems are induced by the wider society. For an instant, there are structural causes that emanate from factors such as absence of houses that are affordable to the homeless individuals; the state of being unemployed; increase in the levels of poverty; and the rationing of social housing. Quilgars et al (2008) claim that there are cumulative evidences that the one of the remedy or responses is through the multi-sector approach which may entail the provision of health services, social services, and housing organisations. They have the potential of serving as solutions geared towards the long term processes. Home Link (2010c) has undertakes annual surveys where they table the progress made through charts in combating homelessness and providing crucial evidences pertaining the characteristics of individuals who are homeless and in need of their services. HM Government (2011) reports that in April 2011, a project termed No second Night out (NSNO) (2011) was commenced. The project focuses on responding rapidly to the individuals who rough sleep for the first time in not only the streets of London but everywhere in London. HM government (2011) approximates that roughly 50 individuals are usually spotted in London rough sleeping. In 2011, the mayor of London expressed that they were aiming that by the end of the year 2012, they would eradicate the phenomenon. In the event that an individual finds himself or herself rough sleeping in the street for the first time then they were guaranteed that it would not happen for the second time. In addition, six commitments to combating the situation have been established by a ministerial group whose intentions and principles are similar to that of the nationwide NSNO. Wright and Tompkins (2006) claim that homeless persons face the challenge of accessing health services and appropriate health care. However, the Scottish Government (2005) explains that there is flexible provision for health services for the individuals who are homeless, as well as the existence of different working models that aid in breaking the barriers of accessing the services. (Queen’s Nursing Institute (2010b) extrapolates that for the services to be provided appropriately then the processes of commissioning need to be effective. The institution elaborates further by highlighting that the nurses in the commissioning process have the leadership role in the provision of health care to the homeless. They are perceived to not only know their groups of clients but also their needs in terms of heath in relation to mental and physical on the basis of the perspective of public health. In addition, the nurses have the knowledge concerning the gaps in the provision of the services; organisation partners; and the models that are deemed as good practice. There are numerous consequences of homelessness. For an instant, it damages the capability of individuals in that they loose their skills and the thinking ability in terms of seeking employment since these individuals tend to worry more about their homeless or housing status. They are also usually at risk of in terms of their health especially while having more thoughts on their predicament. In addition, the condition damages or lowers individual self-confidence, self-esteem, and their resilience to challenges. Besides the above mentioned consequences, the homeless individuals are often isolated or lonely as they tend to lack options on where they can live. Graham (2007) advises that to help the traumatised homeless person, they can be empowered through helping them build their skills, capability and confidence in a manner that enables them to take control of their lives. As illuminated in the essay, one of the consequences of homelessness is health problems. Naidoo & Wills (2008) extrapolate that it is perceived as a major public health challenge and can be associated with several vital health problems. Wilson & Mabhala (2009) argues that housing can be a determinant of an individual’s health especially in the cases where an individual lacks a home or a place to live in. Baggott (2011)supports that existing evidence increases the chances of risks related to physical ill health. Crisis (2002) considers homeless persons as one of the most vulnerable groups in the society as they are usually excluded by the society hence the find it difficult to access the help that they need. Wright & Tompkins (2006) point out that the premature mortality rate among the homeless persons tends to be higher than individuals with home security. In providing these individuals with health services, they usually present cases of numerous morbidity challenges such as dependence on drugs and alcohol, physical problems, and mental health. Some of the health difficulties are associated with tuberculosis, as well as difficulties in breathing. Homeless Link (2010b) illuminates that using their new tool for auditing, they realized that four fifth of the overall participants (who were 700 homeless persons in England) have either one or more needs in term of physical health. On the other hand, seven tenth have more than one mental need. It provides the statistical conditions on both the physical and mental health, as well as the visits made to the departments of practices, accidents and emergencies by the audited participants. Vostanis (1998) claims that families or individuals living in short term or temporary accommodation have higher chances of experiencing health challenges in comparison to the general population. On the other hand, Wilson & Mabhala (2009) support by illustrating that there is increase in the rate of mortality for rough sleepers due to factors such as accidents, violence, alcoholism, and suicide. In addition, among the rough sleepers who use night shelters inclusive of the common hostels and houses for loggings, are perceived to be prone to increase in morbidity. Increase in morbidity emanate from diseases regarded as communicable such as pneumonia, skin infection, and tuberculosis. The morbidity may also emanate from disorders related to musculo-skeleton, neurosurgical such as epilepsy, oral and dental disorders, and gastrointestinal orders such as the disorder of the liver. The status of health of the individuals in temporary accommodation such those in bed and breakfast in the hotels (B&B) is perceived to be worse compared to the control in matching with the age and sex who have house control due to permanent housing or homes. Orme (2007) reveals through the studies on utilization that there is higher admission of emergency cases of accidents and emergences (A & E) in reference to children and adults in the bed and breakfast kind of accommodation. Moreover, children in bed and breakfast accommodation have higher chances of having infections and scalds or burns. Sadly, as Wanless & Great Britain (2002) put it, young individuals who are homeless are prone to the risk of diseases such as the HIV. More often, they are usually involved in activities such as prostitution and abuse of substances such as drugs and alcohol. While injecting