10 things to know about the health of unhoused people in Philadelphia
By Dr Juan Spinnato
July 27, 2020

In the US there are over half a million people documented as unhoused on any given night, a number that includes individuals residing in homeless shelters but also fails to capture the diversity of what housing instability looks like. These numbers are derived from the US department of Housing and Urban Development which is the largest source of federal funds to support programs that attempt to address issues of homelessness. The US Department of Veteran Affairs is also a source of government money given the large veterans homeless population. Government officials in the White House Council of Economic Advisors and HUD are arguing to dismantle the Housing First and Permanent House programs. The Housing First and Permanent Housing programs are attempts to meet people where they are and provide dignity.

1. The health and consent of unhoused people is important. The right to healthcare is a human right and the right to stable social networks to survive is a basic human experience. The intentional erosion and destruction of such networks of survival leads to further deterioration of physical and mental health and is a continuation of systemic racism, economic oppression and gender violence.

2. Many unhoused people are likely to have multiple undiagnosed and untreated chronic health conditions. These health disparities are a result of structural violence and they decrease a person’s quality of life, while leading to severe and chronic suffering as well as decreased life expectancy.

3. Post traumatic stress disorder is likely to be prevalent in unhoused populations. Trauma can be a result of unchecked police brutality towards unhoused people, gender violence as a result of the criminalization of sex work and the social consequences of the war on drugs.

4. Unhoused people face challenges in accessing healthcare. There are basic issues of infrastructure like access to free transportation, and chronic illnesses preventing easy navigation of current sources of transportation. The healthcare system has become unethically complex and has led to the de-prioritization of the needs of unhoused people. Often, the severity of untreated chronic diseases, or mental health issues and the subjectively and/or objectively severe symptoms that can manifest from these conditions are routinely denounced and de-prioritized with each visit to an emergency room or urgent care clinic.

5. Unhoused families and undocumented people are likely facing severe risk. Encampments of unhoused individuals can be a more easily accessible resource for other unhoused people and families. But for families and undocumented people it can be too much of a risk to be present in these encampments because of increased visibility and the constant threat by the state and police t dismantle the encampment and to detain and deport people and separate families.

6. The number of unhoused people in Philadelphia is constantly changing. Increased housing instability is often a result of health issues, notably an increasing overdose epidemic and the covid-19 pandemic that is accelerating economic oppression, including through unethical evictions supported by police. Even with the most dedicated efforts there will be people who remain unhoused and these folks continue to deserve the safe and stable social networks they fight to create as well as a responsive and present healthcare system.

7. Many unhoused people have experienced a lifetime of systemic oppression. In regions like Philadelphia, systemic racism has affected access to housing, increased the risk of people of color being incarcerated, and decreased access to education or employment. These structural inequities coincide with and are often direct risk factors or exacerbating factors to health disparities faced by unhoused people.

8. Many unhoused people face barriers to meaningful and sustainable employment opportunities. Some attempt to work while unhoused, and remain within an economic system that prioritizes exploitation of workers and minimizes safety and wellbeing. This is especially problematic within the covid-19 pandemic where people are forced to choose their safety over the ability to make an income, and often not even a defined livable wage.

9. There are insufficient infrastructures and protections in place to meet the healthcare needs of unhoused people. There are numerous examples of vital community networks like peer support programs, harm reduction programs, community based mental health programs and social advocacy groups that attempt to meet the needs of unhoused people. Many sites are underfunded and face issues of high volume and burnout without adequate public health validation and resources to meet the demand.

10. As unhoused people continue to maintain networks of community and resilience, resources and infrastructure should be provided based on ethical obligations of justice and fairness in order to promote the rights of safety and healthcare and to protect the sustainability of these rights. From local to national levels of government, there should be encouragement of multidisciplinary networks of transparent community and professional advocates who work collaboratively to remove the barriers to sustainable resources and healthcare access to unhoused people.

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