Running head: HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

Health Care Disparities and Health Care Policy Tori Gwilt Ferris State University

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY Abstract Homelessness is defined as either an acute or chronic state of being without a permanent residence. Homelessness is a devastating health disparity that affects millions of people around

the globe; it is also a condition that leaves its mark on hundreds of thousands of Americans each year. This disparity has the power to reach across genders, age groups, nationalities, religions, and educational levels. There are two important social determinants that play a crucial role in homelessness. The first is the attitude and belief system followed by the majority of the American population that negatively labels the homeless population. The second social determinant is the blatant lack of access to available health care services, mainly due to the high cost. A federally run program known as Health Care for the Homeless provides a glimmer of hope to the population; this program offers much needed physical and mental health related care to homeless individuals. The current health care system employed by the United States represents a negative feature in the homeless situation due to the high cost of health insurance coverage versus the high medical bill costs. Homelessness is an issue that has the ability to be eradicated as long as there is dedication, collaboration, and endurance.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY Health Care Disparities and Health Care Policy The term health disparity refers to the health related inequality that has been associated

with a specific group of people; it can occur as the result of a social, economic, or environmental gap between two parties (Healthy People 2020, 2013). The National Healthcare for the Homeless Council (2013) states that homelessness is a public health and societal problem. In line with this statement, homelessness is a health disparity that is too frequently ignored and disregarded. In fact, vagrancy is often looked upon as being a culpable quality; it is almost as if the homeless person is getting what he deserves. I believe that homelessness is a situation that can be minimized and eradicated with the collaboration of many organizations. Population and Health Care Disparity Homelessness is defined as the state in which an individual has no constant residence (National Health Care for the Homeless Council, 2013). According to the National Health Care for the Homeless Council (2013), a person of homeless status may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation. The National Alliance to End Homelessness (2013) estimates that in 2011 to 2012, approximately 3.5 million Americans were homeless for a period of time. There are many different reasons as to why homelessness arises. It often occurs from the lack of steady employment which results from a financial downfall of a person or family (National Alliance to End Homelessness, 2013). Homelessness also affects veterans, youth, and can occur as the result of a domestic violence issue (National Alliance to End Homelessness, 2013). This large assembly of people fall victim to many health care disparities. The most common issues include substance use and abuse, lack of healthcare screenings and treatment for medical conditions, no health insurance coverage, mental illness, and physical disability

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY (National Alliance to End Homelessness, 2013). In addition, the lack of monetary resources results in the shortage of necessities such as food. This phenomenon may be a contributing factor that results in illegal activities, such as breaking and entering and theft. Social Determinants

An article written by Healthy People 2020 (2013) defines social determinants of health as circumstances found in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. In essence, a social determinant of health is any socially grounded causative factor that leads to some type of inequality. Social Norms and Attitudes Poor and underprivileged individuals have endured a long history of discrimination, prejudice, and enmity. An article written in the Social Psychology Quarterly found that society frequently holds the homeless responsible for the state of vagrancy in which they live (Phelan, Link, Moore, & Stueve, 1997). The same article states that the stigma affixed with the title of homeless parallels that of the term mentally ill (Phelan, et al., 1997). This journal article exemplifies the fact that the homeless population must deal with discrimination and judgment from the population in addition to the adversities and afflictions already present as a result of being without a home. Lack of Access to Healthcare Services The homeless population characteristically does not possess health insurance (National Health Care for the Homeless Council, 2013). For this reason, a large number of homeless individuals who require medical care do not receive any sort of professional treatment. Inadequate health is therefore the source and one consequence that results from being homeless.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY According to the National Coalition for the Homeless (2009), there are many different obstacles for the homeless to overcome when attempting to seek healthcare treatment. The most common include a lack of knowledge about where to get treated, lack of access to transportation, and lack of identification,embarrassment, nervousness about filling out the forms and answering questions properly, and self-consciousness about appearance and hygiene when living on the streets (National Coalition for the Homeless, 2009). The most noteworthy difficulty that arises

when the homeless need to seek medical care is the cost of treatment. It is most often the reason as to why many homeless do not seek any sort of medical care (National Coalition for the Homeless, 2009). Lack of medical checkups and treatment result in a slew of maladies; the most common include certain types of cancer, cardiovascular issues, pneumonia, bronchitis, tuberculosis, hypothermia, frostbite, and integumentary problems (National Coalition for the Homeless, 2009). In addition to physical conditions, the homeless also suffer from many psychological issues. An article published in the Canadian Medical Association Journal states that many homeless either have or are prone to mental disability or post-traumatic stress syndrome, along with the those who have been a victim of domestic violence, have a history of drug and alcohol addiction and people who lack sufficient social support (Plumb, 2000). The National Coalition for the Homeless (2009) estimates that the blatant lack of healthcare intervention causes the homeless to be approximately three to four times more likely to die than the general population. Health Care Policy There are a multitude of policies and programs in place that both positively and negatively affect the homeless population in America. In this section, I will address the two programs that I feel are the most influential in this arena.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY Health Care for the Homeless

