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Int. J. Environ. Res. Public Health 2017, 14(12), 1535;

Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants

Royal Perth Hospital, Perth, WA 6000, Australia
School of Population and Global Health and Centre for Social Impact, The University of Western Australia, Crawley, WA 6009, Australia
Author to whom correspondence should be addressed.
Received: 13 October 2017 / Revised: 29 November 2017 / Accepted: 4 December 2017 / Published: 8 December 2017
(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)
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Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homelessness further exacerbates poor health. Aggregated health service data can mask this, and case histories thus provide important insights. Methods: This paper presents three case histories of homeless patients seen at an inner city public hospital in Perth, Western Australia. The case histories draw on several data sources: hospital data, information collected from rough sleepers and clinical observations. Estimates of the cost to the health system of the observed hospital usage by the three patients are included. Findings: The case histories illustrate the interplay of social determinants of health in homelessness that help explain the high level of hospital usage by rough sleepers. The cumulative healthcare costs for the three individuals over a 33 months period were substantial. Hospital attendance plummeted even in the short term when housing needs were addressed. Conclusions: Treating homelessness as a combined health and social issue is critical to improving the abysmal health outcomes of people experiencing homelessness. In addition, the enormous economic costs of hospital care for people who are homeless can be reduced when housing and other social determinants are taken into account. View Full-Text
Keywords: homeless; social determinants of health; health inequalities; health sector homeless; social determinants of health; health inequalities; health sector
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Stafford, A.; Wood, L. Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants. Int. J. Environ. Res. Public Health 2017, 14, 1535.

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