Healthcare for people experiencing homelessness
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1022 (Published 08 March 2019) Cite this as: BMJ 2019;364:l1022All rapid responses
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The editorial “Healthcare for people experiencing homelessness” reports the UK’s rise in homelessness which is a public health disaster. The statistics in the article show that the homeless population tripled from 2011 to 2018. Homeless people experience autism, lack of attention, mental disorder, high rate of bloodborne virus infection and tuberculosis. In UK a pathway model for homeless people emphasised primary care and where possible the recruitment of trained former homeless people.
The census of India uses the term “houseless population", defined as people who do not live in census house i.e. a house with a roof but in open spaces like pavements, railway stations, in pipes, etc. Accordng to the 2011 census, there were 449761 households or families in India which constitute around 0.15% of total country’s population which is homeless. Homeless ratio of other countries is Indonesia 1.36%, China 0.18%, Ireland 0.21%, Nigeria 16.58%.
Homeless women, particularly those who are single, are more vulnerable to physical violence and sexual abuse. Women with children often have unsafe and insecure jobs such as prostitution and drug intervention in exchange for food and shelter. Children often get involved in alcohol and drug abuse dure to stress and depression. Street children have bad performance and behavior issues in school and eventually it results in dropping out, low literacy and a vicious cycle of poverty and homelessness.
Homelessness in India is basically a result of families migrating from rural to urban cities due to various reasons like loss of land, lack of resources, etc. Another cause can be worker wages which is low and people cannot afford a house in the city. Numerous urban welfare programs have existed in India for years. For example,
Swarna Jayanti Shahari Rojgar yojana - the scheme strives to provide gainful employment to the urban unemployed and underemployed poor people through encouraging the setting up of self-employment ventures by people living below the poverty line.
Jawahar Lal Nehru National Urban Renewal Mission - this programe was meant to improve the quality of life and infrastructure in cities. It aims at creating economically productive, efficient, equitable, and responsive cities.
Rajiv Awas Yojana - the objective of this yojana is to make cities slum free, adopting a ‘whole slum approach’. This requires the existing slums in a city to be remodeled so that residents are provided with acceptable level of housing and access to basic services. Homeless people often fail to gain access to these services because they lack identification required by these policies.
One new initiative is Pradhan Mantri Awas yojana is an initiative of India in which affordable housing will be provided to the urban poor with the a target of building 20 million affordable houses by 31 March 2022.
The housing and urban development corporation had a policy for homeless people known as night shelters for urban shelter less. Most of the night shelters in the city are overcrowded with the increasing number of homeless people. According to the India homeless resource network report, these shelters are located close to the areas where the poorest people congregate - railway stations, bus depots, markets, etc. All state and local governments are legally bound to build dignified shelters in sufficient numbers and with appropriate facilities.
Competing interests: No competing interests
I read the article by Bax A, et al. (1) by BMJ with great enthusiasm and some sadness.
Yes, sharing is caring. We all know that from our childhood. But, what is the reality right now? Why we are so ignorant whenever we see homeless people usually on the streets in their so-called cold beds with a well-known company––usually a dog–– ( the saying; a dog is for life, not for Xmas) We all straight to escape a safe bay saying this is the council's, NHS or governments issue, that's nothing to do with me. I pay my tax and work like donkeys for my organization, ––in my situation––NHS, just turned to the age of 70 last year, a clumsy organization and in my opinion, still a bit far from the reality and far from the tailored treatment.
I cordially congratulate the Pathway staff for their selfless efforts in collaborations with the several organizations to save the people from the streets.
Let's sit back and have a look, what is the situations various part of the world: it is about astonishing 150 million people are homeless worldwide (about 2 percent of the world’s population). However, more surprisingly about 1.6 billion, more than 20 percent of the world’s population, may lack adequate housing(2).
That's the striking and embarrassing fact that, we as a human being facing in the UK and worldwide.
Brexit will ax the right to health care enjoyed by the British people since the Lisbon Treaty (3).
Do not wish to go ahead further in details, but, what would be the situation after the Brexit?; is there a life for homeless people after the Brexit?
References:
1. Bax Alex, Middleton John. Healthcare for people experiencing homelessness BMJ 2019; 364: 1022.
2. Yale online. As Cities Grow Worldwide, So Do the Numbers of Homeless htpps://yaleglobal.yale.edu/content/cities-grow-worldwide-so-do-numbers-homeless (accessed on 10.03.2019).
3. Horton R. Offline: UK citizens are losing the right to health—who cares? Lancet 2019; 393: 860.
Competing interests: No competing interests
Re: Healthcare for people experiencing homelessness. Consider homeless migrants, specifically refused asylum seekers.
Dear Editor
I would like to thank Alex Bax and John Middleton for the excellent editorial ‘Healthcare for people experiencing homelessness: a public crisis caused by political choices’ on 30/3/19.
As is often the case in commentaries and strategies on homelessness, the editorial does not mention migrant homelessness. There is however increasing awareness of the importance of specifically targeting migrant homelessness. https://crisis.org.uk/ending-homelessness/the-plan-to-end-homelessness-f...
There are specific issues to be addressed regarding those who are seeking protection from return to their countries of origin. They live not only with the reality of homelessness but also in constant fear of deportation.
As the editorial states, ‘Homelessness is a serious healthcare problem, but it is the consequence of political choices.’ Some find it hard to believe that a government would want anyone to be homeless, instead seeing homelessness and lack of access to healthcare as unintentional consequences of various policies. This is not the case. UK government asylum policy for the past 15 years results in intentional homelessness and destitution for those whose claim for protection is denied. It compounds this - in England only - with lack of free access to most secondary care https://www.bmj.com/content/365/bmj.l2281 including maternity care. https://maternityaction.org.uk/2019/09/listen-to-the-voices-of-midwives/
Those who have been refused asylum have support and housing withdrawn, with no legal entitlement to work. They have no recourse to public funds i.e. mainstream benefits and housing support. Social work departments may refuse to assess those with care needs despite a legal obligation. https://www.homeless.org.uk/sites/default/files/site-attachments/Support...
They face years, even decades, of absolute poverty. They are extremely vulnerable to exploitation including resort to prostitution, exchanging sex for shelter, trafficking and illegal employment. The impact on women has been documented in a devastating report released last week. https://www.refugeewomen.co.uk/not-safe/
These people are from a variety of countries with oppressive regimes, widespread violence and lack of protection for minorities or women. They have come here in the hope of compassionate protection and the opportunity to work and support themselves and their families both here and back home. Instead they have fallen foul of a cynical, hostile, target-driven system. They depend on the support of small local charities for emergency accommodation. https://naccom.org.uk/projects/
Homeless refused asylum seekers and other migrants should not be disregarded in local or national homelessness strategies.
Competing interests: No competing interests