The speed at which the global research community has responded to the COVID-19 pandemic is staggering, with a large number of studies published over only a couple of months. Yet, no studies so far have looked at the impact of COVID-19 on those experiencing homelessness. However, we can still use existing evidence to inform our thinking and it paints a clear picture – people experiencing homelessness are at higher risk during the COVID-19 pandemic based on three interconnected facts:
The initial studies conducted in China (c.1,600 patients and c.72,000 patients) identified that people with these conditions were more likely to require intensive care, a respirator, or both; and also faced a higher risk of death. Data from Italy also showed a similar pattern. In the UK, a very large share of those who have lost their lives to COVID-19 had an underlying condition.
Cardiovascular conditions and other related conditions such as hypertension are common conditions among the population at large. Acute respiratory infections have well-known medical effects on the cardiovascular system that increase the likelihood of death, for example due to cardiac arrest. Initial reviews show that these mechanisms also operate with COVID-19-related infections and are consistent with the risk factors seen with other respiratory viruses like the avian flu.
In the words of Dan Lewer, the relationship between income and health outcomes could be described as climbing a mountain with a constant slope - with health deteriorating consistently for those from deprived backgrounds - while the relationship for those who are not housed is dramatically different: more like falling from a cliff.
Public Health England recognises that income is one of the key determinants of poor health outcomes while a study of 1.7 Million people in Scotland showed that people from more deprived backgrounds are more likely to suffer multiple existing health conditions, and that they can appear 10-15 years earlier than those from more affluent backgrounds. This study also found that people who were ever homeless, even just once, also had worse health outcomes than people from the most deprived areas who had never experienced homelessness..These results are very consistent both in the UK and internationally.
Focusing on homelessness and cardiovascular health more specifically, a systematic review and meta-analysis showed that people living in homelessness in developed countries have a higher prevalence of cardiovascular disease and respiratory conditions, and are also at a higher risk of premature death; acute respiratory diseases are also more common among this group. These facts are consistent with the findings of recent surveys in London and Birmingham that found that cardiovascular diseases and chronic respiratory conditions are between twice and ten times more common among the homeless population even in comparison to those most in need.
While the research community, governments and society at large focus efforts on developing measures to contain the pandemic and ultimately find a cure, and rightly so, it is also crucial to understand who is likely to need the most support. And people experiencing homelessness are amongst those who might be facing the highest risks.
As the COVID-19 outbreak rapidly unfolds, limited resources are being stretched, but local communities are trying to stop and learn from other cities and share experiences. To support local areas’ homelessness response, we launched a new COVID-19 talk series, where city leaders, clinicians and other guests from all parts of the UK and beyond will share lessons and recommendations.
Addressing the evidence gap in using social investment to tackle homelessness
New solutions to addressing homelessness have never been more important. Ending rough-sleeping in England by the end of this parliament remains a UK government commitment, but the challenge is likely to get tougher during the current cost of living crisis. Social investment could be one solution. Find out more about the Everyone In Social Investment pilot and how it will help to address the evidence gap in the role of social investment in ending homelessness.
What makes a hostel effective?
In this blog Jeremy Swain, as associate at CHI, outlines the of research into hostels. He makes the case that the sector needs a shared agreement about what defines a hostel, stronger evidence of which types of provision are effective for different groups and an improved understanding of the role of hostels as part of a system of services intended to help people escape homelessness. Jeremy’s experiences as CEO of Thames Reach and senior advisor to the government’s Rough Sleeping Taskforce provide multifaceted insights into of the nature of the sector and challenges it faces.