One positive policy is known as Health Care for the Homeless (HCH). This federally run programs purpose is to administer fundamental health care to people who are in a state of homelessness. HCH is also responsible for many different types of necessary treatment, including dental care, mental health treatment, supportive housing,substance abuse services, emergency care, outreach, and assistance in qualifying for housing (National Coalition for the Homeless, 2009). It is approximated that HCH provided care to approximately 1,018,084 homeless American individuals at various health care centers in the year of 2009 (National Health Care for the Homeless Council, 2013). Although this number is high, it only accounts for a fraction of the number of people who experience some type of homelessness in America every year (National Coalition for the Homeless, 2009). Current Health Care Program One negative policy that affects the homeless population is the current health care program in place in America. National Health Care for the Homeless Council (2013) estimates that approximately two-thirds (66%) of the homeless are uninsured. The present health care system allows insurance companies to run the gamut; they are able to charge an exorbitant amount of money per month for health coverage. The result is many citizens having to choose between staples (such as food and shelter) versus health insurance coverage. In addition, homelessness often exposes individuals to harmful elements and pollutants which increases the susceptibility to certain illnesses. This coupled with the lack of money and no health insurance coverage has the high potential to lead to health problems due to the conditions in which the person is living along with lack of preventative medical intervention and treatment for both acute and chronic conditions (National Health Care for the Homeless Council, 2013). According to the

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY National Coalition for the Homeless (2009), universal access to affordable, high-quality and comprehensive health care is a necessity in order to address the health aspect related to homelessness. In addition, a universal type health care system has the chance to decrease the financial burden and public transmission of infectious illnesses and disease processes. A statement made by the National Health Care for the Homeless Council (2013) says that when a health care system works well, we can help prevent and end homelessness. Contributing Factors Underlying Beliefs or Values The homeless in America are often thought of as a less important subdivision of the population. Many times, they are looked down upon for their unkempt appearance. The generalist American belief system attributes homelessness to a lack of education, mental illness, laziness, and a propensity for taking advantage of free handouts (The Suitcase Clinic, 2013). Much of the American population also believes that homeless people are responsible for their vagrant situation (The Suitcase Clinic, 2013). In addition, the accepted belief is that

homelessness only happens to those few people who have made poor choices in life. In truth, the Suitcase Clinic (2013) states that in everyday life 1 out of 3 people working today are one or two missed paychecks away from being homeless, especially the 37 million people currently living in poverty. Values Held by Those in Power The belief and value system held by the influential leaders of the United States seem to show concern and care for the homeless population. It is evident that the government is attempting to help by providing some vital resources. President Barrack Obama recently approved the renewal of over $72 million in grants in order to support a wide range of

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY programs including street outreach, client assessment, and direct housing assistance (Sullivan, 2013). I believe the main issue is that homelessness is a condition that runs so rampant that the government alone does not have the power, resources, or money to solely halt the problem. Homelessness is a multi-dimensional problem that requires a multi-faceted approach. I believe the resolution to homelessness needs to involve a combination of governmental support, money, community involvement, and participation from the homeless population. The reduction and eradication of homelessness is possible; however, it will require persistence, money, time, teamwork, and dedication in order to overcome homelessness and the subsequent health related disparities.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY Reference Healthy People 2020. (2013). Social determinants of health. U.S. Department of Health and Human Services. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives 2020/overview.aspx?topicid=39 National Alliance to End Homelessness. (2013). Snapshot of homelessness. Retrieved from http://www.endhomelessness.org/pages/snapshot_of_homelessness National Coalition for the Homeless. (2009). Healthcare and homelessness. Retrieved from http://www.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/ Phelan, J., Link, B., Moore, R., & Stueve, A. (1997). The stigma of homelessness: The impact of the label 'homeless' on attitudes toward poor persons. Social Psychology Quarterly, 60(4), 323-337. Retrieved from http://homeless.samhsa.gov/resource/the-stigma-ofhomelessness-the-impact-of-the-label-homeless-on-attitudes-toward-poor-persons21569.aspx Plumb, J.D. (2000). Homelessness: Reducing health disparities. Canadian Medical Association Journal, 163(2), 172173. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC80208/ 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

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY programs across the U.S. U.S. Department of Housing and Urban Development.

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