Health equity for homelessness: a critical review

Valsechi, Daniel Felix; Marques, Maria Cristina da Costa

doi:10.1590/0103-1104202313917I

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Saúde debate 47 (139) • Oct-Dec 2023 • https://doi.org/10.1590/0103-1104202313917I copy

Health equity for homelessness: a critical review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The notion of equity in health manifests itself in modern societies through different ideas and operational proposals. Concerning homeless persons, equity dialogues with equality and justice to mobilize several applications in health: while the liberal conception of equity in health seeks to favor the health conditions of this population without breaking with the current mode of production, the critical conception aims to expand health conditions and needs in the struggle for an emancipated society. With the aim of characterizing the conceptions of equity in health expressed in the scientific literature on this population, this study carried out a critical review of the articles available on online search portals databases. 1,716 publications were identified in the initial sample and 35 articles were included in the review after application of methodological procedures. The articles were characterized in relation to the ideas and applications of equity in health for the homeless population, discussing methodology, justice and equality, distinction between conceptions, health-disease process, public policies and the COVID-19 pandemic. It points to the dominance of the liberal conception in the literature on this population and the need for investigations from the critical conception.

KEYWORDS
Health equity; Ill-housed persons; Review; Thinking; Health care economics and organizations

Language	Search syntax	Online search portal	Number of publications
Portuguese	(“Equidade” OR “Equidade em Saúde” OR “Equidade no Acesso aos Serviços de Saúde” OR “Estratégias para Cobertura Universal de Saúde” OR “Equidade vertical”) AND (“Pessoas em Situação de Rua” OR “Jovens em Situação de Rua”)	BVS	80
		PubMed®	0
		SciELO	15
		Scopus®	15
Spanish	(“Equidad” OR “Equidad en Salud” OR “Equidad en el Acceso a los Servicios de Salud” OR “Estrategias para Cobertura Universal de Salud” OR “Equidad Vertical”) AND (“Personas sin Hogar” OR “Jóvenes sin Hogar”)	BVS	73
Spanish		PubMed®	0
		SciELO	3
		Scopus®	7
English	(“Equity” OR “Health Equity” OR “Equity in Access to Health Services” OR “Strategies for Universal Health Coverage” OR “Vertical Equity”) AND (“Homeless Persons” OR “Homeless Youth”)	BVS	86
		PubMed®	149
		SciELO	4
		Scopus®	1.284
		Total	1.716

