Introduction
Enactment of appropriate public policies is incredible in aiding to reduce exposures of people to risks that may impair their health. Public policy comprises a systematic and detailed direction that is adopted by the respective administrative state bodies to deal with particular issues in a manner that is consistent with the law. In fact, one of the fundamental human rights is the right to have access to good health care. To help in the realisation of this universal human right, virtually all nations have established various programs and public health campaigns to ensure that people recognise the need for being risk-free from preventable and curable ailments.
Public health refers to the art and scientific approaches to prevent and control diseases with the chief aim of lengthening the lives of people within a nation to promote health via efforts that are well organised and inspired by organisational, societal, individuals, communal, and even public and private sectors to enhance good health for all. Based on this definition of public health, this paper considers homelessness as one of the major problems that hinder the achievement of public health in many nations. An effort is also is made to discuss the various health-service issues associated with homelessness in England and London, the UK.
Homelessness as risk Factor to Poor Health
There is a relationship between homelessness and poor socioeconomic status. Many homeless persons tend to belong to low social economic families (Johnson & Haigh 2012). Consequently, it is hard for such persons to access good housing. Indeed one of the cited reasons by the victim as to why they are homeless is lack of affordable housing (Shelter 2013). Ensuring good health for such persons calls for the creation of means of accessing quality health care for all people within a nation. Full realisation of the challenge of providing quality healthcare to all persons irrespective of their social economic status has seen many nations attempt to implement programs for universal health care. For instance, public health care is free in England.
While it may be plausible to argue against inappropriateness of government to fund health programs for those in the poor socio-economic status including the homeless persons in England and London by creating a public policy that gives such directions, the implication of poverty on the health of people and hence their productivity is important and worth taking into consideration. Indeed, the GDP of a country is related to the health levels of its citizens (Babatsikou 2012, p.66).
The healthier a nation is, the higher its gross domestic product. This finding implies that, if homeless persons belong to low social economic status, the higher their percentage within a nation, the lower the GDP. Hence, the particular nation is less likely to be economically independent. Consequently, poor health associated with homelessness due to probability of such persons belonging to low social economic status incredibly aids in perpetuating and acerbating of poverty within a nation.
Scholarly evidence shows that financial hardships and poverty are associated with poor health. With regard to the Department for Communities and Local Government (2012), poor health can also cause poverty and hence homelessness. For instance, poor health can have impacts on an individual’s ability to engage in productive employment and education, which constitute very important aspects for alleviation of poverty. Poor health can also cause people to sacrifice necessities including housing to meet various medical care and treatment costs (Lynch 2005, p.235). The realisation of this finding has seen the UK government implement policies that ensure public health care is offered free of charge.
Compared to 20 years ago, such policies have made it possible for many people to have constant access to healthcare. From the paradigm of public health in general, poverty has immense negative impacts on it. Adequate statistical analysis has provided a practical demonstration that life expectancy of people, which is one of the key determinants of public health, is dependent on poverty alleviation and expenditures on health care strategies (Raoult, Foucault, Brouqui 2001, p.79).
Since research establishes that homeless people are also poor and have the least expenditures on healthcare, it is also arguable that they have a lower life expectancy. In this line of argument, one of the major issues in public health discourses is the development of policies that would ensure that the life expectancy of people within a particular nation is raised. One of such efforts is ensuring the public health care is free as evidenced by the case of England and London.
Problems of Homelessness in England, the UK, and London
People experience the problem of homelessness in case they do not have places to live with peace, dignity, and good security. People who are considered homeless include those who sleep in vehicles, those living with their friends on a temporary basis, squats, refugees, and those who live in houses that do not have tenure security. According to Landt (2012), in 2001, more than 84, 900 people in England were homeless (Para.10).
The major causes of homelessness among these people were mental challenges, unemployment, substance abuse and alcohol, refugee status, disagreements with property owners, domestic violence, and disagreements with rental house owners. The number of homeless persons in 1997 hiked from 246,000 persons who were homeless in 1995. Scrutiny of the reasons that rendered these people homeless revealed that many of them cited reasons such as sexual violence, physical violence, overcrowding, poverty, and drug and substance abuse. In London, causes of homelessness include poverty, lack of sufficient supply of affordable housing, and unemployment challenges that continue to ruin many nations across the globe (Hafetz 2009, p.1223).
Other causes include public and social policy problems, for instance, community and public housing policies, education, and expenditure without negating taxation policies. Public health challenges associated with homelessness also include ill health, fragmentation of families, intellectual disability domestic violence, alcohol dependency associated problems, and mental illness among others.
The causes of above aforementioned challenges are associated with poverty. In spite of the fact that poverty does not necessarily cause homelessness in England, the UK, and London, it acts as a connecting factor to the entire factors that cause homelessness. As argued before, since poverty is articulated to poor public health, it acts as a major issue facing public health policy designers and implementers. This argument is imperative by considering Shelter’s (2013) argument that poverty has a role to play in rendering people homeless in that it makes them vulnerable to challenges of being homeless especially when crises set in.
