Homeless health in Toronto
Despite Canada’s widely appraised free health care system and high standard of living, the homeless population in Toronto – one of the largest metropolitan cities in this country – suffers from unmet health care needs. A staggering 5453 people are homeless every night, with 29,000 individuals making use of a homeless shelter each year.Due to barriers in accessibility to adequate health care, approximately 17 % of this population is at a heightened risk for severe health complications, in the arena of both mental and physical illness.
The crowded living conditions of homeless shelters can significantly predispose such individuals to various contractible infections such as tuberculosis, rabies and lice. Exposure of the feet to moisture and cold for extended periods of time due to inadequate footwear has been proven to increase the acquisition of cellulitis, venous stasis and fungal infections.Health complications such as seizures, chronic pulmonary diseases, arthritis and musculoskeletal disorders have also been shown to be increasingly prevalent in homeless populations.
Furthermore, the prevalence of mental illness and substance abuse is particular higher among the homeless population, in comparison to the general population.This is related to the exacerbation of pre-existing mental health conditions by the stressors and tribulations of homelessness. Moreover, a study conducted by Dr. Stephen Hwang at St. Michael’s Hospital showed that 38% of homeless individuals experienced mental health concerns, with 29% percent being a victim of assault. This statistic alone exemplifies the high vulnerability of this group and thus, the extra resources and increased efforts that should be put into fulfilling its health care needs.
However, when evaluating the disparity of health care received by the homeless population, it is important to understand that the major problem lies in the health care delivery system, rather than the free health insurance system.
Increasingly prevalent barriers to primary health care services include the lack of transportation to clinics, rehabilitation centers and primary mental health services. Moreover, the lack of insurance benefits prevents homeless individuals from accessing required prescriptions, as they cannot afford the cost of such medications from their own pocket. This further contributes to the elevated severity of health conditions within the homeless population as the maintenance of stable health conditions is negatively impacted. In fact, a survey conducted in 2015 revealed that 72% of homeless individuals in Toronto diagnosed with diabetes experienced difficulty in effectively managing their condition. It has been understood that this may be due to the inaccessibility to specific dietary regulations, physical activity, medication and follow ups required in the treatment regime for such conditions. Coupled with the daily stressors associated with homelessness, managing a diabetic condition along with other health concerns is often under-prioritized by homeless individuals.
Shockingly, a study conducted on the homeless population revealed that 32% of homeless adults do not have a primary health-care physician. Since one’s family physician is the first point of contact in regards to emerging health concerns, this represents a major drawback for homeless individuals. Moreover, many homeless individuals are unable to access primary health care services due to a lost or stolen health insurance card.
Furthermore, psychological barriers also play a significant role in preventing homeless individuals from accessing the health care services they are entitled to. Lack of empathy and understanding from health care providers invokes feelings of shame, low-esteem and worthlessness in homeless individuals. A recent study group interviewed homeless individuals in Calgary and found that such individuals were prone to ample discrimination as others automatically associated them with negatively perceived behaviors such as abusing drugs and partaking in criminal activities. Such stereotypical behavior from health care providers can take a toll on the mental health of these individuals, preventing them from seeking necessary health care and considering it a priority.
Therefore, there is a pressing need to structure health care delivery systems in a manner that specifically addresses the health concerns of the homeless. Implementing teams of health care providers in shelters, drop-in centers and mobile health units is one proposed solution. Additionally, interventions such as educating the homeless in strategies to lower health risks have also been suggested as a means to encourage the homeless to take a proactive role in their health.
However, like all societal shortcomings, the most effective solution lies in targeting the root cause of the problem; that is, eliminating homelessness altogether. Analyzing the homeless population of Toronto reveals that significant portions of this population consists of seniors, immigrants and Aboriginals; individuals that are already considered a vulnerable group in the non-homeless population. Coupled with stressors such as rising tax rates, increasing wait times for subsidizing housing and decreasing unemployment rates, more and more individuals are becoming predisposed to homelessness. Consequently, interventions impacting the quality of life and socioeconomic conditions for this marginalized population should be implemented to ultimately eliminate homelessness and the dwindling health that it is related to.
By Ritika Arora
Please note that opinions expressed are the author’s own. They do not necessarily reflect the views and values of The Blank Page.