Homelessness Prevention: The Public Health Model

March 15, 2018

“If we want to stop people dying on roads, we invest money in seatbelts, not in the emergency department. In the same way in regards to homelessness, why would we wait to intervene with a young person when they’re in crisis, when we can intervene early and keep them at home, and in school and engaged?” – Peter Jacobson, manager, youth services, BCYF, Australia

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Ending homelessness means investing in homelessness prevention – that is, stopping people from becoming homeless to begin with. This involves a change in the way we think about homelessness. Rather than managing the problem through emergency services, such as soup kitchens and shelters, it makes more sense to intervene before the loss of housing occurs, or if someone does experience homelessness, to get them stably housed as quickly as possible. This requires several sectors, like the health, education, justice, child, and housing systems to work together to implement policies and interventions that lower the risks of homelessness.

The Public Health Model of Homelessness Prevention

The public health model of prevention is helpful in altering the way we can respond to homelessness. This model was developed in the 1940s by Leavell and Clark and, was initially used to reduce the risks and harms associated with disease, illnesses, and injuries; that includes smoking, diabetes, strokes, and car accidents. This model was eventually adapted to address societal issues, like crime.

Risk Factors of Homelessness

To decide where prevention legislation, policy, and practices must be implemented, it is important to identify the causes of homelessness. Though these causes are organized into three intersectional categories, we need to keep in mind that the causes of homelessness are complex and involve a number of interacting factors that may play out in different ways from individual to individual.

  • Structural factors are economic and societal issues that limit opportunities and reduce resiliency for the general population.

Examples: discrimination, poverty, lack of affordable housing, and the impact of colonialism on Indigenous Peoples

  • Systems failures are inadequate policies and service delivery.

Examples: barriers to accessing public systems, such as health, social services and legal supports, and failed transitions from publicly funded institutions and systems, such as child welfare and corrections 

  • Individual and relational factors are personal circumstances that increase the risk of homelessness.

Examples: personal or family crisis, housing insecurity, mental health and addictions challenges, and interpersonal violence

Similar to knowing potential causes of diseases, illnesses and injuries, we can put systems and interventions in place to reduce the likelihood that someone will experience homelessness when we know the potential causes of homelessness. The public health model of prevention contains a variety of prevention measures that should operate at the same time. In addition, all these areas play a unique and essential role in homelessness prevention.

Primary Prevention

Primary prevention of homelessness looks a lot like disease initiatives in the form of risk reduction. This involves altering the behaviours and exposures that can lead to a disease or by enhancing resistance to the disease, such as getting vaccination. When thinking about homelessness, primary prevention aims to reduce the risk of homelessness for the entire population by addressing broad structural factors that contribute to this risk and by building protective factors. Primary prevention takes the form of universal interventions aimed at entire communities as well as targeted interventions for at-risk communities.

Examples of primary prevention are poverty reduction strategies, anti-violence work, and early childhood supports, which build assets, enhance housing stability, and creates social inclusion.

Primary prevention breaks down into three categories targeted at different populations:

  • Universal prevention – programs available to the entire population and helps to create greater equality.

Examples: affordable housing and poverty reduction strategies, such as greater access to affordable child care, old age pensions, and subsidized housing

  • Selected prevention – programs aimed at people who may be at risk of homelessness because they belong to a particular group, such as individuals facing inequality and discrimination, particularly Indigenous Peoples.

Examples: school-based programs and anti-oppression strategies, and support for people facing discrimination to access public and private services

  • Indicated prevention – programs aimed at people at higher risk of homelessness due to individual characteristics.

Secondary Prevention

Secondary prevention of homelessness further resembles preventing a disease once a person has been exposed to it, such as quick early detection via screening procedures. For homelessness prevention, secondary prevention involves identifying and addressing homelessness at an early stage by directing interventions to individuals either at imminent risk of homelessness, or who have recently experienced homelessness. The goal is to avoid or exit homelessness quickly by either retaining their housing or using rapid rehousing strategies to ensure people move into permanent and stable accommodation that is affordable, safe, and appropriate with the supports they need.

Examples are coordinated assessment, case management, and shelter diversion strategies. Supports can include family mediation, rent banks, and landlord-tenant mediation.

Tertiary Prevention

For diseases, tertiary prevention involves softening the impact caused by the disease on a patient’s function, longevity, and quality of life. Tertiary prevention of homelessness supports to ensure that those who have experienced homelessness never experience it again. It provides housing stability and other supports to those experiencing chronic homelessness to find and maintain housing.

Importantly, Housing First is a type of tertiary prevention because it provides no-barrier housing and the wrap-around supports needed to keep people stably housed.

It is important to note that primary, secondary, and tertiary prevention do not represent separate categories. They are interrelated and must occur simultaneously.

Takeaways

“We would never build our health care system around the emergency department only”A New Direction: A Framework for Homelessness Prevention

The public health model of prevention is important because it helps us realize that we need to intervene at different levels at all times. It’s not enough to focus in on just one of the areas. We need to reach the general population, those at imminent risk of homelessness, and those who have experienced homelessness. To end homelessness, we need to address all three areas of prevention.  


This blog is the second instalment of a four-part series on homelessness prevention. You can read the first blog article here

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.