Apart from the outstanding number of people who are prone to the challenge of being homeless in England, Landt (2012) estimates that about 35% of people falling in the low-income range encounter situations that expose them to housing stress. This finding implies that housing costs of such people escalate to levels that jeopardise their capacity to meet the daily needs such as food and clothing. Borrowing form Maslow’s hierarchy of needs, it is likely that households with low-income levels would consider getting the most fundamental psychological needs first. In this context, people would meet their food needs first before attempting to look for good housing.
This case is perhaps well exemplified by the study conducted by Landt (2012) in which he interviewed several houseless persons in the streets of England and London. One of such interviewees was Sam. Sam who is single and without any job says that he gets a very low income support per week (£56.25), but quickly adds that, apart from earning extra income amounting to less than 10 pounds from begging, the money cannot be adequate to cater for both housing and food. Another interviewee, Sean, who is 19 years old informed Landt (2012) that he survives by begging in the streets to support his habits including abuse of any drugs that he comes by and food.
Another interviewee, Colins who is 27 years old informs that he engages in part time job, but the amount he gets is not adequate to cater for his housing needs. He further adds that he found himself on the streets for reasons accruing from family problems. While Colins says that he is waiting to benefit from the council housing program, Landt (2012) argues that homelessness in London and England is a result of failing of housing systems coupled with hefty economic and social costs imposed by the increasing number of homeless persons.
From the discussions above, income levels, which constitute a key determinant of poverty levels within a nation, have the capacity to make people resort to living in settlements that may pose health challenges. The central argument here is that, in England and London, a public health policy that is specifically aimed at reducing the incidences of homelessness is vital in ensuring success of the free public health program. This formulation is perhaps largely important since there is a direct relationship between homelessness and public health.
With regard to the Department for Communities and Local Government (2012), in England, 2200 persons sleep in rough places every night based on 2009 statistics (p.20). In 2010, these figure hiked by 23 percent (Mental Health Network 2012). It went up to 2309 in 2012. Statistical results derived from Crisis and University of New York show that about 23,000 persons sleep in emergency accommodations every night (2010, p.8).
Important to note is that these figures are exclusive of persons termed in England as ‘hidden’ homeless persons. The terms cover persons such as single people or families, which live with other families, friends, or in squats. Consequently, it sounds plausible to infer that the problems of homelessness are not only a key public health challenge in the developing nation’s but also in the developed nations. In England, the government is fully aware of these challenges. Consequently, it has moved in to look for mechanisms of ending the problem of homelessness. One of such mechanisms is the establishment of a policy tagged ‘no health without mental health’.
This policy identifies various needs of persons with mental health problems coupled with seeking a means of ending homelessness menace among such persons. The main aim of the policy is to enhance accessibility to mental healthcare coupled with support among homeless individuals. Efforts to end the homelessness menace have truncated to initiation of council housing programs in London, the UK, and England. Combined with the free public health program, the housing program is anticipated to end the challenge of people sleeping in rough places coupled with public health challenges afflicting such persons due to homelessness.
Issues Concerning Homelessness and Public Health
Homelessness is a major challenge in the UK, England, and London. However, it is not a problem in England, London and UK alone. On the global scale, Mental Health Network (2012) estimates that about 100 million people encounter challenges of being homeless by finding themselves living in vehicles, temporary insecure shelters, and parks (p.1). This case shows that, on the global scale, the challenge of homelessness is critical. Its implications on public health constitute an issue that attracts global public health interest. The issue has truncated into initiation coupled with successful completion of studies on emergency medical care facilities, shelters, and even in the streets aimed at determining the traits of populations that are homeless and their health conditions in the UK.
Studies by Cockersell (2011) indicate that many people from various backgrounds: elderly, needy persons, children, youths, and immigrants among other classes of people have a tendency of becoming homeless in the events that they are unable to meet their daily needs. These scholarly findings are astounding since homelessness is a key indicator of health status of people. Indeed, homelessness is directly correlated with chronic illness among them respiratory infections, heart failure, cardiovascular ailments, and physical health challenges such as accidents. Additionally, mental health challenges have also been found to be a key trait of persons living in the streets as homeless.
The link between homelessness and prevalence of certain health-related problem prompts for the creation of appropriate policies to solve risk factors to homelessness. This strategy goes far in resolving public health problems that are associated with homelessness. This move is particularly significant since homeless people of all ages have chances of reporting experiences of sexual abuse, traumatic head injuries, unwanted pregnancies, abuse of substances among them being alcohol and tobacco, and also high prevalence rates for HIV (Hwang, Windrim, Svoboda & Sullivan 2000: Raoult, Foucault & Brouqui 2001).
