The ongoing public health emergency has made it more obvious than ever that housing and health are intrinsically interlinked. Housing is a social determinant of health, but it is rarely considered in health policies. But in times when we are advised to stay at home in a quarantine or self-isolate, it becomes evident that it is the main health setting in our lives, and one cannot enjoy their right to health without a safe home.
Living without a home, rough sleeping or staying in temporary accommodation is very damaging for health. Homeless people often have many complex health issues, including tri-morbidity (the co-existence of physical and mental health and addiction problems). Homeless people also face a number of barriers accessing health care as well as public health information. Due to their compromised immune systems, poor nutrition and hygiene and long-term residence in overcrowded shelters they are at risk of contracting contagious diseases. We know that homeless people are 20 times more likely to be infected with TB than the general population and they are a particularly vulnerable group in the current COVID pandemic. Moreover, many of the measures aimed at the general population – self-isolation, increased hygiene, staying at home, strict social distancing – are not a realistic prospect for people experiencing homelessness. If this gap is not addressed, these and other vulnerable members of our societies will be left out from the public policy responses to the pandemic. Transmission from this high-risk population is also difficult to contain, meaning that protecting people experiencing homelessness is an important element of managing the wider public health crisis.
Calls on local, regional, national and European public authorities to work with homeless service providers to ensure that resources and attention flow to measures to meet the special requirements of people experiencing homelessness in in the context of the COVID-19 pandemic and make sure that no-one is left behind. Core priorities right now should include active case-finding through testing; providing access to emergency housing that is fit for isolation purposes; making existing shelters safe places for homeless people to stay; and treatment programmes.
Homelessness must be considered a public health priority. A public health emergency requires emergency solutions and crisis management, and there are such initiatives including making vacant housing and hotels available for homeless people to self-isolate. However, it is also an opportunity to reconsider policies that are not working and to shift to long term thinking. The current crisis clearly show that shelters cannot replace the safe homes that are indispensable for a healthy life for all.
Support for homeless people should not only include those experiencing homelessness but also be concerned with protecting those vulnerably housed who are at a higher risk of homelessness because of the economic impact of COVID-19 outbreak. Mortgage holidays have been announced in several countries. Similar measures for renters, who are often more vulnerable in the short term, should be developed. Specific measures targeting the insecurely housed are needed, such as a moratorium on evictions to stop people losing their housing during the pandemic. Broader measures to protect vulnerable people from the economic impact of the pandemic will also be important next steps.