Introduction to the Special Issue: Homelessness and Health the next Work Presents a Spanish Study That Addresses Two Relevant Aspects

Introduction 2 Homelessness affects millions of people all over the world and has important physical and mental health implications that, very often, have been ignored when analyzing their condition. While many investigators have taken into consideration the labor status and social relationships of excluded populations (Castel, 2000), there is a third dimension that greatly impacts these people, but unfortunately, it is not often studied; it concerns their lack of access to the resources of the health/sanitary system and to information about healthy habits. Homeless people suffer from a wide range of problems throughout their lives (Muñoz et al., 2004). In this sense, health problems, including abuse of alcohol and diabetes or hypertension (Hwang, 2001), conform one of the most relevant dimensions. Furthermore, the severity of these diseases may have a deeper impact than on housed populations, as homeless people have difficulties to adhere to treatments, are more likely to have cognitive impairment, their diseases may go undetected for longer periods, and their living conditions are usually harsh, as they are exposed to extreme weather conditions that affect their health status (hypothermia, sunburns, etc.). Homeless people in their forties and fifties often develop health disabilities that are more commonly seen only in people who are decades older, especially those who live in the streets. Homeless people have also a greatly increased risk of death. For instance, a study that compared the general youth population of Quebec with a population of homeless youth found that mortality rates among street youth in Montreal are 9 times higher for males and 31 times higher for females (Roy et al., 1998). However, there are striking differences between countries. Death rates among homeless men in Canada are about one-half that of homeless men in US cities (Hwang, 2000), which underlines the need of taking into account Introduction 3 Besides suffering high prevalence of physical and mental health problems, homeless people also face barriers that impair their access to health care (Muñoz, Vázquez, & Vázquez, 2003; Craig & Timms, 2000). In many countries, most of the homeless people do not fill prescriptions they have received because they often do not have insurance benefits and cannot afford the cost of the medication. Even in countries like France, UK, Spain, Denmark, or Canada, which have a system of universal health insurance, many homeless people do not possess proof of coverage because their identification has been lost or stolen or, …