Street Health Report 1992-2007: Changes in health status and access to health care for the homeless population in Toronto, Canada

Background:

Few studies have examined homeless people's health and access to health care under Canada's system of universal health insurance. The objective of this study was to determine changes in the prevalence of physical health conditions and measures of access to health care among homeless adults in Toronto over a 15 year period, and provide information about the possible impact of social policy changes on homeless people's health.

Methods:

Data from two cross-sectional studies of homeless adults in Toronto, Ontario were analyzed (N=458 in 1992, N=368 in 2007). Both studies enrolled a representative sample of homeless adults using almost identical sampling methods and survey questions. In both, recruitment of randomly selected persons occurred at shelters and meal programs. Enrollment took place over the winter and was proportionate to the number of unique individuals using the site each month.

Results:

Significantly higher rates of the following physical health conditions were found in 2007 compared to 1992:

arthritis (43% vs 30%), asthma (21% vs 12%), angina (12% vs 3%), diabetes (9% vs 3%), and high blood pressure (17% vs 13%). A key indicator of homeless people's health care access, the percent reporting having a family doctor, was significantly lower in 2007 than 1992 (41% vs 57%).

Conclusion:

Data from cross-sectional surveys in Toronto indicate that homeless people's health status and access to health care is worse in 2007 than in 1992. Street Health, the organization that conducted both surveys, has developed recommendations and advocated on policies and services affecting homeless people.