June 15, 2022 – Homeless people face countless challenges in achieving any sense of health. They face a myriad of challenges associated with chronic illnesses, including extreme poverty, precarious housing and even drug theft, with no guarantee of timely or compassionate care for acute illnesses and injuries. They significantly increased the risk of infectious diseases and violence. And they face severe stigma and discrimination in their daily lives. However, few schools of public health give special attention to this increasingly visible and vulnerable population. Few schools offer a special course on this topic.

In response to these challenges, the Harvard School of Public Health. T. H. Chana launched a course two years ago called Homelessness and Health: Lessons from Health, Public Health, and Research. This is one of many parts of Harvard’s Chan School of Health and Homelessness (IHH) new pilot initiative, an effort to advance education, research and practice about the devastating impact of housing instability on health.

Howard Koch, Harvey V. Fineberg Professor of Public Health Leadership Practice and IHH Chair, believes public health students should learn the basics of cross-disciplinary homelessness issues. He also hopes that some, if not many, can contribute to research and effective policy.

“Homelessness is a complex and seemingly intractable social crisis that requires an urgent, comprehensive solution,” Koch said. “This is closely linked to the broader issues of poverty, social inequality, education and discrimination. Barriers hinder people’s access to integrated care, mental health care, and care for substance use disorders. IHH’s goal is to create an academic community that will engage the neglected world of health and homelessness through education, research and translation.”

In addition to the course, IHH also provides experiential research support to doctoral students and faculty, explores opportunities for research collaborations with experts and organizations across the country, hosts monthly workshops with local and national leaders, and publishes a monthly newsletter.

Homelessness Course Instructors – Maggie Sullivan, instructor and staff member François-Xavier Bagnoud (FXB) Center for Health and Human Rights at Harvard University, and Jill Roncarati, an instructor at the Department of Education, saw the problems firsthand. Both received doctorates from the Harvard Chan School, and spent every ten years as a medical officer in Boston Homeless Health Program (BHCHP)which cares for more than 11,000 homeless people every year.

Sullivan noted that very few healthcare workers start their careers with the goal of working specifically with the homeless. “But I do think they underestimate how often medical professionals take care of homeless people, often without even knowing it,” she said. “As a new nurse practitioner, I didn’t think I would be taking care of the homeless. But, lo and behold, at a community health center for immigrant families, I cared for several homeless people, although I did not know about it at first. That’s why I think it’s important that we get to know about it. We will not be able to positively influence the health status of patients and their outcomes if we do not directly address the issue of their housing status.”

The course covers a range of topics, including demographic trends, the impact of structural racism on homelessness, the landscape of homeless programs in the US, and homelessness among groups such as veterans, LEP populations, families, and children. The course also features guest speakers, including leaders in the field, as well as people who have experience living with the homeless.

One week of the course is dedicated to exploring two case studies specifically written for IHH that offer a detailed look at how BHCHP manages health care for Boston’s homeless population in response to the COVID-19 pandemic. Efforts included expanding telemedicine, redeploying staff, and creating a massive field hospital in a time of great need.

The students in the class came from all over Harvard, including the Graduate School of Design, Harvard Kennedy School, and Harvard Medical School; students also took the course. Roncarati and Sullivan said the students’ different perspectives enriched the class discussions. “There never seems to be enough time for discussion, which is great,” Sullivan said. “There are always more questions and more conversations that people want to have.”

Roncarati hopes students will leave the classroom with a better understanding that the homeless are a heterogeneous population — “a whole group of different people from different walks of life,” she said.

“Homelessness can be ended if we all work together,” she added. “We got here through a very complex chain of events. And we can all be part of the answer.”

— Karen Paramedic

photo: Kent Dayton

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