Homelessness: A Tale of Two Publications

By Neil Stewart, The City View

Sunday reading had a nasty surprise in two of my favourite publications – The Lancet and the Croydon Advertiser. The Lancet’s research paper on Inclusion Health revealed that people who are homeless: excluded; addicted; prisoners; and sex workers, suffer 10 times worse mortality than the mainstream population and the figures are worse for women than men. We, who work with the lead charity Pathway, had always suspected this but the figures were cruel and shameful to read.

The Croydon Advertiser revelations were in a small two column list on page 9. Under the headline “Rise in rare and deadly conditions”, it reported on a freedom of information report from Croydon, one of 32 boroughs in London, that listed for 2016/17 6 cases of typhoid fever, 60 of tuberculosis, 5 of scurvy, 5 measles, 5 of polio and 210 cases of dysentery. Croydon is much maligned in the press for its love of concrete and bad design but, let’s be honest, it is one of the wealthiest and fastest growing boroughs in one of the richest cities in the world. So typhoid, TB, scurvy, polio and dysentery on my doorstep was a sharp reminder that all is not well in our living, breathing communities.

Unless public policy gets a grip on homelessness and exclusion, the price of people in extreme poverty being excluded may be paid by more than the poor. The price of being ignored or marginalised by the rest of us will be paid not just by the individuals who die younger; have less healthy lives; children and relatives who suffer neglect, abuse and share the exclusion. It will be paid by people who travel on the tube with someone with TB, get measles or polio from someone who fell outside the immunisation system or is at risk of polio – a disease believed eradicated. When you think about the air we breath in London it is not just carbon emissions we should be worrying about.

The government has a separate plan to eradicate hepatitis C by 2030 and a careful, planned, annual spend to achieve it, but every clinician I speak to says that won’t be achieved without a tenfold effort targeted among the homeless and excluded, especially drug users in the worst hotspots. If not, it will incubate in the excluded population like the growing threat of antibiotic resistant TB.

In a recent seminar with Pathway one delegate estimated the cost of treating a homeless person with multiple needs at 13 times the average patient cost. They have no where to turn to except A&E. They are not clogging the system – this is their only system and the result of neglect and failures of every other part of our welfare state. Rethinking Homelessness, the annual Inclusion Health expert symposium has been showcasing treatment pathways and clinical and voluntary sector innovation for 5 years, but the causes keep coming back to the core issue of homelessness.

The Lancet report ended with a powerful editorial from Sir Michael Marmot in which he borrows from Bentham to say “social exclusion is deprivation on stilts” . Andrew Hayward from UCL’s institute of epidemiology and healthcare uses the figures as a warning: “ Socially excluded groups are the canaries in the mine, they point to something toxic in our society”. He may have been speaking of moral, political and policy neglect by the majority but there is a more literal interpretation of that warning that needs to be heeded.

Marmot ends by saying “ we need the involvement of society as a whole to tackle the causes of the causes of social exclusion and its dramatic health consequences. This approach might save money and it is the right thing to do.”

The moral and humanitarian case for tackling homelessness and exclusion is uncontestable, but it is always worthwhile reminding the comfortable majority of the threat to their own health and their utilitarian self interest in tackling homelessness if you want action.

So let’s congratulate The Lancet, but let’s hear it for the Croydon Advertiser.

Register for “Rethinking Homelessness” Homeless Inclusion Health 2018 here.

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