Intended for healthcare professionals

Education And Debate

Health, health promotion, and homelessness

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:590
  1. Robert Power, senior lecturer in medical sociology (,
  2. Rebecca French, research fellowa,
  3. James Connelly, senior lecturer in public healthb,
  4. Steve George, senior lecturer in public health medicinec,
  5. Derek Hawes, lecturer in housing policy and practiced,
  6. Teresa Hinton, researchere,
  7. Hilary Klee, research professor in psychologyf,
  8. David Robinson, research fellow,g,
  9. Jeanette Senior, health promotion specialisth,
  10. Philip Timms, senior lecturer in community psychiatryi,
  11. David Warner, directorj
  1. aDepartment of Sexually Transmitted Diseases, Royal Free and University College Medical School, London WC1E 6AU
  2. bNuffield Institute for Health, Leeds LS2 9PL
  3. cHealth Care Research Unit, University of Southampton, Southampton SO16 6YD
  4. dUniversity of Bristol, Clifton, Bristol BS8 4EA
  5. eHealth Action for Homeless People, London E8 3DL
  6. fFaculty of Community Studies and Education, Manchester Metropolitan University, Manchester N13 0JA,
  7. gCentre for Regional Economic and Social Research, Sheffield Hallam University, Sheffield S1 1UB
  8. h Department of Health Studies, North Yorkshire Specialist Health Promotion Service, York YO3 7BY
  9. iUnited Medical and Dental Schools of Guy's and St Thomas's, London SE1 9RT
  10. jHomeless Network, London SW1H 0QS
  1. Correspondence to: Dr Power
  • Accepted 24 November 1998

Contemporary health promotion emphasises the concepts of lifestyle, risk, and preventive health behaviour alongside the broader societal concerns of the environment, public policy, and culture.1 The recent green paper Our Healthier Nation stresses a more coordinated approach to health promotion for people who are socially excluded, emphasising behavioural change through targeted interventions at the level of the community.2 There have been extensive reviews of homelessness and health, 3 4 along with calls for urgent action,57 but little attention has been paid to the health promotion needs of homeless people, and there is no firm evidence base for practice. One challenge for health promotion is to develop and deliver appropriate initiatives to a heterogeneous population that is not always easy to categorise but has a wide range of needs. The healthcare priorities of a young man sleeping on the streets differ from those of a single mother in temporary accommodation. To be homeless means more than just the absence of secure accommodation. Homelessness has as much to do with social exclusion as with bricks and mortar, and demands a range of health promotion strategies.

Summary points

  • Homeless people are a heterogeneous population whose diverse health promotion needs are poorly met

  • Needs assessment and qualitative research are required to identify the specific health promotion needs of subgroups of homeless people

  • Action research followed by rigorous process and outcome evaluation are needed to provide an evidence base that can inform good practice

  • A multisectoral approach to health promotion would capitalise on help seeking patterns of homeless people

  • Health promotion among homeless people should be practical and educative, taking into account their hierarchy of needs and specific housing environments

Health and housing

At one level, the health condition of homeless people is a product of housing policy.3 Over the past two decades in …

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