Critical Public Health - Homelessness and Health

This session explores how research can influence policy and professional practice, focusing on homelessness and health, and includes a guest lecture.

Discuss how social research can inform policy makers and professional practice.
Develop research skills:
- Data collection and analysis
- Report writing
Generic and subject-specific skills:
- Identifying and commenting on the value of sociological work for specific organizations regarding social, public, civic, and/or policy issues.
- Translating research for effective communication with different audiences.
- Working effectively with others.

Consensual approach: Researchers collaborate with policy makers and practitioners to provide knowledge for improving service delivery and outcomes.
Contentious approach: Researchers maintain a critical stance from the sidelines.
Paradigm challenging approach: Research is used to question established frameworks and propose new principles for action.

Research can both support and critique policy and practice decisions.
Research can influence overall strategy, local priorities, operational procedures, service design, and managerial decision-making.
Research findings require interpretation through dialogue and engagement.

Can research provide objective answers to complex social and political questions?
There are assumptions that research evidence can provide objective answers.
There may be disillusionment regarding the ability of research to solve complex social problems.
Challenges exist in interpreting research findings as 'evidence.'
Many factors combine and interact to influence policy and service delivery.

Assignment 2: Health policy and practice short report (1500 words).

Aim: To link academic research to health policy or practice.
Work individually.
Use information provided by Shelter (week 9) to outline the issue at stake (homelessness and health).
Draw on at least three pieces of published research to discuss how empirical research/theory might be useful to policy makers or those in professional practice in understanding or approaching this issue (covered next week).
A list of papers is provided on Learn (week 10).

Title: How can we improve the health of homeless populations?
Introduction:
- Outline the context with reference to government reports and other policy documents.
- Introduce the third-sector organizations you are aiming your report at (e.g., Shelter).
Main Body:
- What sociological research exists on homelessness and health, and what does it tell us?
Recommendations:
- How can we change current policies and practice to address these issues? (List of bullet points)

What is homelessness, and how might we measure it?
What are the realities vs. myths of homelessness?
How does homelessness relate to health and the body?
What is being done to improve the health and well-being of homeless populations?
What more could be done to improve the health and well-being of homeless populations (e.g., recommendations for how we could change practice)?

Defining homelessness: Housing hardship linked to extreme poverty; the vast majority are not chronically homeless.
Significant risk of physical and mental health issues is both a cause and consequence of homelessness.
Food insecurity leads to nutritional problems.
Higher levels of infectious and chronic conditions.
Higher than average histories of alcohol and/or drug abuse.
Elevated risks of depression and suicidal ideation.
Stress.
Exposure.
Lack of access to basic hygiene.
Higher mortality rates: the average age at death is in the 40s-50s.
Frequent victims of crime, violence, and sexual assault.
Co-occurring drug addictions.
Dependence on professional and voluntary services, plus 'shadow work' to meet basic needs.
Have a range of unmet needs that can impact health and well-being – proper nourishment, effective sleep, social inclusion, and relationships.
Policy approaches – divergent agendas:
- Exclusion and criminalization.
- Housing/treatment first.
- Promoting inclusion.

Key Policies/Legislation:
- Rough Sleeping Strategy (2018): Aims to end (core) homelessness, focusing on prison and care leavers through Prevention, Intervention, and Recovery.
- Everyone In (2020): Coupled with eviction bans and the furlough scheme.
- Repeal of the 1824 Vagrancy Act: Decriminalizing rough sleeping.
Critiques:
- Ignores upstream factors leading to homelessness.
- Strong focus on some groups and situations only.
- Lack of funding and scale.

Health is a major concern and correlates with homelessness; mental health support is lacking.
Access to health services is an important issue; many barriers exist.
The type of accommodation available and social rules mean people often ‘drop out’; lack of integration between health and other services.
Different groups of people each have distinct needs.
A patchwork of organizations and services exists.
Different policy choices (e.g., housing first vs. treatment first, Success of ‘Everyone In’).
Lack of housing and funding to fully implement the policies.

What is homelessness? How is it defined?
What are the realities vs. myths of homelessness? E.g., why do people become homeless? What does it mean to be homeless? How do homeless people meet their basic needs – eating, sleeping, and keeping clean?
What does the organization set out to do?
In what ways is homelessness interconnected with health?
What are the key issues at stake from the point of view of charitable organizations?
What can be done to improve health and well-being of homeless populations? (What solutions do they propose?)
What is missing from their approach? (Critiques)