drug substances into their body systems, they have the risk of contracting hepatitis A, hepatitis B and Hepatitis C. Besides, the above illuminated disease, the homeless persons are also prone to a wide range of problems related to mental health or illness. Larkin (2009) explains that they are have a higher chance or prevalence of suffering from depression. This is due to the fact that they usually tend to be isolated from the general population. Loneliness and solitude coupled with the feeling of desperation and disillusionment usually infiltrate the minds of the homeless persons and when prolonged can result into depression. In extreme cases depression may result into stroke which is normally detrimental. Moreover, the children in bed and breakfast hostels or accommodation may exhibit behavioural disturbance. As for the children in the streets who are rough sleepers, their behavioural disturbances tend to be more pronounced and worse of all the rough sleepers are prone to committing suicide. Furthermore, Wilkinson & Pickett (2011) highlight that the residents in the homeless hostels have a higher probability of suffering from conditions related to not only schizophrenia but also abuse of substances. The other health related challenge or problem is having access to services related to health and the utilization of these services, as well. For an instant, Acheson (1998) reveals that more often, the homeless persons rarely register with the general practitioners in the field or climate of health. In addition, they may be faced with the barrier of accessing the care services. They may emanate from having negative attitudes due to their earlier experiences. According to Labonte & Schrecker (2007), the homeless individuals are usually faced with pressing or compelling needs for their survival, as well as other challenges/reasons. For example, they may not proiritise on their health due to low self esteem. Kemm (2013) suggests that for the provision of health care services to be effective, there is the need for specialist. This should encompass the services being provided with outreach services by the staff that is specially trained or even delivered and provided by specific designated practitioners’ surgeries (GP) in the various center in towns. However, this work may need the incorporation of other agencies such as the Local Strategic Partnership or integration of services or shops known as one stops. Even though the provision of these services is vital, the social needs for the homeless are normally so profound that more emphasis or priority is often laid on health instead of the health care. Since Home Link published the data in 2010 concerning the health of the homeless, the provision of support to this particular menace has completely changed. The latest findings on resent research indicate that ill health among the homeless is significantly widespread. Home Link (2014) research illuminates that of the 73% reported to be having physical health problems, 41% have had the problem for quite a longer time. The majority of the respondents in the research are reported to have mental problem of which 45% have been diagnosed with the problem. In addition, approximately 40 percent are drug abusers or are in the recovery process while 28% are either having or on recovering mode from the alcoholic problem. The lifestyle of the homeless also leaves more questions than answers. At least 35% are unable to afford at least two meals daily. On the other hand, there rate of alcohol consumption is a cause of concern. They consumer more alcohol than the recommended amount and majority of them smoke. Unfortunately, some are not receiving help (Home Link, 2012). However, there are signs that progress has been made compared to the last report of 2010. 36% of the homeless who were admitted in various hospitals are being discharged. Unfortunately, they are being discharged to the streets and in turn leaving them with little or lack thereof of options hence they become prevalent to the problem. This is unlike in 2010 where 73% were admitted in medical institutions or hospitals. Interestingly, Home Link in conjunction with the St. Mango research (2012) 52 projects has received ten million Euros with the aim of improving the procedure for the discharge for the homeless persons. If the project is critically evaluated, great results can be realized by jointly commissioning of the health and housing. Prevention of homelessness has been one of the priorities of the government of UK. They attempt to alleviate the problem by providing funds geared towards the improvement of homeless services. The local council also has the mandate of developing and instituting strategies in their areas of jurisdiction to prevent the menace. However, Fitzpatrick, Kemp & Klinker (2000) suggest that the contemporary approach to preventing the problem can be improved in several ways. One of the ways is that the local authorities should have services related to tenancy sustainment that aid people who are vulnerable to remain in their residential. The other technique entails making the systems of housing benefits to work better and favourably. In order to provide long lasting solutions in England, more houses that are affordable should be constructed. In addition, the social housing sector should optimize the housing needs with the help of the private housing or rented sector, as well as the sector that is privately owned. Conclusion Maslow’s hierarchy model of need illuminates that shelter is a basic need. Individuals without shelter are termed homeless and it encompasses the need for both the short term accommodation and the long term as well. Some forms of homelessness are sleeping rough in the streets; bed and breakfast hostels and accommodations; temporary accommodation such as squatting at friends and relatives and many more. This phenomenon can degenerate into public health problem and at times it is associated as a form of social exclusion. The causative factors that lead to homelessness are quite numerous. The major causative factor is breakdown in relationship which is more common with males who are homeless. The other factors are due to the need for the homeless persons to escape the sexual and physical abuse; abuse of drugs, violence and many more. The government of the UK has incorporated several measures that are aimed at eradicating homelessness. In addition, the government has also put measures in place in order to improve health services provided to the homeless. Since the inception of NSNO project, there is a significant drop in the figures of homelessness. However, more still needs to be done through an inclusive approach that involves all the required sectors. Reference List: Acheson, D. (1998). Independent inquiry into inequalities in health report. Retrieved on 2th April 2015 from: http://www.archive.official-documents.co.uk/document/doh/ih/ih.htm Baggott, R. (2011). Public health: policy and politics. Basingstoke: Palgrave Macmillan. 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