From the public health perspective, some groups of the population are more vulnerable than other ones, which means that there are more threats to their health. My area, The Hammocks, Miami-Dade County, Florida, is a quiet place with a generally healthy population, but even here I can identify vulnerable groups. One of them is homeless persons who suffer from the lack of access to healthcare services and healthy practices. Analysis of their condition from the vulnerable population assessment perspective will suggest possible community health measures to improve their situation.
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Vulnerable Population Overview
In today’s world, homelessness remains a vulnerability factor in terms of public health. Homeless people are deprived of not only proper access to healthcare services but also opportunities to practice adequate hygiene, which contributes to health risks they face. In my community, homeless people can be seen sleeping on bus stops with carts full of their belongings. Also, they can be seen at intersections begging for money to buy food in order to survive. In my windshield survey, I observed that homeless people were insanitary, frail, and unkempt. Also, homeless persons can be occasionally seen in supermarkets, where they just sit and look depressed.
Homelessness is a condition that is largely influenced by social circumstances. Nies and McEwen (2014) identify three factors that contribute to homelessness: “(1) shortage of affordable housing, (2) insufficient income to meet basic needs, and (3) inadequate and scarce support services” (p. 61). The discussion on homelessness among researchers is an ongoing debate on how the condition should be defined because it largely affects the way its causes are identified and the way it should be approached as an issue, from the public health perspective particularly. In terms of social factors, it is generally agreed upon among researchers that a worsening economic situation increases homelessness rates. Also, inadequate social and public policies may result in a growing number of homeless people.
Strengths, Risk Factors, and Barriers
From the public health perspective, several strengths, risk factors, and barriers can be identified for the homeless as a vulnerable group of the population. First of all, it should be understood that homelessness is a condition that is likely to repeat in the lives of those who have experienced it before, i.e. the recurrence rate is high (McQuistion, Gorroochurn, Hsu, & Caton, 2014). Homeless people have to adopt a lifestyle that is dramatically different from the lifestyles of those who have homes, which is why homelessness as a vulnerable state can be highly persistent.
Within recent decades, much academic effort has been made to explore and define risk factors for homelessness, and some progress has been made, but the reasons and risks factors for individuals to become homeless remain unclear and hard to generalize. For example, McQuistion et al. (2014) studied the role of alcohol and drug use and concluded that substance use disorders contribute not only to the risk of becoming homeless but also to recurrent homelessness. At the same time, the authors acknowledge that there is a complexity of causes of homelessness, and they should be considered fully from the public health perspective in order to address the issue effectively. For example, income-related population factors should be acknowledged as capable of contributing to homelessness. These factors are particularly relevant for my community, Miami-Dade County, where 20 percent of the population are estimated to be in poverty, while the US average is 13.5 percent (“Quick facts,” 2016). Also, Miami-Dade is among ten counties in Florida with the highest income inequality rate (“Health outcomes and health factors,” 2016). All these data emphasize the importance of public health efforts toward vulnerable groups, including homeless persons, whose vulnerability is associated with poverty and other income-related causes.
For public health providers, it is also important to understand that homeless people are particularly vulnerable because their condition is highly resistant to recovery. The experience of being homeless for a significant period has such a strong psychological effect on a person that psychological assistance may be needed as part of individual care. This is a major barrier for this vulnerable group: its members may be unwilling to recover, and even those who are willing may be in a psychological state that is altered to such an extent that recovery efforts will be ineffective.
In Miami-Dade County, Florida, there are various homeless services available. For example, Miami-Dade County Homeless Trust is an organization that clearly states its goal to end homelessness in the county. The goal is pursued through providing shelters, delivering social support, and consulting. The Homeless Trust is also involved in coordinating a wide network of volunteers who assist the homeless. Another example is Safe Haven youth emergency shelter, which does not only accommodate homeless persons but also receives and distributes money and items as donations. Also, there is the Community Partnership for Homeless, which sees its mission as helping homeless men, women, and children to make a transition to a more stable and more self-sufficient life outside of the homelessness threats.
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However, in my area particularly, there are no adequate homeless service organizations, which means that homeless people need to travel to Miami or Hialeah to get help. I believe it can be challenging considering that homelessness is often a highly resistant condition (see Strengths, Risk Factors, and Barriers), which makes it harder for the members of this vulnerable group to seek help properly.
Community Health Problem Diagnosis
One of the Healthy People 2020 objectives is to “increase the proportion of homeless adults with mental health problems who receive mental health services” (“Mental health and mental disorders,” 2017). Although this objective does not comprehensively reflect the scope of issues that homeless people might face as a vulnerable group in terms of public health, it is still important that their risks of having mental challenges are recognized by the global community. In this area, a community health nurse can make a positive impact.
In terms of addressing the homelessness issue from the community health perspective, there are two major approaches. Nies and McEwen (2014) explain them through the metaphor of a river. In the first approach, downstream interventions are used to pull people out of the river of homelessness, i.e. treat or alleviate their health problems trying to end their homeless lifestyle. A newer approach suggests going upstream instead, i.e. addressing social issues that contribute to homelessness and preventing cases where individuals fall into this vulnerable group of population.
It has been demonstrated that various social and psychological factors can contribute to homelessness. Also, homelessness was identified as a highly resistant condition. In order to address the issue effectively through providing healthcare services, it is necessary to acknowledge the complexity of causes and the specificity of homelessness as a vulnerable state. A general recommendation for community health efforts is to not be restricted to addressing homeless persons’ health problems only but to address factors contributing to homelessness and strive for reducing their influence.
McQuistion, H. L., Gorroochurn, P., Hsu, E., & Caton, C. L. (2014). Risk factors associated with recurrent homelessness after a first homeless episode. Community Mental Health Journal, 50(5), 505-513.
Mental health and mental disorders. (2017). Web.
Nies, M. A., & McEwen, M. (2014). Community/public health nursing: Promoting the health of populations. St. Louis, MO: Elsevier Health Sciences.
Quick facts: Miami-Dade County, Florida. (2016). Web.