Original Article by International Journal for Equity in Health, cited below.

Summary by Simply the Basics

Researchers in Spain found that those experiencing homelessness have a life expectancy 30 years lower than their national average and have a lower perceived quality of health than the rest of the population. In a country where “all Spaniards and foreign citizens residing in the national territory have the right to health protection and medical attention”, as well as a law that states access to health services must be granted under “equal access for equal need”, why do their unhoused neighbors have such a large gap in health from their housed neighbors? This study aims to look at the conditions of public health services and tries to better understand the inequalities and inequities of access in Barcelona.

Homeless individuals have no political representation to advocate their interests, which places them in a severe situation of marginalization and institutional invisibility

For five months, interviews were performed with two focus groups of those living on the streets as well as those working in healthcare and social assistance.

The results showed that individuals were mostly accessing healthcare only once they were already seriously ill or suffered an injury and once there they would encounter a myriad of barriers arranged into three categories: 1) individual capacities and personal resources such as fear of discrimination or treatment pricing; 2) administrative health systems that are not adaptable for the particularities of this population; and 3) the truth that treatment tends to be minimalistic in comparison to other patient populations based upon work dynamics, biases and behaviors by healthcare workers. The results are further broken down in the study by economic capacity, knowledge levels, healthcare culture and understanding of the system, mobility, personal autonomy, and social support, adaption of the healthcare system and lack of resources, as well as the role of healthcare professionals such as attitude and perceived quality of care.

Sample Responses from Healthcare professionals

Sample Responses from Homeless Individuals

One finding of the present study is that homeless patients often complained about the treatment they received from healthcare professionals. This can negatively affect future visits to healthcare centers, so it seems vital that a homeless individual’s first visit to a healthcare center, whether primary care or hospital emergency care, be a positive experience

Their recommendations to improve inequities of services include more adequate care, increasing sensitivity/awareness among healthcare workers, developing more care units where folks experiencing homelessness reside most, and more healthcare collaborations that support the population.

As Hygiene Banks, we understand how important basic hygiene care is to our health and wellness and how creating trust between service workers and those who access services is crucial in developing positive relationships and long term support. It is important that we also understand the barriers that our neighbors may face when looking to establish a primary care provider or seeking medical attention and this study provides a glance into those barriers. We highly recommend looking at the sample responses above and reading directly from the unhoused community and healthcare professionals where they have found barriers to the healthcare system.

Citation: Cernadas, A., Fernández, Á. Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain). Int J Equity Health 20, 84 (2021). https://doi.org/10.1186/s12939-021-01409-2