N	Authorship	Publication year	Methodology	Analysis location	Concept of equity in health and its main application
1	Aguiar MM, Iriart JAB¹³13 Aguiar MM, Iriart JAB. Significados e práticas de saúde e doença entre a população em situação de rua em Salvador, Bahia, Brasil. Cad. Saúde Pública. 2012 [acesso em 2022 mar 12]; 28(1):115-24. Disponível em: https://doi.org/10.1590/S0102-311X2012000100012. https://doi.org/10.1590/S0102-311X201200...	2012	Qualitative study	Brazil	Liberal conception of health equity: equity in access to health services
2	Andrade R, Costa AAS, Sousa ET, et al.¹⁴14 Andrade R, Costa AAS, Sousa ET, et al. O acesso aos serviços de saúde pela população em situação de rua: uma revisão integrativa. Saúde debate. 2022 [acesso em 2022 mar 12]; 46(132):227-39. Disponível em: https://doi.org/10.1590/0103-1104202213216. https://doi.org/10.1590/0103-11042022132...	2022	Integrative literature review	Brazil	Liberal conception of health equity: equity in access to health services
3	Baggio S, Jacquerioz F, Salamun J, et al.¹⁵15 Baggio S, Jacquerioz F, Salamun J, et al. Equity in access to COVID-19 testing for undocumented migrants and homeless persons during the initial phase of the pandemic. J. Migr. Health. 2021 [acesso em 2022 mar 12]; (4):100051. Disponível em: https://doi.org/10.1016/j.jmh.2021.100051. https://doi.org/10.1016/j.jmh.2021.10005...	2021	Transversal study	Switzerland	Liberal conception of health equity: equity in resource allocation
4	Baum F, Newman L, Biedrzycki K, et al.¹⁶16 Baum F, Newman L, Biedrzycki K, et al. Can a regional government’s social inclusion initiative contribute to the quest for health equity? Health Pro. Int. 2010 [acesso em 2022 mar 12]; 25(4):474-82. Disponível em: https://doi.org/10.1093/heapro/daq033. https://doi.org/10.1093/heapro/daq033...	2010	Qualitative study	Australia	Liberal conception of health equity: equity in resource allocation
5	Borysow IC, Furtado JP¹⁷17 Borysow IC, Furtado JP. Acesso, equidade e coesão social: avaliação de estratégias intersetoriais para a população em situação de rua. Rev. Esc. Enferm. USP. 2014 [acesso em 2022 mar 12]; 48(6):1069-76. Disponível em: https://doi.org/10.1590/S0080-623420140000700015. https://doi.org/10.1590/S0080-6234201400...	2014	Case Study	Brazil	Liberal conception of health equity: equity in access to health services
6	Borysow IC, Conill EM, Furtado JP¹⁸18 Borysow IC, Conill EM, Furtado JP. Atenção à saúde de pessoas em situação de rua: estudo comparado de unidades móveis em Portugal, Estados Unidos e Brasil. Ciênc. saúde coletiva. 2017 [acesso em 2022 mar 12]; 22(3):879-90. Disponível em: https://doi.org/10.1590/1413-81232017223.25822016. https://doi.org/10.1590/1413-81232017223...	2017	Comparative data analysis	Portugal, USA and Brazil	Liberal conception of health equity: equity in access to health services
7	Carneiro Júnior N, Jesus CH, Crevelim MA¹⁹19 Carneiro Júnior N, Jesus CH, Crevelim MA. A Estratégia Saúde da Família para a equidade de acesso dirigida à população em situação de rua em grandes centros urbanos. Saúde Soc. 2010 [acesso em 2022 mar 12]; 19(3):709-16. Disponível em: https://doi.org/10.1590/S0104-12902010000300021. https://doi.org/10.1590/S0104-1290201000...	2010	Experience report	Brazil	Liberal conception of health equity: equity in access to health services
8	Cernadas A, Fernández A²⁰20 Cernadas A, Fernández A. Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain). Int. J. Equity Health. 2021 [acesso em 2022 mar 12]; (20):84. Disponível em: https://doi.org/10.1186/s12939-021-01409-2 https://doi.org/10.1186/s12939-021-01409...	2021	Qualitative study	Spain	Liberal conception of health equity: equity in access to health services
9	Clifford B, Wilson A, Harris P²¹21 Clifford B, Wilson A, Harris P. Homelessness, health and the policy process: a literature review. Health Policy. 2019 [acesso em 2022 mar 12]; 123(11):1125-32. Disponível em: https://doi.org/10.1016/j.healthpol.2019.08.011. https://doi.org/10.1016/j.healthpol.2019...	2019	Systematic literature review	USA, Australia, Canada and France	Liberal conception of health equity: social determinants of health
