Homelessness in London: Health Problems and Issues - Essay Example

?Homelessness in London: Health Problems and Issues Introduction More than 2,000 people live and sleep in the streets in England and more than 40, 000 people in temporary accommodations such as hostels amongst others; physical illness, mental illness and substance abuse are often the consequences of chronic homelessness. Long-term illness, several literature points out, leads to mortality at a relatively younger age than the general national population. Several research findings posits that long term homelessness is directly linked to a poor quality life and that even shorter stay in the streets might be linked to long term health problems. In London, the homeless face the problem of insufficient primary and secondary care, in spite of their critical health situations. National Health Service, the primary provider of public health in the UK, cannot provide such essential services to people without access to fixed address, a common feature in developed nations (Daly, 2013, p.213). In addition, Rogers and Pilgrim (2010, p.60) asserts that the homeless are prone to neglecting their health status, more than the general population, and they only seek such services when their health status have reached advanced stages. Homelessness is a complicated global issue that is caused by several issues while at the same time it does not have a single solution. In recent years, the government and global health organisations such as the World Health Organisation (WHO) have identified the complex health challenges affecting the homeless as the underlying problem apart from the obvious accommodation issues amongst others. In England, there are several National Health Services and other privately sponsored charitable services, which provide the necessary healthcare and support to the homeless. The civil society in England, noted that during the global downturn, the National Health Services reduced its spending on the homeless. This paper will explore homelessness in London focusing on Newham while at the same time discussing health problem and issues associated with homelessness. What is homelessness? From the specifics of the word itself and probably as observed, a simple definition of the term would imply without home yet according to (Gramlich, 2011, p.15) the overall definitions of the term homelessness are twisted by the multi-dimensional nature of the term in practical scenarios. Gramlich (2008, p.70) observes that there is not a single specific definition of the term as variance in temporal dimensions, cognition and lifestyle amongst the homelessness street people. Since homelessness is mirrored in different settings, several situations come into play; this paper posits that the political agenda as well as the prevailing social values have been strongly linked to the definitions. Conventionally, homelessness has a residential dimension and this can often be used to redefine the term in this context. This is because the apparent feature of the classification stems from the lack of conventional housing for those deemed homeless. Levy and Sidel (2013, p.176) applies the United Nations Committee on Human Rights definition of the term and they intone that people who sleep in outdoors such as vehicles and abandoned non intended for human dwelling. Legal and statutory definition of the term have a characteristic contradictory nature and in the United Kingdom alone, there are several acts that define the term both at the national level and in the devolved systems. However, housing authorities in the United Kingdom consider domiciled individuals who have applied for their accommodation as homelessness applicants and therefore categorized. In the strictness of the term, the city of London has often distinctly identified two groups; the homeless and the rough sleepers. The rough sleepers are those who live and sleep on the streets of several English cities, yet in our case we shall be confined to London and Newham in particular. The Department of Communities and Local Government (2013) describes a person as statutorily homeless and hence entitled to apply for homeless duty. A statutory homeless person is one that is recognised by law and within the confines of the Housing Act of 1996; therefore, the criterion used for selecting and identifying homeless persons has been dealt with below under the topic Newham, London. Those who do not have housing have a right, backed by law to accommodation, which is available and actually accessible to them and their dependants, and that is reasonable for the whole household to continue to live in (Feldman 2009, p.481).  In the same statutory breath, an individual is deemed to be ‘at the risk of homelessness’ if they are probably going to be homeless in twenty eight days. The definition of the term from legal interpretation appropriately captures the complexity of the term, but does not provide a conclusive definition of homelessness. The definition, though limited by these mentioned above, ought to be given more concise wordings to bring out the true meaning. Barker (2009, p.287) admits that attempts at quantification normally mirror not only professional but also the political interests of those framing them and that further difficulty can be experienced when categorizing and de-categorizing homelessness. Consequently, writers caution that as with much of the work on the homeless, the social values of researchers, advocators and policy makers shape the criterion by which this group is defined. Therefore, homelessness is a multidimensional and it manifests in different forms, majority of people in London incorrectly misconstrue that only the rough sleepers fit into the definition. Therefore, the definition of homelessness should be widened to include hostel dwellers, those in bed and breakfast, those staying with friends and relatives, usually referred to as the sofa surfers. In fact, according to statistics pointed above, the rough sleepers account for a small population of the