Published by: Katie Reid on 8/16/2010 10:25:01 AM
Country songs often get a bad reputation (the old “my tractor broke, my boat sank, and I lost my dog” stereotype), but I love their way of bringing attention to topics that are so often overlooked. This morning, a song by Mark Wills called “Don’t Laugh at Me” came on the radio. The song’s verses tell the story of a man and the tragic events that led him down the path to poor health and homelessness:
“I'm the cripple on the corner - you've passed me on the street. And I wouldn't be out here beggin' if I had enough to eat. And don't think I don't notice that our eyes never meet.
I lost my wife and little boy when someone cross that yellow line. The day we laid them in the ground is the day I lost my mind. And right now I'm down to holdin' this little cardboard sign.”
Every time I hear the song, the line “And don’t think I don’t notice that our eyes never meet,” brings a tear to my eye. Each day, we see (and often ignore) the faces of homelessness: the Vietnam vet on the corner asking for spare change, the man sleeping on a park bench using rain-soaked newspapers as a blanket, or the woman shouting as she walks down the sidewalk fighting an endless battle with her inner demons. Most don’t have adequate access to health care and are at increased risks for having poor physical and mental health. For some, it was poor health that led directly to their homelessness. Now that health reform has passed in the US, will the homeless finally receive the full access to health care that they need?
The article, "Universal Health Insurance and Health Care Access for Homeless Persons" published in the August 2010 edition of the American Journal of Public Health, can help shed light on that question. Dr. Stephen Hwang and his colleagues discuss the barriers to care and the extent to which the health care needs of the homeless of Ontario were addressed under Canada’s universal health insurance system. Under the universal health insurance system, all care which is deemed medically necessary (physician-services and hospital-based care) is fully covered and no co-payments are required. However, the study found that despite the universal health coverage, homeless patients were still at a much greater disadvantage for receiving proper care to meet their health care needs.
The study found that having worse physical and/or mental health status was associated with increased odds of having unmet health care needs. Those homeless who were of a younger age were also more likely to have unmet care needs, frequently citing fears of being negatively judged by health care professionals as a common barrier to getting proper health care. Additionally, women with dependent children were unable to meet their health care needs at a rate more than double what the authors expected.
The study also had some surprising results. Despite Canada’s system of universal health care coverage, 32% of the study’s homeless population did not have a primary care physician. Additionally, 31% of study participants could not receive proper health care because their health insurance card (which is required as a proof of insurance) had been lost or stolen. These findings are important to show that despite having universal health care coverage, not all of those people who are eligible are receiving the proper care and the homeless still face challenges in receiving health care.
So what does this mean for the homeless in the US now that health reform has passed? Even though most of the homeless will now be eligible for health care coverage at little to no cost, we still must focus on developing strategies to reduce the barriers the homeless will face. Dr. Hwang and his colleagues suggest examples of strategies, including creating primary prevention programs for physical assault, emphasizing the importance reducing the stigma of homeless individuals among health care professionals, and creating special programs to provide primary care to the homeless. Additionally, programs like the 100,000 Homes Campaign (discussed in earlier a post by Dr. Jim O’Connell) can help provide permanent housing for homeless patients, bringing stability into their lives. Hopefully, with interventions like these to supplement the benefits of health reform, those who suffer from homelessness may be able to get back on their feet and on the road to a happy and healthy life.