10	Cruz JR, Taquette SR²²22 Cruz JR, Taquette SR. Viver na rua: vulnerações e a bioética da proteção. Rev. Bioét. 2020 [acesso em 2022 mar 12]; 28(4):637-46. Disponível em: https://doi.org/10.1590/1983-80422020284427. https://doi.org/10.1590/1983-80422020284...	2020	Qualitative study	Brazil	Liberal conception of health equity: equity-based interventions
11	Dunn JR, van der Meulen E, O’Campo P, et al.²³23 Dunn JR, van der Meulen E, O’Campo P, et al. Improving health equity through theory-informed evaluations: a look at housing first strategies, cross-sectoral health programs, and prostitution policy. Eval. Program Plan. 2013 [acesso em 2022 mar 12]; 36(1):184-90. Disponível em: https://doi.org/10.1016/j.evalprogplan.2012.03.006. https://doi.org/10.1016/j.evalprogplan.2...	2013	Theory-based assessment	North America, Venezuela e New Zealand	Liberal conception of health equity: equity in resource allocation
12	Embleton L, Shah P, Gayapersad A, et al.²⁴24 Embleton L, Shah P, Gayapersad A, et al. Characterizing street-connected children and youths’ social and health inequities in Kenya: a qualitative study. Int. J. Equity Health. 2020 [acesso em 2022 mar 12]; (19):147. Disponível em: https://doi.org/10.1186/s12939-020-01255-8. https://doi.org/10.1186/s12939-020-01255...	2020	Qualitative study	Kenia	Liberal conception of health equity: social determinants of health
13	Farina M, Lavazza A²⁵25 Farina M, Lavazza A. Advocating for greater inclusion of marginalized and forgotten populations in COVID19 vaccine rollouts. Int. J. Public Health. 2021 [acesso em 2022 mar 12]; (66):1604036. Disponível em: https://doi.org/10.3389/ijph.2021.1604036. https://doi.org/10.3389/ijph.2021.160403...	2021	Cases study	USA and United Kingdom	Liberal conception of health equity: equity in resource allocation
14	Field H, Hudson B, Hewett N, et al.²⁶26 Field H, Hudson B, Hewett N, et al. Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation. BMC Health Serv. Res. 2019 [acesso em 2022 mar 12]; (19):857. Disponível em: https://doi.org/10.1186/s12913-019-4620-1. https://doi.org/10.1186/s12913-019-4620-...	2019	Exploratory data analysis	United Kingdom	Liberal conception of health equity: equity in resource allocation
15	Gallaher C, Herrmann S, Hunter L, et al.²⁷27 Gallaher C, Herrmann S, Hunter L, et al. The St Thomas’ Hospital Emergency Department Homeless Health Initiative: improving the quality, safety and equity of healthcare provided for homeless patients attending the ED. BMJ Open Quality. 2020 [acesso em 2022 mar 12]; (9):e000820. Disponível em: https://doi.org/10.1136/bmjoq-2019-000820. https://doi.org/10.1136/bmjoq-2019-00082...	2020	Project analysis	England	Liberal conception of health equity: equity in health care
16	Horvitz-Lennon M, Zhou D, Normand SLT, et al.²⁸28 Horvitz-Lennon M, Zhou D, Normand SLT, et al. Racial and ethnic service use disparities among homeless adults with severe mental illnesses receiving ACT. Psychiatr. Serv. 2011 [acesso em 2022 mar 12]; 62(6):598-604. Disponível em: https://doi.org/10.1176/ps.62.6.pss6206_0598. https://doi.org/10.1176/ps.62.6.pss6206_...	2011	Exploratory data analysis	USA	Liberal conception of health equity: equity in health care
17	Kazevman G, Mercado M, Hulme J, et al.²⁹29 Kazevman G, Mercado M, Hulme J, et al. Prescribing phones to address health equity needs in the COVID-19 era: the PHONE-CONNECT Program. J. Med. Internet Res. 2021 [acesso em 2022 mar 12]; 23(4):e23914. Disponível em: https://doi.org/10.2196/23914. https://doi.org/10.2196/23914...	2021	Experience report	Canada	Liberal conception of health equity: eHealth strategies
18	Lazarus JV, Baker L, Cascio M, et al.³⁰30 Lazarus JV, Baker L, Cascio M, et al. Novel health systems service design checklist to improve healthcare access for marginalised, underserved communities in Europe. BMJ Open. 2020 [acesso em 2022 mar 12]; 10(4):e035621. Disponível em: https://doi.org/10.1136/bmjopen-2019-035621. https://doi.org/10.1136/bmjopen-2019-035...	2020	Collaborative project report	Europa	Liberal conception of health equity: equity in access to health services
19	MacKenzie M, Purkey E³¹31 MacKenzie M, Purkey E. Barriers to end-of-life services for persons experiencing homelessness as perceived by health and social service providers. J. Am. Board Fam. Med. 2019 [acesso em 2022 mar 13]; 32(6):847-57. Disponível em: https://doi.org/10.3122/jabfm.2019.06.190066. https://doi.org/10.3122/jabfm.2019.06.19...	2019	Qualitative study	Canada	Liberal conception of health equity: equity in health care
