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Shelter, homelessness and public health

As coronavirus took hold earlier this year, states across the world began to lockdown. We were told at various points, across multiple geographies, to protect ourselves and others by staying at home and practising physical distancing. And throughout the outbreak, the importance of these measures for infection control has become markedly ever clearer.

What has also become evident is the overwhelming and sometimes insurmountable difficulties that social distancing and shelter-in-place orders pose for some. This is especially so for rough sleepers, many of whom have nowhere to shelter in the first place. Yet challenges also arise for those housed, but whose accommodation lacks the safety that most would associate with a home. These people may thus fall under broader definitions of the term ‘homeless’ and include:

  1. those experiencing domestic violence, whose ‘home’ may be a place of exacerbated danger in the context of shelter-in-place orders compelling people to stay indoors, or
  2. those living in hostels, refuges or informal housing/encampments (typically confined living spaces that are conducive to disease transmission)

Such circumstances force us to recognise that, in real terms, shelter represents more than merely having a roof over one’s head. The COVID-19 response has shown us that shelter is actually about having a place of safety – safety from the elements outside, safety from violence and, crucially, safety from ill-health.

With housing, but without shelter?

Given their lack of shelter – or, in other words, safe housing – people experiencing domestic violence and other homeless people have been identified as particularly vulnerable in the context of COVID-19 and the international coronavirus response.

For domestic violence victims, the consequences of lockdown include being trapped with perpetrators, experiencing intensified abuse and trauma, and having fewer opportunities to leave the house to escape or access support. For those able to leave, COVID-secure refuge spaces are not necessarily available, with many providers finding themselves overstretched and under-resourced. These circumstances leave many facing a choice between unsafe housing and no housing at all. The health risks of each are dire.

Meanwhile, for homeless populations living in congregate settings, such as hostels with communal living spaces, shared facilities also pose a threat. increased exposure to the virus. Should they contract COVID-19, they also risk becoming seriously ill, given the increased prevalence among this population of underlying respiratory conditions. sanitation facilities may be especially scant

Tackling coronavirus and its ‘shadow pandemics’

As a result of these circumstances, we have seen media outlets decrying the harms of the deadly ‘shadow pandemics’ of domestic violence and homelessness. This has been followed by governments worldwide increasing emergency accommodation for these groups, but also striving to make facilities safer in hostels and refuges; improving sanitation infrastructure in informal settlements; pledging considerable sums to services supporting those in abusive households.

Thus, as states have issued stay-at-home orders to protect citizens from COVID-19, so too have they been compelled to recognise the centrality of and genuine need for safe housing – shelter – to facilitate that public health mission.

Shelter: a public health priority not to be forgotten

The COVID-19 emergency has thrust into view the importance of shelter for public health; with shelter understood not merely in terms of accommodation, but as housing that provides safety from a range of threatening elements.

This imperative, however, is not something that is confined to the current context of coronavirus. While the coronavirus outbreak has highlighted the acute health vulnerabilities faced by populations without safe housing, these vulnerabilities pre-existed the virus. And, without action, they will surely outlive it.

Even before the coronavirus outbreak, the health implications of homelessness included lower life expectancies, higher morbidity and poor mental health. Meanwhile, victims and survivors of domestic violence have long reported a considerable health and wellbeing burden, including chronic pain; chronic disease; suicidal thoughts; and post-traumatic stress disorder. Negative health outcomes are likewise common among other groups living in abusive settings or under-resourced congregate arrangements.

This tells us that having a safe home is, has always been, and will remain of critical importance for health. Shelter – that is, housing which offers protection from the elements outside, from violence, and from ill-health alike – must therefore continue to be a public health priority, even when coronavirus starts to look like a thing of the past.

Author Details: PJ Annand is a researcher in social science at King’s College London. PJ’s work revolves around health and social inequalities, focusing on homelessness, violence and gender. PJ is also on twitter – @DrPJAnnand.