Effectiveness of Interventions to Improve the Health and Housing Status of Homeless People

A Rapid Systematic Review

Donna Fitzpatrick-Lewis; Rebecca Ganann; Shari Krishnaratne; Donna Ciliska; Fiona Kouyoumdjian; Stephen W Hwang


BMC Public Health. 2011;11(638) 

In This Article


Each year approximately 160,000 individuals in Canada are homeless.[1] Homelessness can be experienced across genders, age groups, marital status or family composition, as well as among immigrants and life-long citizens of a country.[2] There is no common definition for homelessness, and it remains a challenge to enumerate this population. Homelessness can be hidden; there are estimates that among the "homeless" population, as many as 80% are not experiencing absolute homelessness yet are marginally housed in substandard unsafe housing, are at risk of being evicted, or spend more than 60% of their monthly income on housing.[1] Many homeless people "couch surf" or temporarily sleep in the homes of friends or relatives.[3] Being homeless negatively impacts health as people who are homeless or marginally housed have less access to healthcare and poorer health outcomes than those living in stable housing.[3] There is a lack of awareness and implementation of interventions that have been demonstrated to positively impact health and housing status in people who are homeless.

Research on interventions to improve the health of homeless people has received significant attention over the past 5 years. Policy agendas have placed increasing emphasis on poverty reduction strategies and addressing the social determinants of health.[4] Homeless persons have been identified as a priority population within both health policy and practice environments.[4,5] This review stands to inform public health agencies engaging in health promotion and policy development activities with these local priority populations.

In 2005, Hwang et al. published a systematic review examining interventions that can increase access to healthcare for homeless individuals.[6] This review included 45 studies of good or fair quality conducted between 1988 and 2004. At the time, this review identified case management and assertive case management as being effective in improving psychiatric symptoms. Case management was also found to be effective in decreasing substance use for homeless persons with substance abuse issues. The current review was conducted at the request of a local public health department seeking an expedited review of the literature pertaining to homelessness and access to health, healthcare, and housing. This review identifies new research on the impact of interventions on health and health care access for homeless individuals since the review by Hwang and colleagues,[6] with specific focus on the impact of these interventions on their housing status.


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