Bernie Pauly is a professor of nursing at the University of Victoria; Marilou Gagnon is an associate professor. Both are scientists with UVic’s Canadian Institute for Substance Use Research.
Most of us understand that it is better to prevent something bad from happening than suffer the consequences. Prevention is the cornerstone of public health and it matters for both individual and collective health.
This has been brought home again and again over the past weeks as individuals, groups and communities have taken seriously public health orders and the important prevention measures that are needed to protect our health and health care system during COVID-19.
By washing our hands, physically distancing, staying at home and self-isolating, we are all doing our part to prevent the transmission of COVID-19 and “flatten the curve.”
However, these prevention measures assume that everyone has a home and the resources to stay at home. But what happens when you don’t have a home? For people who experience homelessness, these prevention measures are out of reach.
Physical distancing is simply not possible in our permanently overcrowded, underfunded, understaffed shelter system. Furthermore, regular hand washing cannot be done without access to public washrooms equipped with a sink, soap and water.
Finally, self-isolation is impossible when people are forced to share amenities in our shelter system, or they are required to stand in crowded offices, buildings, and streets in order to access services, medications, and care. And to make things worse, many programs on which homeless people rely on for food, bathrooms, showers and laundry have now limited access or have closed their doors in order to meet public health requirements making daily survival even more challenging.
Bottom line: This pandemic is exposing the woeful inadequacy of the emergency responses we have been relying on for decades to manage rather than prevent homelessness. Preventing homelessness is critical and part of overall public health prevention now more than ever.
We have long known that homelessness is bad for one’s health. People who experience homelessness are more likely to die prematurely often 20 to 25 years sooner than the rest of the population.
Being homeless makes it far more likely someone will have chronic health problems including respiratory problems and compromised immune systems.
These communities are already grappling with multiple systemic failures and public health crises: homelessness, food and income insecurity, infectious disease epidemics and a declared public health emergency due to overdoses. All are being escalated by COVID-19.
Building a response to COVID-19 and homelessness that continues to rely on emergency measures is not prevention, is escalating pre-existing crises and continues to put people’s health at risk.
Access to affordable and adequate housing is ground zero for prevention of COVID-19. This is true for the general population and it is true for the homeless population.
In a recent statement, the UN Rapporteur on Housing described housing as the frontline prevention for COVID-19. Despite this, and despite the calls for and evidence of economic effectiveness of homeless prevention, governments seem determined to continue using ineffective emergency measures during COVID-19 regardless of the health risks to people who are homeless.
Proven prevention approaches include rapidly housing people in hotels and housing rather than creating physically distant indoor shelters, setting up open-air shelters, or other designated locations for warehousing homeless people that make physical distancing a charade and self-isolation a myth.
If we are to take prevention seriously, we have to take it seriously for everyone.
For homeless people, prevention has to go beyond issuing orders that some cannot comply with to provision of housing, an already established evidence-based prevention for homelessness and key to COVID-19 prevention. When governments fail in fully enacting a prevention agenda, people wo experience homelessness have few options to protect their health.
COVID-19 reminds us, we are all connected and we all need the same basic necessities to stay safe. These necessities cannot be assumed. There has never been a time when it is more possible to immediately provide housing.
As a society, we need to hold governments accountable for ensuring that the public health and prevention agenda applies to everyone.
