Homelessness is a health crisis

cohealth Chief Executive Nicole Bartolomeusz on why homelessness is a health crisis

As a community health service working at the frontline, every day at cohealth we see the impact that homelessness has on people’s physical, mental and social health.    

We take health care to people living on the streets, operate drop-in clinics and help people from all walks of life access GPs, nurses, allied health, family violence support, mental health services and alcohol and drug treatment.  

Our Central City Community Health Service, located in the Melbourne CBD, provides culturally safe and trauma-informed healthcare and supports to people experiencing homelessness.   

Homelessness in Victoria grew 43 per cent between 2006 and 2016 and continues to grow. This is reflected at Central City, where we have seen a 20 per cent increase in client numbers in 2019/2020, on top of a 15 per cent increase from the year before.   

Homelessness is a health crisis; secure housing is one of the key social determinants of health and drives health inequity. As a healthcare provider we provide great care every day, but essentially the care is a band aid, if we don’t address the social determinants of health.  

Safe housing, and more importantly a place to call home, is one of the fundamental determinants of good health.  When we don’t have the things we need, like a secure home, and are constantly worrying about making ends meet, it puts a strain on our bodies. This results in increased stress, high blood pressure, and a weaker immune system.    

A study by St Vincent’s hospital showed that people who are unhoused die up to 22 years earlier. Premature death due to homelessness is entirely preventable.   

People experiencing homelessness face chronic health issues and the risk of mental illness, as a result of the stress and trauma associated with homelessness, is greater.  People often experience stigma and discrimination, which can make physical or mental health conditions worse.  

Almost every person can be impacted by homelessness. But too often, the community sees the problem of homelessness, not the person behind it.  

Homelessness can rob people of agency and dignity and trap them in a terrible cycle. Someone who has not been able to shower or wash their clothes is far more likely not to attend appointments, even when they are important for their health. They may avoid contact with family or others who may be able to offer connection and support.  Similarly, people who have had their proof of identity documents lost or stolen will struggle to access health care and other support.  

At cohealth, we understand the stigma around homelessness and the barriers to support, that’s why we offer support such as a drop-in shower service, clothes washing and access to health care without the need for Medicare cards and appointments. Our services are trauma informed and culturally safe.  

Providing immediate health responses while waiting for bigger solutions

With an adequate supply of social and affordable housing, plus wraparound healthcare and support services, people’s lives can be transformed. They can stop worrying about where they’ll sleep that night, and focus on building relationships, raising their kids, finding work and engaging with education.   

Countless people wouldn’t need to go to emergency departments and hospital waiting rooms if they had secure housing. We could help keep many people away from expensive health settings and reduce ambulance callouts if we simply provided them with safe and secure housing and the supports to keep it.   

There is no one-size-fits-all solution that will work for everyone. And yet, there are some similarities among the needs of all consumers. Critical to a person’s recovery is addressing both their mental and physical health and housing needs; you cannot have one without the others.   

Improving lives and achieving better health for people experiencing homelessness requires an approach that responds not just to individual health factors but also to the social structures and the policies and practices that are so influence our health and wellbeing. 

If we want to improve the health system for everybody, we need to look at all the factors that lead to poor health. Investment in safe, affordable housing for people who need it most is an investment in the health of the nation.

A longer version of this article appeared in Parity Magazine’s July 2023 edition ‘Responding to Rough Sleeping’.