Homelessness as a Public Health Issue

While it is important to recognize that homelessness is a health care crisis and that people experiencing homelessness are deserving of healthcare and social support, it is known that the health issues among people experiencing homelessness does not remain restricted to them. Continuing from the previous entry, the experience of homelessness makes a person extremely vulnerable to disorder and disease due to a lack resources and support. However, from a public health perspective, homelessness is a major concern for the general wellness of the community at large. As a shelter provider, Central Arizona Shelter Services sits at the forefront of how public health problems manifest within the homeless population, and how they can easily snowball into larger problems across the community.

We’ve seen first-hand that people within shelters are at high risk for health vulnerabilities for a number of reasons but notably, due to living in a communal shelter. Living in a communal space removes the client’s ability to isolate when sick, makes sanitation harder to manage, and lacks options many people have in their day-to-day lives to stay clean and healthy. In fact, during the spread of the Spanish Flu in the beginning of the 20th century, communal living arrangements were identified as one of the major contributing factors to the rapid spread of that strain of Influenza. Even with modernity, communal shelters continue to be a place where disease can spread more easily.

Reaching Beyond the Most Vulnerable

While communal living and the experience of homelessness can contribute to the spread of disease in general, there are two major health problems that are most notable from a public health perspective as it relates to the role homelessness play.

The first is the HIV Epidemic, an ongoing and world-wide public health battle that has been fought since the 1990s. HIV is a blood-borne pathogen that is most often transmitted sexually or through needle sharing during intravenous drug use. People experiencing homelessness are at high risk for engaging in both of these behaviors, which is considered to be the main reason HIV is so prevalent among this population. The lack of infrastructure for protecting and supporting people experiencing homelessness makes managing HIV difficult, and contributes to their transience which can increase the spread. While harm reduction philosophies can help in addressing this, better and more comprehensive support is needed to treat HIV in order to prevent the spread entirely.

Harm Reduction 

CASS embraces the philosophy of harm reduction, and trains all staff on how to interact with clients from a harm reduction perspective. Harm reduction teaches that many of our clients will participate in harmful or dangerous behaviors as a survival mechanism, and mandating abstinence from these behaviors does not effectively reduce them. Instead, teaching clients how to engage in these behaviors safely and from a low-risk position, and encouraging them to do so helps in reducing over-all risk.

The second is airborne diseases such as tuberculosis, influenza, and COVID-19. As previously mentioned, the Influenza Outbreak in 1918 taught us how dangerous communal spaces can be during airborne disease outbreaks. Clients living in communal spaces aren’t able to properly self-quarantine or isolate to protect themselves from being infected, or from infecting others. People experiencing homelessness often do not have places to safely rest and recuperate either, causing them to be out in public where they can further spread airborne diseases. Thus, cities that fail to properly address homelessness contribute to public health crises. A century ago, “TB wards” were used where countless people suffering from tuberculosis would be required to rest at, which would have abysmal recovery rates due to the inability to get away from the disease. Nurses working at these wards followed strict sanitation standards, but could often unknowingly become vectors for transmission working and then going home. We see the same risk in running communal shelters with staff that and clients alike, who may be working or sleeping next to someone infected with the flu or COVID-19, and then leaving the shelter on a day-to-day basis.

Addressing Public Health Issues

Unfortunately, the nature of homelessness means that many people enduring it will be exposed to disease, and from a public health perspective this has large consequences and implications. The key to addressing this is not just providing better healthcare options for people experiencing homelessness, but addressing homelessness as a problem over-all. In addressing this public health crisis, the blame cannot fall on the people suffering, who have no choice when reckoning with disease, but with the systems that fail to have infrastructure in place to prevent the problem. The massive economic toll of treating homelessness mentioned in the previous entry only grows when you consider how homelessness may be contributing to large health issues beyond the homeless population. People who are enduring homelessness deserve dignity and health, and addressing homelessness not only provides that, but addresses the public health consequences of homelessness as well.

In the next entry, how Central Arizona Shelter Services addresses these problems and how they can be addressed in the larger system will be explored.

About CASS:

Founded in 1984, CASS is the largest and longest serving homeless emergency shelter provider in Arizona. Our adult and family shelters, as well as our temporary senior shelter operate at full capacity, 365 days of the year. CASS’ provides shelter, case management and housing support to a truly vulnerable community, from around the state and beyond.