Public Health's Role at the Intersection of Health and Homelessness

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Background

People experiencing homelessness need system change and services to help them protect their health. This not only means addressing root causes of housing insecurity – economic, social, educational, safety – that push people into homelessness and poor health. It also means recognizing the longer people experience homelessness and have inconsistent access to medical care, the more their health and well-being will deteriorate. Data shows people experiencing homelessness have a higher burden of illness, including chronic disease, infectious disease and behavioral health conditions, than the general population.¹ Data also shows people of color, especially Black/African American and Indigenous communities, experience homelessness at higher rates than white communities due to long-standing structural racism.² People who have survived adverse childhood events and other forms of trauma, who may be escaping homes that are not safe or stable, or who are experiencing economic instability, may have health needs in addition to and compounded by their housing needs.³

Multiple entities in King County are working to promote health among people experiencing homelessness, working to address the root causes of homelessness, or both. This document summarizes the unique role of Public Health – Seattle and King County (PHSKC) in this ecosystem.

¹ CDC. Homelessness as a Public Health Law Issue: Selected Resources. March 2, 2017.

² National Alliance to End Homelessness. Homelessness and Racial Disparities. October 2020.

³ Oppenheimer S, Nurius P and Green S. Homelessness History Impacts on Health outcomes and Economic and Risk Behavior Intermediaries: New Insights from Population Data. Family Sociology, July 2016.

Public Health – Seattle and King County's Role: Promoting Health for People Experiencing Homelessness

PHSKC works to improve the health of people living homeless through a continuum of activities ranging from system change to health promotion to treatment. Providing health care for people experiencing homelessness represents our largest body of work.

We aim to promote health among all King County residents lacking permanent, stable housing. Homelessness in our county takes multiple forms. People may live on the streets, in a shelter, a vehicle, "doubled-up" with friends or family, and more. We seek to meet the various health needs that arise in these different situations.

The following figure illustrates our efforts to promote health by addressing root causes, preventing illness and providing treatment to people experiencing homelessness. These activities can be characterized as addressing the upstream, midstream and downstream causes and impacts of poor health among people living homeless.

Figure 1
Public Health – Seattle and King County's role in addressing causes and impacts of poor health among people living homeless.

Our activities

PHSKC operates using trauma-informed practices in the following capacities to improve the health and wellbeing of people living homeless. We take a collaborative approach and value relationship-building, flexible and respectful service models, and a diversity of backgrounds, lived experiences and perspectives among our staff and the people we serve. Our activities are guided by data and evidence, including best practices developed locally and in other jurisdictions.

• We inform policy and systems change to promote health among people living homeless. We recognize improving health depends on addressing underlying social determinants related to economics, education and safety. Support of health through housing is integral to the success of our other activities and to building trust with community.
  
  
• We collect, analyze and interpret data to understand the health-related needs of the population, and we seek ways to supplement existing data to better understand and serve the segment of the population that is living "doubled-up" with friends, relatives or others.
  
  
• We promote physical and behavioral health. This includes providing health education materials designed for people living homeless, providing preventive care like routine exams and cancer screening through our Healthcare for the Homeless network, and supporting the behavioral health needs of our community members through outreach and education, improving access to overdose prevention medications, and needle exchange programs. Our HEART team also provides direct health outreach at encampments and homeless service sites.
  
  
• We support hygiene, sanitation and access to drinking water in collaboration with homeless service providers and local governments, including publishing sanitation and hygiene guidance for homeless service sites.
  
  
• We prevent the spread of communicable diseases such as COVID-19, hepatitis A, shigella, flu and more through outreach, education, contact tracing, isolation and quarantine, and vaccination.
  
  
• We support emergency preparedness for severe weather events, disease outbreaks, natural disasters and more through guidance, education and planning, with an emphasis on building resilience among those communities most impacted by emergencies such as people experiencing homelessness.
  
  
• We respond to emergencies through our Emergency Medical Services division. We serve all of King County outside of the City of Seattle by coordinating five dispatch centers, five paramedic providers, and twenty-nine fire departments providing life-saving care for our community members, including those living homeless.
  
  
• We provide treatment for people experiencing homelessness, including bringing health care teams to streets, encampments, shelters and supportive housing, as well as serving people at our clinics. Our multidisciplinary teams offer a broad range of medical, dental, mental health, substance use and case management services. We promote a trauma-informed and culturally responsive approach to care. Our Healthcare for the Homeless Network sends health care providers from Public Health and nine community-based partner agencies to over 60 locations throughout King County in order to meet people where they are. We also provide medical respite.

Our collaborative work

PHSKC serves as a link to other King County agencies including our Department of Community and Human Services, which leads King County's housing initiatives. We also collaborate closely with other government entities, service providers, people with lived experience of homelessness, community-based organizations and more to achieve our shared goals.

Please contact Semone Andu, Regional Health Administrator for the Health Care for the Homeless Network, to explore additional opportunities to work together at sandu@kingcounty.gov