entire group. From the above discussion this paper concludes that the definition of homelessness is very broad and comprises people who face imminent dislocation and what is typically referred to it the media as inadequate housing. Causes of Homelessness In England, majority of people do incorrectly link homelessness to personal failures, this is unfortunate, as the causes are complicated and entail composite interactions involving personal circumstance and what writers refer to as structural factors, which are normally beyond an individual’s control. There are numerous causes of homelessness and this paper will be short of space and time to enumerate all of them, given these constraints, the discussion will consider the broader categorizations and thereafter suggests examples of them. Recent literature suggests that the causes might be fragmented into two; the personal causes and the structural causes. Nevertheless, given the complexity and as discussed above, the broad categorization of the causes is not limited by the two above and that new examples continue to emerge which might seem distant to the two categorization above (Levy and Sidel, 2013). Personal causes Hughes and Lewis (2012) refer to this as the immediate causes of homelessness, noting that the primary causes of homelessness have transformed in recent years. The authors cite breakdown of previous living arrangements as the most common cause homelessness. The breakdown may have been because parents, relative and friends who hitherto accommodated them are no longer unable and/or unwilling to accommodate them. Other causes under the banner of personal or immediate causes include individual factors, background factors and institutional background. Individual factors refer to personal breakdown and might include alcohol and substance abuse, unemployment, lack of social support, being weighed down by debts, deteriorating physical and mental health, and crime. Family background comprises of family breakdown and dysfunctional ties within such units. In addition, sexual and physical abuse on children and adolescents, irresponsible parenting have driven young children to the streets and the general state of homelessness in the family or a previous experience as such. Insley (2011) asserts that family breakdown is the biggest contributor to homelessness amongst children in the United Kingdom. Children and young adults experience homelessness after undergoing trauma and disruption in childhood. Institutional background may also lead to homelessness, psychologists point out that those who have served in the armed forces such as the military and police or even those who have completed their terms in prison are at the risk of being homeless. Structural Causes These causes of homelessness are typically beyond the control of the household or a person when the case refers to single homelessness. A single or combination of these factors might cause homelessness, joblessness, poverty, unaffordable accommodation, accommodation programmes and policies, structure and administration of housing benefit and other policies. Burrows, Pleace and Quilgars (2002, p.1953) observed that in the City of London and over the years, unemployment has persisted as the major contributing factor linked to homelessness. Homelessness in Newham, London Newham is the most populous borough in London with an estimated population of 308,000, though the number might be higher as a result of an estimated 70,000 referred to by the authorities as the hidden populations. They are made up of the unemployed, those who have failed in seeking asylum status and other groups who have been unable to claim benefits and therefore unable to access permanent, private and social dwelling. Newham has a diverse population because it is a multi-cultural town in the UK. Newham's two-third of the total population consists of "Blacks, Asians and minority ethnic groups known as the BAME" (Gillings, 2008). The Department of Communities and Local Government (2013) defines homelessness acceptance, as “households found to be eligible for assistance, unintentionally and falling within a priority need group.” The level of acceptance by the Newham authorities fell from 2007 to 2011, however, in recent times the number has begun to rise. Local need and local policy determine the rate and level of acceptance and Newham Council just like others owe a duty of settling and accommodating the homeless. The Council of Newham applies a very narrow definition of the term homeless; in fact, the Council restricts the definition within the Housing Act of 1996. This recognizes homeless, as “an individual and household lacking a license to inhabit a house, inability to gain their usual housing or it must be difficult for them to inhabit the house they are used to currently occupy”. According to Gillings2008, the number of homeless individuals in the borough has been approximately 2,500 per year in the past two years. However, there is an acceptance range of 50 percent (1,250) for all homeless individuals. However, by the year 2008, the number of homeless households declined to nearly 400 persons, and this is just a third of the homeless persons in the year 2005/6. The borough has the highest rate of acceptance, which has led to an increment in the number of homeless persons in temporary accommodation. As a result, in April 2008, the number was slightly above 5,500 households. In the same time, people who registered for accommodation increased by 47 percent (Gillings, 2008). The council further categorizes the homeless into two groups; the intentional and the unintentional. The council identifies the unintentional group as that group that is priority need of acceptance, that such household must have dependent children or meeting a variety of criteria classified as vulnerable. The intentional homeless category, according to the council comprises situations, which made an individual to leave accommodation such as failure to pay rent, mortgage, and interests, amongst other reasons (Gillings, 