Article 5.docx

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Family Relations and Human Development
FRHD 3090
Michelle Preyde

Article 5 Summary Homelessness and Health in Canada: research lessons and priorities – Frankish, Hwang & Quantz - 2 primary goals of article: 1. Provide an overview of previous research on homelessness and its relationship with health 2. To spur discussion on strategic directions for future research The scope of homelessness in Canada - From 2001 census, 14,000 Canadians were homeless (highly underrepresented) - Challenges with obtaining a complete picture: o Lack of a consistent definition o Difficulty in identifying homeless individuals o Transient nature of homeless persons o Difficulty communicating with o Lack of participation by local agencies - Definition of homelessness can be viewed along a continuum o At extreme end, those living outdoors or places not intended for human habitation, then those in shelters (these two are ‘absolutely homeless’), then those staying with people temporarily, those at risk of being homeless (in substandard housing or spending very large portion of monthly income on housing) o Very important for policy, resource allocation, and methods to evaluate success of initiatives o Other important aspects of homelessness in Canada: impact of urbanization (80% of Canadians live in cities >10,000; lack of affordable housing), the heterogeneity of the homeless pop’n (all types of people; for some it is transient/crisis, for some it is chronic), complexity of the causes (at individual and social/economic level) The health status of homeless persons - Causal pathways o Direct impact on health (ex. Crowded shelter conditions and exposure to TB, foot disease from walking/moisture/cold) o Risk factors such as poverty and substance abuse, many remain at risk even after securing housing o Homelessness and health status are bi-directional, and along with additional factors determine quality of life - Specific health conditions o Mortality rates significantly higher (ex. In Montreal street youth, 9x higher than avg. for M and 31x higher than avg. for F), as is prevalence of substance abuse and mental illness (affective disorders, not schizophrenia as popular misconception) o Increased risk of TB due to alcoholism, nutritional status, and AIDS; difficult to treat b/c no follow-up, non-adherence to therapy, prolonged infectivity and drug resistance o Biggest risks for homeless youth is HIV infection, sexual and reproductive health o Injuries and assaults serious threat to health, accidents (struck by vehicle, drug overdose) o Wide range of chronic medical conditions, often inadequately controlled, dental health, disability dev. in older homeless pop’n o Barriers to health care access(esp. mental health and substance abuse treatment) o Competing priorities means a daily struggle for the essentials of life Interventions to reduce homelessness and improve the health of the homeless persons - Biomedical health care strategies o Focus on medical interventions to improve health status and includes primary healthcare programs, clinical services, psychiatric treatment and substance abuse treatment o Interventions which are purely biomedical are useful in improving health, but not addressing their homelessness need to be reconsidered to combine healthcare with housing and other social
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