Homelessness and healthcare: A crossroad in need of remedy

Living on the street or in crowded shelters places individuals at a severely heightened risk of illness.

According to a Canada-wide study, people who experience homelessness are significantly less likely to reach the age of seventy-five—and despite this risk, their healthcare needs are often outpaced by the ongoing battle for basic food and shelter.

As recent as 2019, Public Health Ontario reported that members of the homeless community experience disproportionate rates of mental illness.

Mental health, along with drug addiction, is often cited as not only a contributing factor to homelessness but also as an added barrier to later achieving stable housing.

In a 2007 health survey of Toronto’s homeless, 38 percent of respondents rated their mental health as fair or poor, compared to 5 percent of the city’s housed population. Similar results were reported by a later survey in Winnipeg, which listed depression, anxiety disorder and schizophrenia among the most common diagnoses.

Carrie Whittley is a Nurse Practitioner at the Ottawa Mission’s Primary Care Clinic, which specializes in providing primary medical care to people experiencing homelessness.

“I always say that a homeless shelter is the new psychiatric hospital that they closed, without the resources,” she said, speaking to the mental health crisis afflicting the city’s homeless.

To help mitigate the issue, the clinic runs specialized programs on mental health. More time can also be allotted to each visit, so the nurses are better able to tackle any mental health challenges.

Whittley also spoke to the issue of malnutrition that is commonly associated with homelessness.

“Diabetes is rampant because their access to food in the shelters is generally fried high carbohydrates and they do not generally come from families where nutrition was available.”

Several studies have associated malnutrition—especially in the face of housing instability—to poor health outcomes. According to one particular study, more than 70 per cent of Toronto’s homeless youth are missing key nutritional elements required for muscle, nerve and immune system function.

Malnutrition—along with common factors like chronic disease and drug-use—can therefore raise the risk of infection.

Within the homeless community, rates of chest and skin infections are disproportionately high. As well, there are notable delays in the diagnosis and subsequent treatment of many conditions.

“By the time they are with us, they have kidney disease, or they have loss of feeling in their feet from their diabetes or they have had a heart attack and now they are looking after their health,” said Whittley.

A 2011 Montreal study on homelessness specifically highlighted the delayed diagnosis of tuberculosis (TB), an infectious disease that predominantly affects the lungs. Since TB is contagious, deferred treatment increases the likelihood of disease transmission, especially within crowded shelter conditions.

Hepatitis C, foot problems, and bed bug bites are also more common.

In the Winnipeg health survey, 41.3 per cent of respondents experienced bed bug bites while staying at shelters within that past year. In Toronto, 36 per cent of respondents had experienced bites, but more than half of them had slept in shelters infested with bed bugs.

Remedial strategies

Canada’s universal health coverage is definitely a fortunate reality, as are the social assistance programs that allow people experiencing homelessness to access the majority of medical testing, prescription medication and dietary supplements.

However, at the border of homelessness and healthcare lies a greater social issue that must be further examined.

This problematic crossroad and the need for curative strategies does not fall solely in the hands of the healthcare system. It is a problem that falls onto the lap of society, an issue that calls upon all levels of governments and institutions.

With meaningful investment on housing, individuals can better prioritize their health, potentially eliminating some of the healthcare costs associated with homelessness.

Other potential channels of progress include improving the conditions of shelters and rooming houses, investing in more outreach programs, specializing more primary care clinics and—above all—eliminating social stigma.

Promoting awareness and education of social issues like homelessness can help us approach situations with the understanding and sensitivity they deserve.

We need to approach the issue of homelessness with the familiar values of respect and inclusion that our nation is so often praised for.