Public Health Care & Service Delivery

Public Health Care & Service Delivery

While Canada has universal health care, there are still many barriers preventing homeless individuals and families from accessing health services. The lack of identification – particularly their health ID card – is often cited as the biggest barrier to obtaining health care for people experiencing homelessness. Another significant barrier is following up on prescriptions (due to lack of insurance benefits or inability to pay the co-payment) or ongoing medical “home treatment” (such as sitz baths, bedrest or wound care).

Other barriers to adequate health care faced by people experiencing homelessness include the daily struggle for the essentials of life. A reliance on drop-ins and shelters for meals does not provide a nutritionally balanced or adequate diet. Living situations (i.e. sleeping outside, squats or crowded shelter) often result in increased disease transmittal. Many shelters require people to leave during the day preventing someone from obtaining needed rest. 

Homeless people as a group die younger than housed people and many suffer from more frequent severe illnesses and at an earlier age. For example, the 2011 Winnipeg Street Health report found that compared to the general population, homeless people in their survey were:

  • 20 times as likely to have hepatitis C
  • 8 times as likely to have epilepsy 
  • 3 times as likely to have had a heart attack
  • 6 times as likely to have angina
  • 2 times as likely to have asthma
  • 2 times as likely to have arthritis or rheumatism 
  • 3 times as likely to have diabetes
  • 10 times as likely to have FAS/FAE 
  • 5 times as likely to have migraine headaches 

These numbers echo an earlier report from Toronto’s Street Health which in 2007 found that the homeless people they interviewed were:

  • 29 times as likely to have hepatitis C
  • 20 times as likely to have epilepsy
  • 5 times as likely to have heart disease
  • 4 times as likely to have cancer 
  • 3 1⁄2 times as likely to have asthma
  • 3 times as likely to have arthritis or rheumatism
  • Twice as likely to have diabetes 

In terms of public mental heath care in Canada, there are three different types of care. Primary mental health care (first-line services) includes simple diagnostic procedures, basic treatment and referral to more specialized services as needed. Secondary care consists of specialized care that provides more extensive and complicated procedures and treatment. It may be provided within hospitals, clinics or office-based practices, on an inpatient or outpatient basis. Tertiary care is a set of specialized interventions delivered by highly trained professionals to help individuals with problems that are particularly complex and difficult to treat in primary or secondary settings.