Presentation given by Dearbhal Murphy, policy officer in the FEANTSA secretariat, at a FEANTSA conference on "The Right to Health is a Human Right: Ensuring Access to Health for People who are Homeless", 2006
"The Right to Health is a Human Right: Ensuring Access to Health for People who are Homeless"
The Right to Health is a Human Right: Ensuring access to Health for people who are Homeless FEANTSA ANNUAL THEME 2006
Why Health? « Processes of extreme exclusion can reveal the shortcomings of any system, including a healthcare system. » Health has a role to play in understanding and communicating about homelessness. Health is a crucial factor in being able to access and maintain employment and housing. Health policy and health care systems have a place and role in homelessness strategies.
The Annual Theme A detailed questionnaire was drawn up by FEANTSA’s international expert group on health The Adminstrative council member in each country coordinated the drafting of a national report – available on FEANTSA’s website and on the conference CDs The European report was drawn up on this basis, drawing together the commonalities, highlighting shared problems and different approaches and solutions.
The Right to Health for people who are homeless The right to health – our starting point is that health is a human right. People who are homeless have the right to the highest attainable standard of health and to a life in dignity. The health of many people experiencing homelessness is a damning indictment of the commitment of States to uphold the right to health of their citizens. This right to health is the vital baseline to the discussion on entitlements to healthcare and on access to good health. It is both the basis for action and the final aim.
The European Report - Findings Health Profiles of People who are homeless Entitlements to healthcare Barriers to accessing healthcare Efforts to overcome the barriers Access to quality healthcare Training to meet the needs of people who are homeless Networking and interagency working Data collection on the health situation of people who are homeless.
Health Profiles of People experiencing Homelessness Physical health problems and substance abuse Mental health and dual diagnosis Multiple needs: a challenge to the medical model Treatment problems associatedwith the situation of homelessness - Assumption of « self-care », - Previous negative experiences of the healthcare system, - Competing needs, - Difficulties recognising the need for care
Entitlements to healthcare Health and social protection systems in Europe have made provisions for vulnerable groups to access care at minimal or no cost BUT these provisions do not translate into real access to quality care. Non-nationals in an irregular situation: particularly problematic – emergency care only Evolution of the healthcare system: Negative impact of cost-cutting reforms Move from public provision to private sector can be a problematic one for people who are homeless.
Barriers to Care Administrative and Financial barriers are very commonly cited. Even a small charge upfront can be a significant barrier Administrative procedures are complicated and difficult « The gap between homeless and hospital life » Inflexible appointment systems, difficulties adapting to hospital environment, cultural or linguistic barriers, etc.
Efforts to overcome these barriers Special low-threshold and outreach health services Mediating role of homelssness services Flexible approach to administrative requirements (such as local residency) Special public health insurance packages to do away with the need to pay upfront and await reimbursement
Access to quality healthcare Specialist care for people who are homeless – can be tailored to their needs – BUT: specialist Vs mainstream debate. Homeless services – often coordinate the provision of certain health services Breakdowns: Mental health care and dental care hard to access Breakdown of care at the recuperative stage Provision of care in rural areas remains problematic in many countries.
Conclusions People who are homeless do not enjoy their right to health – States need to adopt a proactive stance in light of their vulnerability There is knowledge and experience in the service provider sector that can facilitate States in their work in this area Ensuring access to health is a vital part of a strategy on homelessness