Presentation given by Dearbhal Murphy, policy officer in the FEANTSA secretariat, at a FEANTSA conference on "The Right to Health is a Human Right: Ensuring Access to Health for People who are Homeless", 2006

1. The Right to Health is a Human Right: Ensuring
access to Health for people who are Homeless
FEANTSA ANNUAL THEME
2006

2. Why Health?
 « Processes of extreme exclusion can reveal the
shortcomings of any system, including a
healthcare system. »
 Health has a role to play in understanding and
communicating about homelessness.
 Health is a crucial factor in being able to access
and maintain employment and housing.
 Health policy and health care systems have a
place and role in homelessness strategies.

3. The Annual Theme
 A detailed questionnaire was drawn up by
FEANTSA’s international expert group on
health
 The Adminstrative council member in each
country coordinated the drafting of a national
report – available on FEANTSA’s website and on
the conference CDs
 The European report was drawn up on this
basis, drawing together the commonalities,
highlighting shared problems and different
approaches and solutions.

4. The Right to Health for people
who are homeless
 The right to health – our starting point is that
health is a human right. People who are
homeless have the right to the highest attainable
standard of health and to a life in dignity.
 The health of many people experiencing
homelessness is a damning indictment of the
commitment of States to uphold the right to
health of their citizens.
 This right to health is the vital baseline to the
discussion on entitlements to healthcare and on
access to good health. It is both the basis for
action and the final aim.

5. The European Report - Findings
 Health Profiles of People who are homeless
 Entitlements to healthcare
 Barriers to accessing healthcare
 Efforts to overcome the barriers
 Access to quality healthcare
 Training to meet the needs of people who are
homeless
 Networking and interagency working
 Data collection on the health situation of people
who are homeless.

6. Health Profiles of People experiencing
Homelessness
 Physical health problems and substance abuse
 Mental health and dual diagnosis
Multiple needs: a challenge to the medical
model
Treatment problems associatedwith the
situation of homelessness
- Assumption of « self-care »,
- Previous negative experiences of the
healthcare system,
- Competing needs,
- Difficulties recognising the need for care

7. Entitlements to healthcare
 Health and social protection systems in Europe
have made provisions for vulnerable groups to
access care at minimal or no cost
 BUT these provisions do not translate into real
access to quality care.
 Non-nationals in an irregular situation:
particularly problematic – emergency care only
 Evolution of the healthcare system:
 Negative impact of cost-cutting reforms
 Move from public provision to private sector can be
a problematic one for people who are homeless.

8. Barriers to Care
 Administrative and Financial barriers are very
commonly cited.
 Even a small charge upfront can be a significant
barrier
 Administrative procedures are complicated and
difficult
 « The gap between homeless and hospital life »
 Inflexible appointment systems, difficulties adapting
to hospital environment, cultural or linguistic
barriers, etc.

9. Efforts to overcome these
barriers
 Special low-threshold and outreach health
services
 Mediating role of homelssness services
 Flexible approach to administrative
requirements (such as local residency)
 Special public health insurance packages
to do away with the need to pay upfront
and await reimbursement

10. Access to quality healthcare
 Specialist care for people who are homeless –
can be tailored to their needs – BUT: specialist
Vs mainstream debate.
 Homeless services – often coordinate the
provision of certain health services
 Breakdowns:
 Mental health care and dental care hard to access
 Breakdown of care at the recuperative stage
 Provision of care in rural areas remains problematic
in many countries.

11. Conclusions
 People who are homeless do not enjoy
their right to health – States need to adopt
a proactive stance in light of their
vulnerability
 There is knowledge and experience in the
service provider sector that can facilitate
States in their work in this area
 Ensuring access to health is a vital part of
a strategy on homelessness