Why public health approach to Covid should lead to a step change in how we tackle homelessness – Melissa Espinoza

Now that Covid-19 vaccines are being rolled out, we are starting to return to a busy society, planning for celebrations, festivals and, for some people, a first visit home in a long time.

Transitions can be uneasy, uncomfortable, and stressful. They are a reminder of change and, for some, anxiety that is rooted in a lack of control and the unknown. However, for people experiencing homelessness, transition is often a constant state.

For many people, the pandemic was the first time they experienced the lack of choice over, for example, when or how long you can leave your home, where you can go, or even food because of flour and pasta shortages early in the pandemic.

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Yet, many homeless shelters have decided such choices for their residents long before Covid-19 For people staying in temporary accommodation or night shelters, autonomy is often limited by the rules of organisations and a constant state of transition.

They are often told when they can rest or be out, if friends or family may visit, and what will be offered for dinner. People's choices and agency are reduced to fit what works best for everyone else – not necessarily for their well-being.

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Cities across the UK saw a dramatic decrease, even if short-lived, in the number of people sleeping outdoors due to efforts to reduce the spread of Covid-19.

Government guidelines for everyone to shield, quarantine, and practice social distancing could not be done in shared spaces. During the pandemic, many shelters in Scotland and the UK moved away from shared spaces and night shelters, using hotel rooms instead.

People can stay homeless for long periods because the system designed to help them is not fit for purpose, says Melissa Espinoza (Picture: Andy Buchanan/AFP via Getty Images)

For those with “no recourse to public funds” restrictions attached to their migration status, this pandemic would be the first time they would have been offered their own accommodation and not have to be in shared accommodation or night shelters.

People experiencing homelessness are vulnerable to several kinds of risk, particularly around health, well-being, and safety. The pandemic has shifted the perception of the role of public health and challenges us to ask ourselves: what does everyone in society need to be protected?

Everyone has the right to feel safe. Everyone needs a place to rest and recover from ill health. Everyone needs a place to maintain good health and practice activities that are positive for their mental health. They need privacy.

How many of our temporary shelters or similar accommodation are set up to offer this? Not enough, and these are often some of the reasons why many people continue to sleep rough. This is not caused by shelters themselves, but by a lack of investment in them and coherence in policies designed to tackle homelessness.

People often point to drugs, alcohol, and the lack of work as the main reasons why people are sleeping rough. But these reasons alone are only partial and based on ignorance that does not encompass other factors like access to healthcare, including mental health services, drug-and-alcohol treatment, benefits, a living wage, the cost of living, and the environments of the limited accommodation available.

When people first become homeless, they may think it will only be a temporary problem, but the current systems in place and often the standard of accommodation itself exacerbate experiences of homelessness and can turn it into a long-term issue.

Essentially, people can stay homeless longer in a system that is intended to resolve their homelessness because that system is not fit for purpose. People are often put in positions of having to make choices based on survival rather than focusing on moving on from homelessness.

Yes, some people experiencing homelessness engage in risky or harmful practices to cope with trauma, undiagnosed medical conditions, and the stresses of being without shelter. And some do not.

However, when people are in supported accommodation and have safe shelter, they can get connected to GPs because they have a permanent address and get the treatment they need, and they are less likely to become victims of crime than when sleeping rough in public spaces.

Appropriate accommodation helps prevent avoidable health problems – like Covid – and keep chronic illnesses under control. Consequently, more safe, affordable housing would mean fewer people had to utilise urgent and emergency care, because they would be able to engage in more preventative health measures and treat illnesses before they get worse.

Many people want to centre conversations about homelessness around what certain people deserve. Housing and health should not be privileges and benefits of wealth. They should be seen as answers to obstacles in the way of the well-being of everyone. Providing people safe, affordable, and, when needed, supported housing is necessary for the general welfare of individuals and the wider community.

There are essential resources and services our communities need individually and collectively. It should not fall on grassroots groups, individuals or non-profits to always make up for what the government fails to address.

The rise in the need for food banks is not acceptable. Sure, it is a noble act of selflessness to create a food bank for people without food. However, creating more food banks does not solve hunger. Let us address why people cannot afford food.

Similarly it is not enough to only treat people when they are sick, we must work to prevent people from getting sick.

Preventive care is the best approach to maintaining good health. We can prevent certain types of illnesses by proactively putting measures into place to minimise risk.

We need a similar preventative approach to homelessness with eviction-prevention policies, robust welfare system, more accessible healthcare services and minimum income guarantees. The fight against Covid-19 has shown what we can do in a crisis, now we need to deal with the homelessness crisis with the same vigour.

Melissa Espinoza is a PhD researcher at Heriot-Watt University

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