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Health Care Disparities and Health Care Policy for the Homeless Population Shannon Sheffer Ferris State University

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR Abstract

Homelessness is a devastating health disparity that affects millions of people around the world. It is a condition that leaves its mark on thousands of Americans each and every year. This disparity reaches across genders, age groups, nationalities, and socioeconomically groups. The purpose of this paper is to address the disparities that affect the homeless population and the ramifications of those disparities. Also, I will examine and discuss current policies that both positively and negatively affect this population.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR Health Care Disparities and Health Care Policy for the Homeless Population

Homelessness is a growing concern that affects millions worldwide. The National Health Care for the Homeless Council (2013) refers to homelessness as an individual who lacks permanent housing who may live on the streets, shelters, missions, abandoned buildings, vehicles, or other unstable or non-permanent situation (National Health Care for the Homeless, 2013). According to Healthy People 2020 (2013), health disparities can occur as a result of social, economic, or environmental gaps between two parties. These factors can be anything from mental illness, under employment or lack of employment, natural disasters, disability, immigration, violence, or abuse (Healthy People 2020, 2013). By helping eliminate or decreasing these disparities, communities can help stamp out homelessness. Population and Health Care Disparity In 2011, an estimated 3.5 million Americans were homeless (National Alliance to End Homelessness, 2013). Many occur from lack of employment causing individuals and their families to financially collapse. Homelessness affects all age groups like military veterans or children, leaving this group prey to many health disparities. The most common health disparity issues are no health insurance, lack of health care screening and treatment options, or substance use or abuse (National Alliance to End Homelessness, 2013). Unfortunately, health care is not a priority or even an option for the homeless, rather finding food, shelter, and safety for themselves and their families takes precedence. Social Determinants According to Harkness & DeMarco (2012), social determinants of health are the social conditions in which people live, personal income, social status, education, literacy, home and work environment, support networks, gender, culture, and availability of health services.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR

Essentially, social determinants of health are any socially grounded factor that may lead to some type of inequality or bias behavior. Social Attitudes The homeless population endures discrimination, alienation, and prejudice daily. An article written in the Psychological Services found that a majority of homeless veterans were involved in a variety of criminal activity ranging from disorderly conduct to vagrancy (Rosenheck & Tsai, 2013). These crimes do not seem to be too criminal to some people, but when connected with the homeless population it seems to magnify the discrimination and judgment of them. It is with information like this that is presented to community members that the stigma of the homeless population develops. This journal article exemplifies some of the reasons why the homeless population has to deal with the stigma the community puts on them as well as the affliction they already endure from being homeless. Lack of Accessible Health Care According to the National Health Care for the Homeless Council (2013), many of the currently homeless individuals do not have health insurance (National Health Care for the Homeless Council, 2013). It is this in combination with lack of monetary means that the large number of homeless does not seek medical care or attention. Inadequate health is a source and one consequence that results from being homeless. The availability of health services for the homeless is limited. Many physicians offices, specialists, and for-profit clinics will not see patients without insurance or payment for services up front. According to the National Coalition for the Homeless (2009), many of the homeless population lack the knowledge about where to get treated, lack of access to transportation, and lack identification (National Coalition for the Homeless, 2009). Many are embarrassed or afraid

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR about the simple task of filling out registration forms or their physical appearance and hygiene. The most common deterrent for seeking health care is money (National Coalition for the Homeless, 2009). Lack of medical treatment results in issues with bronchitis, frostbite, cancer, cardiovascular issues, and tuberculosis for the homeless population (National Coalition for the Homeless, 2009). The National Coalition for the Homeless (2009) estimates without health care, these individuals are three to four times more likely to die than those that have routine checkups. Health Care Policies and Programs In my search for health care policies for the homeless, I found many that positively and negatively impact this population. One positive policy is known as the Health Care for the Homeless (HCH). This program is federally funded and ran to help the homeless with their health care needs. It is designed for primary health care and also includes dental care, mental health treatment, supportive housing, substance abuse services, emergency services, and assistance in qualifying for housing (National Coalition for the Homeless, 2009). In 2009, over 1 million homeless Americans were enrolled in this program (National Health Care for the

Homeless Council, 2013). Unfortunately, this is only a fraction of the number of people who are in some way homeless in America. One negatively impacting policy that affects the homeless population in America is our current health care program. The Patient Protection and Affordable Care Act (PPACA) increased funding of Medicaid for the homeless population but not all homeless persons qualify (Technical Assistance Collaborative, 2011). Unfortunately, if they do not meet certain criteria such as age, disability, or income level, they are ineligible for Medicaid. Increased federal support of these programs to include all citizens would not only help the homeless population, but all Americans.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR Sometimes it is the cost of health care that sends individuals and their families into financial hardships or even homelessness. Contributing Factors Stereotyping of the homeless is a contributing factor for many of the struggles and barriers the homeless population has to overcome. Some of the beliefs are the homeless population are that they lack education, have mental illnesses, are lazy, and take advantage of free handouts (The Suitcase Clinic, 2013). Most Americans believe that homelessness is a result of poor judgments or decisions in their lives. According to the Suitcase Clinic (2013), many Americans are only one or two missed paychecks from being homeless themselves. Some of the values of those in influential positions have shown concern by advocating for policy makers to recognize the need of the homeless population in America. It is evidence that President Obama and the government are attempting to make these changes and provide the

resources they need. Recently, $72 million dollars was awarded to aid in the support of resources like medical care, outreach programs, and housing assistance (Sullivan, 2013). I believe that homelessness has become such prevalence among Americans, that no one person, community, or government will dissolve it. I believe that by educating the community and government about the facts and myths of the homeless would help greatly decrease the health disparities for the homeless population and together help reduce homelessness.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR References Harkness, G. & DeMarco, R. (2012). Community and public health nursing. Philadelphia, PA: Lippincott Williams & Wilkins. Healthy People 2020. (2013). Social determinants of health. U.S. Department of Health and Human Services. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39 National Alliance to End Homelessness. (2013). Snapshot of homelessness. Retrieved from http://endhomelessness.org/pages/snapshot_of_homelessness National Coalition for the Homeless. (2009). Healthcare and homelessness. Retrieved from http//nationalhomeless.org/factsheets/health.html National Health Care for the Homeless Council, Incorporated. (2013). What is the official

definition of homelessness? Retrieved from http://www.nhchc.org/faq/official-definitionhomelessness/ Rosenheck, R.A. & Tsai, J. (2013). Homeless veterans in supported housing: Exploring the impact of criminal history. Psychological Services. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24079354 The Suitcase Clinic. (2013). Homelessness defined. Retrieved from http://www.suitcaseclinic.org/homelessness-defined/ Sullivan, B. (2013). Obama administration renews support for more than 500 local homeless programs across the U.S. U.S. Department of Housing and Urban Development. Retrieved from http://portal.hud.gov/hudportal/HUD?src=/press/press_releases_media_advisories/2013/ HUDNo.13-062

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY FOR Technical Assistance Collaborative, Incorporated. (2011). How health care reform strengthens Medicaids role in ending and preventing homelessness: Medicaid eligibility expansion. Retrieved from http://www.tacinc.org/downloads/Medicaid%20Expansion%20homeless%20final.pdf