2008). Health problems among homeless people Every resident in the United Kingdom is by law eligible to primalaccess tomedical facilities to the point of need at no cost. The residents are required therefore to provide a fixed address, if one is unable to provide such they the individual is less likely to register for the services. This confirms research work conducted which posit that homeless people are more likely to register with a local GP. Physical Health Given the nature of streets, the homeless are more prone to physical violence than the general population, even though the public are often the ones perpetrating this to the helpless homeless person. Researchers have found out that homeless people have higher risks of contracting bronchitis, pneumonia, wound infections, frostbite, trench foot, cardiovascular conditions, cancer, epilepsy, renal damage, hernia and liver damage. This is often compounded by the lack of adequate access to healthcare as they face a number of challenges in accessing the free primary care. The homeless in England are at a higher chance of not being registered with a GP, than the general population and research suggests that more than fifty percentages of the homeless people have not had contact with the GP in the previous year. In these settings, emergency services are frequently used as opposed to GP, and the typical homeless person who has not registered with the GP will frequently have untreated medical state that could characteristically developed to dangerous situations, which might need urgent medical response (Gillings, 2008). Homeless individuals also experiences high rates of contracting and developing resistance strain of TB. Physicians have learnt that any homeless person with persistent cough and fever must undergo a test for TB. Homelessness conditions provide an environment that favours the spread of TB; for example, crowded and poorly ventilated shelters. Most homeless people with TB have a cluster of primary TB. The UK has limited data on TB trends among homeless individuals. However, in 1994, Celia Hall reported that TB was the major killer of homeless people in London. More than two percent of the homeless people in London had the disease and this rate was higher than the rate of TB infections in third world countries. Moreover, it was 200 times more common among homeless people as compared to the rest of the population (Gillings, 2008). The difficulty of treating TB among homeless people is a lack of adherence to physicians' instructions. In addition, homeless people may also experience prolonged infectivity and develop a strain of TB that is resistant to drugs. At the same time, there are also rampant cases of relapse after commencing the treatment. Such patient requires direct treatment and close observation in order to avoid relapse and ensure adherence to physicians' instructions. Moreover, some cases with "positive tuberculin skin test may require direct observation under prophylaxis". Generally, Wellcome Trust estimated that the incidence of TB among homeless people in the UK was 34 times higher than the rest of the population. Homeless individuals also experience high occurrence of HIV, hepatitis C, and TB than the broad populace of the United Kingdom. The trend of HIV infection has increased over the years as many homeless persons begin to inject themselves with drugs. Bernard also noted that London had the highest rate of HIV incidences among the Injecting Drug Users (IDUs) at four percent in 2006. The rate of IDUs among homeless people in London had increased. As a result, the number of homeless persons in London with HIV may also increase. IDUs who visited health care centres had tested HIV positive, but only "two-third of them were aware of their status" (Bernard, 2007). Homeless people have continued to report new cases of HIV infections, health care providers believe that such new cases normally take place through injection of drugs by sharing needles. Homeless people also have health problems that relate to sexual and reproductive health, homelessness is also associated with prostitution and this has led to the spread of sexually transmitted diseases among many youths. In fact, many suffer from gonorrhoea and Chlamydia, but do not report their cases. This suggests that health care providers must rely on anecdotal reports in order to manage such cases. Pregnancy is also a common reproductive health problem among street youths. Cases of pregnancy are common among female aged between fourteen and seventeen years old (Glaze, 2000). Mental Health Mental status had earlier been mentioned earlier in this paper, mental health can often be a cause of homelessness, and this paper will thereafter shortly discuss mental health due to homelessness. It is widely accepted fact that the rate of mental health problems is considerably higher amongst the homeless population. In reiterating an earlier point, life as a homeless person is not only physically challenging but also mentally exhaustive. In most cases, shock and stress that emerge when a person is exacerbated on the thought of being homeless might lead to mental health problems. Research suggests that close to fifty percentages of clients of homelessness services in England have been reported to have mental health need, whereas up to twenty percentages have personality disorder. Recent research work has claimed that the homeless populace has double the degrees of known mental health problem in comparison to the general populace (Feldman, 2009). Alcohol and Substance Abuse Alcohol and substance abuse often leads people into homelessness and it is important to note that patterns and trends of mental cases and drug abuse differ with the demographic characteristics. Most homeless women are prone to "mental illness even without the use of any drug" (Hwang, 2001); however, the rate of drug abuse among single homeless men is much higher in comparison to those of single women. Homeless women who head their households were not likely to abuse drugs like their male