Since the 1980s, the poverty rate has grown in the United States, Britain, and Canada—a trend that corresponds to the shift away from Keynesian economic models towards a new fabric of relations between the state and civil society. This new fabric consists of neoliberalism in the form of deregulation, fiscal austerity, and the corporatization and privatization of the public sector.
The phenomena of homelessness and poverty are not new, and neither are the responses they generate. Typical reactions are to stigmatize poor people and to distinguish between those that are “deserving” or “undeserving” of societal support. The actions (and inactions) of governments at the federal, provincial, and municipal levels have contributed to the problem.
In an academic sense, homelessness illustrates how the individual can be subordinated to the body politic. Fundamentally, poverty is rooted in a system that promotes the well being of some members at the expense of others, and thereby reflects the inability of sectors of society to gain adequate access to essential resources. Far too frequently, this disparity is reflected at the individual level in the psychological and physical correlates of anomie and ill health. Homelessness predisposes individuals to a plethora of acute health problems and exacerbates chronic health conditions, leading to further deterioration of health status.
While health is undoubtedly a complex issue—especially when it occurs in the context of poverty, addictions, and social marginalization—its multi-faceted nature is often a barrier to public policy. The medical problems of the homeless are numerous and reflect the lives they lead. These hardships tend to divert attention away from the simple policy solutions that need to be implemented. Examples include the provision and subsidy of affordable housing, the implementation of welfare rates that are tied to an “acceptable standard of living”.
It is tragic that more than a quarter of a century after the World Health Organization recognized that “the fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity,” there has been a wholesale abandonment of these principles at the policy level [Ottawa Charter, 1986].
There needs to be the explicit recognition that social inequities constitute and compound health care issues. Typically, the intended impacts of policies aimed at reducing poverty and income inequality are economic and social. Health outcomes are not usually the target of these efforts. This arbitrary division between health care and socio-economic policy is a substantial barrier to the promotion of health, as Geoffrey Rose concludes: “The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart.” (Rose, 1992).
Pieter de Vos, PhD Candidate (Anthropology), MSc Public Health
Director, Board of Directors, John Harvey Lowery Foundation