20	Magwood O, Hanemaayer A, Saad A, et al.³²32 Magwood O, Hanemaayer A, Saad A, et al. Determinants of implementation of a Clinical Practice Guideline for Homeless Health. Int. J. Environ. Res. Public Health. 2020 [acesso em 2022 mar 13]; 17(21):7938. Disponível em: https://doi.org/10.3390/ijerph17217938. https://doi.org/10.3390/ijerph17217938...	2020	Project analysis	Canada	Liberal conception of health equity: equity in health care
21	McNeil R, Guirguis-Younger M, Dilley LB³³33 McNeil R, Guirguis-Younger M, Dilley LB. Recommendations for improving the end-of-life care system for homeless populations: a qualitative study of the views of Canadian health and social services professionals. BMC Palliat. Care. 2012 [acesso em 2022 mar 13]; (11):14. Disponível em: https://doi.org/10.1186/1472-684X-11-14. https://doi.org/10.1186/1472-684X-11-14...	2012	Qualitative study	Canada	Liberal conception of health equity: equity in access to health services
22	Mercer T, Khurshid A³⁴34 Mercer T, Khurshid A. Advancing health equity for people experiencing homelessness using blockchain technology for identity management: a research agenda. J. Health Care Poor Underserved. 2021 [acesso em 2022 mar 13]; 32(2):262-77. Disponível em: https://doi.org/10.1353/hpu.2021.0062. https://doi.org/10.1353/hpu.2021.0062...	2021	Project analysis	USA	Liberal conception of health equity: equity in access to health services
23	Moledina A, Magwood O, Agbata E, et al.³⁵35 Moledina A, Magwood O, Agbata E, et al. A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Syst. Rev. 2021 [acesso em 2022 mar 13]; 17(2):e1154. Disponível em: https://doi.org/10.1002/cl2.1154. https://doi.org/10.1002/cl2.1154...	2021	Systematic literature review	USA, Canada, United Kingdom, Netherlands and Australia	Liberal conception of health equity: equity in resource allocation
24	Orciari EA, Perman-Howe PR, Foxcroft DR³⁶36 Orciari EA, Perman-Howe PR, Foxcroft DR. Motivational Interviewing-based interventions for reducing substance misuse and increasing treatment engagement, retention, and completion in the homeless populations of high-income countries: an equity-focused systematic review and narrative synthesis. Int. J. Drug Policy. 2022 [acesso em 2022 mar 13]; (100):103524. Disponível em: https://doi.org/10.1016/j.drugpo.2021.103524. https://doi.org/10.1016/j.drugpo.2021.10...	2022	Systematic literature review	USA	Liberal conception of health equity: equity-based interventions
25	Paiva IKS, Lira CDG, Justino JMR et al.³⁷37 Paiva IKS, Lira CDG, Justino JMR, et al. Direito à saúde da população em situação de rua: reflexões sobre a problemática. Ciênc. saúde coletiva. 2016 [acesso em 2022 mar 13]; 21(8):2595-2606. Disponível em: https://doi.org/10.1590/1413-81232015218.06892015. https://doi.org/10.1590/1413-81232015218...	2016	Integrative literature review	Brazil	Liberal conception of health equity: equity in access to health services
26	Patterson ML, Markey MA, Somers JM³⁸38 Patterson ML, Markey MA, Somers JM. Multiple paths to just ends: using narrative interviews and timelines to explore health equity and homelessness. Int. J. Qual. Methods. 2012 [acesso em 2022 mar 13]; 11(2):132-51. Disponível em: https://doi.org/10.1177/160940691201100202. https://doi.org/10.1177/1609406912011002...	2012	Qualitative study	Canada	Liberal conception of health equity: social determinants of health
27	Pinto AH, Fermo VC, Peiter CC, et al.³⁹39 Pinto AH, Fermo VC, Peiter CC, et al. Determinantes sociais, equidade e Consultório na Rua. Rev. Enferm. UFPE. 2018 [acesso em 2022 mar 13]; 12(12):3513-20. Disponível em: http://dx.doi.org/10.5205/1981-8963-v12i12a236025p3513-3520-2018. http://dx.doi.org/10.5205/1981-8963-v12i...	2018	Experience report	Brazil	Liberal conception of health equity: social determinants of health
28	Purkey E, MacKenzie M⁴⁰40 Purkey E, MacKenzie M. Experience of healthcare among the homeless and vulnerably housed a qualitative study: opportunities for equity-oriented health care. Int. J. Equity Health. 2019 [acesso em 2022 mar 13]; (18):101. Disponível em: https://doi.org/10.1186/s12939-019-1004-4. https://doi.org/10.1186/s12939-019-1004-...	2019	Qualitative study	Canada	Liberal conception of health equity: equity in health care
