Homelessness, health, and inclusion

Abstract

Sexually abused at 14 years old by an alcoholic father. Left home for the streets. Alcohol dependent by 15. Sex work. Intravenous drug dependent by 17. Hepatitis C by 19. Epilepsy and anxiety disorder. In and out of hostels, hospital, and prison (for violence, theft, drugs) in 20s and 30s. Not registered with a general practitioner. Rough sleeping at times, hostels at others. Tuberculosis at 35. Discharged from hospital in pyjamas without shoes back to under the railway bridge. Chronic leg ulcers. Violent, aggressive behaviour. Four children, no contact with them. Died at 40 of haematemesis. Two of his children now homeless, addicted, depressed.This man, his father, and his children, have been failed by their health system and society. Look around the streets and see the people on the benches, in the bus shelters, under the bridges, by the canals, and in the hostels. How can they best be helped?Government leadership is crucial, especially in times of economic hardship. Employment, housing, and welfare policies, and a legal framework to iron out inequalities in health, are fundamental. But health-care workers can do more to ensure that excluded groups, such as the homeless, sex workers, prisoners, migrants, and gypsies and travellers, receive the health care they need.Inclusion health, also defined as health care for excluded groups, was the subject of the inaugural conference of the UK Faculty for Homeless and Inclusion Health, held in London last week. Passionate and inspirational leaders in inclusion health shared their experiences of providing specialist health care for the homeless in primary care centres in London and Oxford. Street medicine practitioners in Boston, Pittsburgh, and Dublin were praised by service users attending and speaking at the conference, for their commitment in founding services in their cities. Rapid access to integrated services—health, housing, social care—is needed. Training of students is crucial. Never give up on anyone was the resounding message. We agree. To encourage research and best practice, The Lancet commits to a Series on inclusion health, which we hope will promote research and continuing debate, and ultimately make a difference to those currently excluded. Sexually abused at 14 years old by an alcoholic father. Left home for the streets. Alcohol dependent by 15. Sex work. Intravenous drug dependent by 17. Hepatitis C by 19. Epilepsy and anxiety disorder. In and out of hostels, hospital, and prison (for violence, theft, drugs) in 20s and 30s. Not registered with a general practitioner. Rough sleeping at times, hostels at others. Tuberculosis at 35. Discharged from hospital in pyjamas without shoes back to under the railway bridge. Chronic leg ulcers. Violent, aggressive behaviour. Four children, no contact with them. Died at 40 of haematemesis. Two of his children now homeless, addicted, depressed. This man, his father, and his children, have been failed by their health system and society. Look around the streets and see the people on the benches, in the bus shelters, under the bridges, by the canals, and in the hostels. How can they best be helped? Government leadership is crucial, especially in times of economic hardship. Employment, housing, and welfare policies, and a legal framework to iron out inequalities in health, are fundamental. But health-care workers can do more to ensure that excluded groups, such as the homeless, sex workers, prisoners, migrants, and gypsies and travellers, receive the health care they need. Inclusion health, also defined as health care for excluded groups, was the subject of the inaugural conference of the UK Faculty for Homeless and Inclusion Health, held in London last week. Passionate and inspirational leaders in inclusion health shared their experiences of providing specialist health care for the homeless in primary care centres in London and Oxford. Street medicine practitioners in Boston, Pittsburgh, and Dublin were praised by service users attending and speaking at the conference, for their commitment in founding services in their cities. Rapid access to integrated services—health, housing, social care—is needed. Training of students is crucial. Never give up on anyone was the resounding message. We agree. To encourage research and best practice, The Lancet commits to a Series on inclusion health, which we hope will promote research and continuing debate, and ultimately make a difference to those currently excluded.