counterparts. Several research works conducted and quite a number reported in the mainstream British media have linked poor health status to homelessness. BBC had reported that homeless people die thirty years younger than average national population, whereas the telegraph confirmed by admitting that homeless women die by the age of forty three (Feldman, 2009). The Guardian summarized it by relaying the empirical evidence from various research work, they reported that homeless people have a life expectancy of just forty-seven. Undergoing homelessness is extremely difficult and as such it can result into detrimental effect on an individual’s mental and physical health and wellbeing. Majority of those people who withstand the worst of these effects are the rough sleepers, nevertheless, those living in the hostels and other forms of temporary accommodation might be affected by mental and physical health. Spending time on the streets, in temporary accommodations might have damaging effect on an individual’s physical health. Chronic form of homelessness is characterized by tri-morbidity; physical illness, mental illness and alcohol and substance abuse (Rogers and Pilgrim, 2010). Homelessness and public health system Public health is a broad multidisciplinary field that is strongly associated with a broad range of health determinants such as housing amongst others. In addition, public health is linked to ways that promote health and well-being at the prevention stage rather than at the treatment stage that is aimed at cure. The Department of Health Services in England, the primary authority of public health within the jurisdiction has enumerated a number of initiatives on the White Paper on Public Health to improve public health in England. The initiatives include; health protection, emergency preparedness, recovery from drug dependency, sexual health, immunization, health checks and screening, alcohol prevention, nutrition amongst others. The homeless face a myriad of health problems both physical and mental as well as problems arising from alcohol and substance abuse (Glaze, 2000). Therefore, public health is the deliberate attempt by the authorities to include in their programs and policies the needs and requirements of the homeless with respect to their health. The White Paper under section one mentions health inequalities and emphasize the need to reduce smoking, reduce the use of illicit drugs and heavy drinking, prevent mental health and reduce the rates of the sexually transmitted infections. These are some of the problems directly linked to the homeless and they undergo disproportionate health and wellbeing needs. Such programs and recognition might help address their plights, a complex societal dilemma that such initiatives aid in addressing. Conclusion In the communities, homeless people undergo some of the poorest health experience, exposing a complicated quagmire to the policy makers. Typically, homeless people are at the risk of physical, mental illnesses as well as alcohol and substance abuse. Chronic homelessness are characterized by a tri-morbidity of these three mentioned above. As a result, homeless people, have lower life expectancy than the average population at about forty-seven. Newham borough in London has considerable number of homeless people due to the sheer size of its population. The Newham council offers acceptance to those who have applied for such status within the borough, but it is believed that the majority of the hidden population within the borough have not done so. The paper above has explored the importance of accommodation to people for not only physical comfort but also mental, without which people deteriorate in mental and physical health and wellbeing. Such deterioration often leads to alcohol and substance abuse in people who have lost accommodation. Public health organs have an important role to play regarding the health situations facing the homeless and therefore must adopt policies that will lead to prevention rather than cure which in theory is more expensive to the authorities. References Barker, P. J. (2009). Psychiatric and mental health nursing: the craft of caring. London, Hodder Arnold. Burrows, R., Pleace, N., & Quilgars, D. (2002). Homelessness and social policy. London, Routledge.  Daly, G. P. (2013). Homeless: Policies, strategies, and lives on the street. London: Routledge.  Glaze, B. (2000) ex-service personnel homeless after leaving the military. Mirror. [Online] Available at: http://www.mirror.co.uk/news/uk-news/9000-ex-service-personnel-homeless-after-2071049 [Accessed 28/07/2013] Top of Form Feldman, D. (2009). English public law. Oxford, Oxford University Press. Bottom of Form Gramlich, J. J. (2011). Adaptation and self-presentation among homeless street people: making the invisible visible. , bliobazaar, Llc. Gramlich, J. J. (2008). Adaptation and self-presentation among homeless street people: making the invisible visible. [S.l.], Bibliobazaar, Llc. Hwang, S 2001, ‘Homelessness and health', CMAJ, vol. 164, no. 2, pp. 229-233. Hughes, G., & Lewis, G. (2012). Unsettling welfare: the reconstruction of social policy [...] [...]. London [u.a.], Routledge [u.a.]. Insley, E (2011) Homelessness prevention: Can we afford not to? Reconnecting families to prevent youth homelessness.London: Depaul Levy, B. S., & Sidel, V. W. (2013). Social injustice and public health. Oxford, Oxford University Press. Gillings, S. (2008). Newham Homelessness Strategy 2008-2013, 2008, [Online] Available at: http://www.newham.gov.uk/NR/rdonlyres/475FFCDD-7A2B-4CFB-9E1C-A8D4AF291FDE/0/HomelessnessStrategy.pdf [Accessed 28/07/2013] Rogers, A., & Pilgrim, D. (2010). A sociology of mental health and illness. Maidenhead: Open University Press. The Department of Communities and Local Government (2013).Statutory Homelessness: October to December Quarter 2012 England. [Online] Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/157996/Statutory_Homelessness_4th_Quarter__Oct_-_Dec__2012_England_revised.pdf[Accessed 28/07/2013] Read More