Introduction by Croakey: A big test for many concerned with the social determinants of health will be on whether tonight’s Federal Budget sufficiently addresses Australia’s housing crisis.
Pre-Budget submissions by Everybody’s Home, the Australian Council of Social Services and Homelessness Australia made strong calls to address the conditions that are driving more Australians into homelessness.
Homelessness and Australia’s housing crisis impacts physical and mental health directly, as well as broader social determinants of health including employment and income. Recently published at Croakey, Dr Blair Williams and Chris Hartley also argue that homelessness and housing should form part of long COVID discussions and policies, following a Health in All Policies approach.
In the below article, Dr Rachel D Zordan, Dr Jessica L Mackelprang and Associate Professor Vijaya Sundararajan discuss the impacts of homelessness and unstable housing on children and say that “health and housing are basic human rights. And stable housing is a critical determinant of health”.
The article was originally published at The Conversation under the headline: “Homelessness today sees workers and families with nowhere stable to live. No wonder their health is suffering”.
Rachel D Zorda, Jessica L Mackelprang and Vijaya Sundararajan write:
They may be living in a motel room, vehicle, tent or caravan park. They may be on a friend’s couch or on the street.
They may be exposed to health hazards, including excessive heat or cold, poor ventilation or mould, injury, overcrowding, vermin, violence, or a combination of these – all while trying to hold down a job or getting their kids to school.
Here are some of the unique physical and mental health challenges of being homeless today.
Housing is too expensive
Unaffordable housing is a leading cause of homelessness in Australia. And having a job no longer guarantees secure housing.
A recent report from Anglicare Australia described just how hard it is to afford a private rental in 2023, even if working full time on the minimum wage.
Families with children are homeless and living in insecure housing, too. Figures from the last census show around 19,400 children aged up to 14 years were homeless that night, either with their families or alone.
Impacts on health
For decades, we’ve known people’s health suffers if they experience homelessness. This has included our own research into homelessness among people who attend emergency departments, which shows the long-term consequences of unstable housing.
We found that even being marginally housed (at risk of homelessness) was enough to increase mortality rates. These people died, on average, six years earlier than people who were housed.
Steep housing costs, poor dwelling conditions, overcrowding, and evictions leave people vulnerable to illness, injury, and victimisation.
We know overcrowding directly contributes to poor physical health, such as infectious diseases and injuries.
Unstable housing contributes to unhealthy behaviours, such as substance use and poor diet, which can compound over time. Unstable housing may also disrupt access to health care, including to prescription medications, causing people to delay seeking care.
Being homeless increases the likelihood of being the victim of violent crime, which threatens physical and psychological health in the short and long term.
Understandably, the psychological wellbeing of adults experiencing homelessness is worse than the general population.
Lack of routine and loss of a sense of home and community can lead to social isolation and onset or recurrence of mental illness. Indeed, post-traumatic stress disorder, substance use disorders, and suicidality (thinking about or attempting suicide) are more common in people who experience homelessness.
Impacts on children
When crammed into undersized spaces or places not meant for people to live, a lack of space for cooking, playing, or schoolwork can have their effects, particularly on children.
For instance, children who live in overcrowded homes are more likely to have poorer mental health and do less-well at school.
Children’s long-term health may also be affected if preventative health care, such as immunisations or dental visits, are missed.
Working while homeless is uniquely challenging.
People who work and are homeless may hide their homelessness out of shame, fear of judgement, and worry about losing their job.
Workers who are rough sleeping report particular struggles. Getting adequate sleep is difficult and even risky. Maintaining good hygiene and clean clothing is tough. Transport to and from work may become difficult to afford.
Human rights issue
Health and housing are basic human rights. And stable housing is a critical determinant of health.
But as recent evidence shows, even renting is unaffordable for some, despite working full time.
It’s time we acknowledged the impact of structural issues on homelessness, including housing affordability and the job market, rather than blaming individual risk factors, such as substance use or mental health difficulties.
We also need to tailor support services for homeless people so they are suitable and affordable, as well as being close to family, friends and children’s schools.
About the authors and disclosure
Dr Rachel D Zordan is a Research Fellow at St Vincent’s Hospital Melbourne and Honorary Research Fellow at the University of Melbourne. Zordan receives funding from St Vincent’s Health Australia.
Dr Jessica L Mackelprang is a Senior Lecturer in the Department of Psychological Sciences at Swinburne University of Technology. Mackelprang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Vijaya Sundararajan is an Associate Professor of Epidemiology and Biostatistics in the Department of Medicine at St Vincent’s Hospital. Sundararajan receives funding from St Vincent’s Research Endowment Fund.
See Croakey’s extensive archive of articles on the housing crisis.