Image: The Hand from Sam Leighton's Flickr PhotoStream

The rise in rough sleeping is a result of policies of austerity and exclusion,  Yet, increasingly, public discourse frames homelessness as an individual problem.  How can we refocus, so that the health of homeless people becomes a barometer for the health of a city?

The death of a man in February who had been sleeping rough in Westminster underground station in London generated widespread media interest. Yet this media interest seemed to focus on the individual and their ‘choices’ rather than the political choices that produce homelessness.  As always, charity was seen as the core mode of response. A month ago, as snow was on the ground,  a radio story described the limits on emergency shelters for the homeless in Edinburgh and then a commentator said – seemingly oblivious to any contradiction – that some people are ‘putting themselves at risk’ by sleeping in the snow.

That a death occurred at the doors of parliament underscores the discomforting truth that homelessness is tied to political decisions. And yet public debate is neutralising this by ignoring systemic forces and seeing homelessness as an isolated issue, with homeless people seen as separate from the rest of society. Increasing levels of homelessness can be seen as direct consequences of austerity, financialisation of the housing sector, insecurity of private sector renting and flexible low-paid work. There is no attempt at a meaningful reform of a housing system that has clearly failed so many. A sociological analysis within this public debate seems urgent to ensure a more critical response to experiences of social exclusion. And yet, a too full-throated account of systemic forces may be alienating, even self-defeating. New frames for this debate are needed.

Crisis, a homelessness charity, recently outlined how social attitudes to the homeless echo this non-political tone, emphasising morality, individualism and choice. The person out of place on the street commonly elicits sympathy but also elicits responses around the individual needing to guide themselves towards recovery and as being held as responsible for their choices.

A public logic of ‘choice’ for sleeping in Westminster underground station or the Scottish snow does not really marry up to the practical experience – it seems a strange choice to make. The precarious health of people who are homeless reflects a lack of food, shelter and support. Rather than individual choice, these examples reflect political choices that led to the erosion of support services and social housing. It is these political choices, not individual choices, that have led to a steady increase in people sleeping rough and homeless since 2010.

Views that were once privately held are now spoken freely and indeed are written into hostile ‘defensive’ city architecture to physically exclude the homeless from public space. These citizens have suffered from the coarsening of public debate as attitudes towards the homeless ‘other’ have hardened. There is now a harsh economic, political and social climate in which the average age of death for a rough sleeping woman is just 43 (while the UK average is 82).

As the Crisis report argues, we need new frames for debate on homelessness that can respond to this harsh climate and a focus on individuals and their ‘choices’. They suggest an emphasis on systems and solutions. I imagine this programme of work echoes the wishes of many sociologists. Although sociological analysis of systemic forces and solutions may need distilling and blending to have an effect. A recent review by Katherine Smith and Rosemary Anderson of lay views on health inequalities has shown that people’s understanding of social causes of ill health often mirrors more academic analysis. However, while many accept that health has social causes, many are also reluctant to acknowledge the health inequalities that flow from them. This can be read as an effort to resist the stigma and shame of the experience of poverty. A sociological imperative to emphasise systemic forces and their ill-effects in public debate may then risk alienating some or reinforcing stigma.

How do we respond? Smith and Anderson suggest that we are cautious about the language we use. But inequalities need to be framed as having consequences for us all. We also need to broaden our analyses away from focusing on narrow problems to also address proposals for action and the political processes and decisions involved (and so dovetailing with the Crisis report).

So if a radio or newspaper editor calls (and I’m not holding my breath) my response to the current debate might be something like this: Tackling homelessness is an urgent problem. But a political and social one. The systemic forces shaping homelessness also have broader effects which are increasingly clear: the NHS is challenged, and rising housing markets are only benefitting a few. And so the health of the city’s most vulnerable is also a grim barometer of the health of the city. This is not to suggest that everyone is equally vulnerable to becoming homeless, or that ill-health is experienced the same, but that the sickness in the systems of the city impacts all.

So what to do? Alongside emergency assistance, we need to keep talking about the systemic forces and implement evidenced-informed changes to health care, housing, and work. The death at Westminster or sleeping in the Scottish snow are markers of homeless health and of the health of the broader systems in which we are all enmeshed.

About the Author: Andy Guise lectures on social science and health at King’s College London. His research focuses on community and structural level determinants of health in contexts of urban exclusion.