Although many studies have been conducted in England, the UK, and London to unveil various health problems that are associated with homelessness as discussed before, mental health is one of the most significant problems. According to Mental Health Network (2012), more than 70 percent of all persons who seek homelessness services experience mental health challenges.
About 64 percent of these groups of people have problems associated with excessive consumption of substances. This argument means that abuse of substances is a major contributing factor to poor mental health and hence a major driver of the main public heath challenges that face many London, England, and the UK. Mental Health Network (2012) also notes that there is a myriad of causes of homelessness in the UK though it singles out mental health as one of the major contributing factors.
For persons having mental health problems, once an individual becomes homeless, chances are that the mental problems may become worse. With this information at hand, it is crucial for nations to consider various possible policy options that may help to end the challenges of homelessness in the effort to mitigate its associated health risks including mental illness.
Magnified emphasis is placed on mental healthcare since it is a common public health problem among the homeless persons in many regions of the world having informal settlements. Studies such as Mungo (2009) and Rees (2009) claim that many persons who are considered as homeless have one or a number of mental health challenges coupled with problems of alcoholism. Mungo (2009) estimates that the persons having this dual diagnosis range between 10 to 50 % among homeless individuals in England.
The realisation of this fact prompted the publication of a health framework for health outcomes (Department of Health 2012). The publication advocates for deployment of statutory homeless persons as a noble indicator of housing conditions in England both at the local and national levels. However, in this endeavour, a challenge persists since statutory figures of homeless persons are drawn from archives of local authority. These figures are based on persons who are considered eligible for and or in dare need for good housing.
They do not take into consideration a myriad of single homeless persons. Therefore, even if available data is utilised in the design of a public health policy seeking to reduce the number of homeless persons as evidenced by England’s vision for cutting sharply on health problems related homelessness, it is inadequate to inform such policies. What is required is an all-inclusive data for all homeless persons in cities seeking to mitigate the public health problems associated with homelessness.
Dealing with Public Health Issues related to Homelessness
Among many options considered in England, London and UK to deal with the problem of homelessness are encapsulated in the government’s vision of ending incidences of people sleeping in rough places (Johnson & Haigh 2012, p.31). The vision outlines six main key areas in which partners coupled with the government departments remain committed to including advocacy for committing state resources to enable homeless persons to access decent health care.
From the risk factors for making people homeless such as low social economic status, it is imperative to argue that efforts to deal with public health challenges are likely to succeed if risk factors are dealt with pragmatically. Such strategies are principally dependent on generation of solutions through public policies that aim at preventing incidences of homelessness coupled with the needs of enactment of appropriate programs to support people economically and socially within their physical environments. Such measures would encompass putting in place ways of providing affordable housing, development of alternative approaches to good accommodation, detection of various public health risks such as mental illness and drugs and substance abuse
Early detection is critical in enhancing a full response to treatment and rehabilitations of persons suffering from defiant behaviours associated with engagement in crime in London, the UK, and England. Indeed, crime is a psychological problem that is mostly prevalent among persons from low social economic status including the homeless ones. In this regard, creation of policies that guarantee funding of primary programs for heath care as provided for in England is paramount in the effort to ensure continued equal access to social coupled with health care services.
Additionally, health care public policy developers also need to pay attention to concerns of improvements and provision of good shelter and other psychological needs to homeless persons, address challenges of crime among homeless persons, and adopt strategies for organisational improvements of service delivery among voluntary agencies coupled with statutory agencies that address and provide healthcare services to destitute persons. Such persons also happen to be homeless. In fact, according to Babatsikou (2012), implementing various interventions for public health is a major milestone towards diminishing the risks of diseases associated with homelessness amongst these noble groups at risk raising enormous public health issues within a society (p.66).
In the effort to improve accessibility to health care, it is significant that all health care stakeholders are engaged including the homelessness care agencies staff. This strategy is incredible in aiding to develop and improve staff awareness of the challenge of homelessness in public health. Such a model would also provide a means of complex presentations and complex engagements between the homeless persons and those seeking to develop policies to cut on rough sleeping.
Conclusion
Homelessness is a major challenge that faces London, England, and the UK. The paper argued that homelessness forms incredible issues in public health discourses in England, the UK, and London since it is associated with health problems including mental illness, behavioural problems such as alcoholism, crime and substance abuse, and chronic ailments. Nevertheless, amid these problems, England, the UK, and London still have statistics indicating high rates of persons living under conditions that pose threats to their lives. Such conditions include sleeping in rough places, in vehicles, squats, and even in temporary and poorly hygienic forms of accommodation.
Faced with the problem of homelessness, it becomes impossible to achieve the concerns of public health in London, England, and the UK, which entail the prevention and control of diseases with the noble aim of lengthening the lives of people in these places. The paper maintained that eradicating some of the common problems that are prevalent among low social economic status persons living under conditions posing challenges to their health in England, the UK, and London initiates with eradication of the challenge of homelessness.
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