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Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants

Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results fro...

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Detalles Bibliográficos
Autores principales: Stafford, Amanda, Wood, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750953/
https://www.ncbi.nlm.nih.gov/pubmed/29292758
http://dx.doi.org/10.3390/ijerph14121535
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author Stafford, Amanda
Wood, Lisa
author_facet Stafford, Amanda
Wood, Lisa
author_sort Stafford, Amanda
collection PubMed
description Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homelessness further exacerbates poor health. Aggregated health service data can mask this, and case histories thus provide important insights. Methods: This paper presents three case histories of homeless patients seen at an inner city public hospital in Perth, Western Australia. The case histories draw on several data sources: hospital data, information collected from rough sleepers and clinical observations. Estimates of the cost to the health system of the observed hospital usage by the three patients are included. Findings: The case histories illustrate the interplay of social determinants of health in homelessness that help explain the high level of hospital usage by rough sleepers. The cumulative healthcare costs for the three individuals over a 33 months period were substantial. Hospital attendance plummeted even in the short term when housing needs were addressed. Conclusions: Treating homelessness as a combined health and social issue is critical to improving the abysmal health outcomes of people experiencing homelessness. In addition, the enormous economic costs of hospital care for people who are homeless can be reduced when housing and other social determinants are taken into account.
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spelling pubmed-57509532018-01-10 Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants Stafford, Amanda Wood, Lisa Int J Environ Res Public Health Article Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homelessness further exacerbates poor health. Aggregated health service data can mask this, and case histories thus provide important insights. Methods: This paper presents three case histories of homeless patients seen at an inner city public hospital in Perth, Western Australia. The case histories draw on several data sources: hospital data, information collected from rough sleepers and clinical observations. Estimates of the cost to the health system of the observed hospital usage by the three patients are included. Findings: The case histories illustrate the interplay of social determinants of health in homelessness that help explain the high level of hospital usage by rough sleepers. The cumulative healthcare costs for the three individuals over a 33 months period were substantial. Hospital attendance plummeted even in the short term when housing needs were addressed. Conclusions: Treating homelessness as a combined health and social issue is critical to improving the abysmal health outcomes of people experiencing homelessness. In addition, the enormous economic costs of hospital care for people who are homeless can be reduced when housing and other social determinants are taken into account. MDPI 2017-12-08 2017-12 /pmc/articles/PMC5750953/ /pubmed/29292758 http://dx.doi.org/10.3390/ijerph14121535 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Stafford, Amanda
Wood, Lisa
Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants
title Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants
title_full Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants
title_fullStr Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants
title_full_unstemmed Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants
title_short Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants
title_sort tackling health disparities for people who are homeless? start with social determinants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750953/
https://www.ncbi.nlm.nih.gov/pubmed/29292758
http://dx.doi.org/10.3390/ijerph14121535
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