The document discusses health promotion for homeless people. It outlines the major health needs of homeless populations as dual diagnosis, high rates of substance abuse, alcohol abuse, mental health issues, and infectious diseases. It also discusses barriers to healthcare for homeless individuals. The document then provides recommendations for addressing the specific health needs of homeless populations through integrated housing, social support, treatment programs, and prevention strategies.

1. Health Promotion For People Who
Are Homeless
FEANTSA conference
Wroclaw, 2006
Dr Nat Wright MBChB DRCOG FRCGP

2. Being Housed Is:
“having an adequate dwelling (or space) over
which a person and his/her family can
exercise exclusive possession, being able to
maintain privacy and enjoy social relations,
and having a legal title to occupy”
Edgar B, Doherty J, Meert H. Review of Statistics on Homelessness in
Europe.
www.feantsa.org/obs/stats_review_2003_announcement.htm . Accessed 10-2-2
.

3. WHAT IS HEALTH
PROMOTION?
World Health Organisation 1986 Ottawa Charter
“the process of enabling people to increase control
over and improve their health….to identify and to
realise aspirations, to satisfy needs, and to change or
cope with the environment. Health is seen therefore
as a resource for everyday life, not the objective of
living. Health is a positive concept emphasising
social and personal resources, as well as physical
capabilities.”
World Health Organisation. Ottawa Charter. 1986. Geneva, WHO.

4. What are the major health
needs of homeless
people?
Dual Diagnosis, high morbidity and
mortality particularly related to:
- Substance Use
- Alcohol Use
- Mental Health
- Physical infestations and infections
- Common clinical problems more difficult to
manage in homeless populations e.g
- diabetes
- Elderly

5. Barriers to healthcare
involvement
- Workload
- Lack of skills
- Value base - “deserving” / “undeserving”
- migrant
- violent
- antisocial
- Double exclusion (ethnicity,
sexuality, gender)

6. Addressing Health Need –
generic issues
• Combine pharmacology (medicines
interventions) with psychology (e.g.
cognitive behavioural therapy,
motivational enhancement therapy)
• Addressing housing, benefits,
employment issues – floating support
• Importance of primary care –
mainstream, specialised, hospital based

7. Addressing Health Needs
Due to Drug Misuse
• Opiate maintenance therapy –
methadone or buprenorphine (possible
role for injectable heroin)
• Overdose prevention training to reduce
risk of heroin related death; naloxone
distribution through peer training model
• Supervised Injecting Centres

8. Addressing Mental Ill-Health
• Talking Therapies
• Caution prescribing antidepressants
that are toxic in overdose
• Assertive outreach models
• Dual diagnosis with alcohol – access
mainstream services but not alcohol
specific

9. Addressing Tuberculosis
Infection
• Tuberculin test screening (chest x-rays
and sputum testing are not necessarily
feasible)
• Contact tracing (through homeless
shelters rather than named person
contacts)
• Treatment completion rates higher if
directly observed through housing
programmes rather than acute hospitals

10. Addressing Physical Ill-
Health
• Anti-retroviral therapy for those with
hepatitis C
• Podiatry (nail cutting, adapted shoes)
• Insecticides in hostels to address
infestations

11. Prevention
• Immunisations – hepatitis A and B, tetanus,
influenza, pneumococcus and diphtheria;
• Informal interactive methods (video, role play)
to promote sexual health
• Contraception
• Personal and community hygiene to promote
physical health (facilities to wash clothes and
shower);
• Podiatry interventions to provide adapted
shoes or cut toe nails

12. Integrating Housing and
Social Support
• Floating support
• Housing quality standards and
competitive tendering
• Shifting housing provision from large
scale institutions to individualised
support
• Healthy Housing Policy – abolishing
“priority need” for “intentional”
homeless

13. And finally……….
Better links and integrated programmes with
• Prisons
• Housing – stat and non-stat sector
• Life skills options
• Benefits and future employment opportunities
• Political highlighting of naloxone and drug
consumptions rooms to reduce drug related
deaths

14. The End!
n.wright@leeds.ac.uk
Full WHO report:
How can health care systems effectively deal
with the major health care needs of homeless
people?
http://www.euro.who.int/eprise/main/WHO/Progs/H