29	Robards F, Kang M, Steinbeck K, et al.⁴¹41 Robards F, Kang M, Steinbeck K, et al. Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia. Int. J. Equity Health. 2019 [acesso em 2022 mar 13]; (18):41. Disponível em: https://doi.org/10.1186/s12939-019-0941-2. https://doi.org/10.1186/s12939-019-0941-...	2019	Qualitative study	Australia	Liberal conception of health equity: equity in access to health services
30	Seaman A, King CA, Kaser T, et al.⁴²42 Seaman A, King CA, Kaser T, et al. A hepatitis C elimination model in healthcare for the homeless organization: a novel reflexive laboratory algorithm and equity assessment. Int. J. Drug Policy. 2021 [acesso em 2022 mar 13]; (96):103359. Disponível em: https://doi.org/10.1016/j.drugpo.2021.103359. https://doi.org/10.1016/j.drugpo.2021.10...	2021	Experimental study	USA	Liberal conception of health equity: equity in resource allocation
31	Smithman MA, Descôteaux S, Dionne E, et al.⁴³43 Smithman MA, Descôteaux S, Dionne E, et al. Typology of organizational innovation components: building blocks to improve access to primary healthcare for vulnerable populations. Int. J. Equity Health. 2020 [acesso em 2022 mar 13]; (19):174. Disponível em: https://doi.org/10.1186/s12939-020-01263-8. https://doi.org/10.1186/s12939-020-01263...	2020	Literature scoping review	USA, Canada, Australia,United Kingdom, New Zealand, Israel, Italy, Mexico e Deutschland	Liberal conception of health equity: equity in access to health services
32	Stajduhar KI, Mollison A, Giesbrecht M, et al.⁴⁴44 Stajduhar KI, Mollison A, Giesbrecht M, et al. “Just too busy living in the moment and surviving”: barriers to accessing health care for structurally vulnerable populations at end-of-life. BMC Palliat. Care. 2019 [acesso em 2022 mar 13]; (18):11. Disponível em: https://doi.org/10.1186/s12904-019-0396-7. https://doi.org/10.1186/s12904-019-0396-...	2019	Qualitative study	Canada	Liberal conception of health equity: equity in access to health services
33	Varanda W, Adorno RC⁴⁵45 Varanda W, Adorno RC. Descartáveis urbanos: discutindo a complexidade da população de rua e o desafio para políticas de saúde. Saúde Soc. 2004 [acesso em 2022 mar 13]; 13(1):56-69. Disponível em: https://doi.org/10.1590/S0104-12902004000100007. https://doi.org/10.1590/S0104-1290200400...	2004	Qualitative study	Brazil	Liberal conception of health equity: equity in access to health services
34	Wang JZ, Mott S, Magwood O, et al.⁴⁶46 Wang JZ, Mott S, Magwood O, et al. The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review. BMC Pub. Health. 2019 [acesso em 2022 mar 13]; 19:e1528. Disponível em: https://doi.org/10.1186/s12889-019-7856-0. https://doi.org/10.1186/s12889-019-7856-...	2019	Systematic literature review	USA, Canada, South Korea and Netherlands	Liberal conception of health equity: equity-based interventions
35	White BM, Newman SD⁴⁷47 White BM, Newman SD. Access to primary care services among the homeless: a synthesis of the literature using the Equity of Access to Medical Care Framework. J. Prim. Care Community Health. 2014 [acesso em 2022 mar 13]; 6(2):77-87. Disponível em: https://doi.org/10.1177/2150131914556122. https://doi.org/10.1177/2150131914556122...	2014	Systematic literature review	USA	Liberal conception of health equity: equity in access to health services

Concept of health equity	Main application of health equity for the homeless population	Number of articles (n = 35)	Number of article(s) in Box 1
Liberal conception of health equity	Social determinants of health	4	9, 12, 26, 27
	Equity in resource allocation	7	3, 4, 11, 13, 14, 23, 30
	Equity in healthcare	5	15, 16, 19, 20, 28
	Equity in access to health services	15	1, 2, 5, 6, 7, 8, 18, 21, 22, 25, 29, 31, 32, 33, 35
	eHealth Strategies	1	17
	Equity-Based Interventions	3	10, 24, 34

Centro Brasileiro de Estudos de Saúde Av. Brasil, 4036, sala 802, 21040-361 Rio de Janeiro - RJ Brasil, Tel. 55 21-3882-9140, Fax.55 21-2260-3782 - Rio de Janeiro - RJ - Brazil
E-mail: revista@saudeemdebate.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflict of interests: non-existent