RESPONDING TO HOMELESSNESS, MULTIPLE EXCLUSION AND STIGMA: DEVELOPING A COMPLEX PUBLIC HEALTH INTERVENTION APPROACH

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Homelessness is a growing challenge in the UK, particularly because it has severe impacts on health: people who are homeless can live 30 years less than the population average. London in particular has a high and growing number of people who are homeless, including people rough sleeping, but also in hostels and temporary accommodation. The causes of homelessness and poor health are complex, and can include a person's life history but also social processes like housing availability. This research will focus on one component of this complexity: stigma. Stigma refers to people being 'marked' - in society's eyes - as lesser, unworthy or disgraced. This stigma that often focuses on people who are homeless is a persistent barrier to addressing ill-health and homelessness. It can mean people don't seek care and support, and receive poor quality support if they do; a result is worsening health and reduced chances of ending homelessness. Stigma is a problem across health care, welfare support and other parts of society and the systems that people rely on. Importantly, the stigma across these separate areas link and cause complex problems; for instance, problems with benefits can cause problems with health care access. We have some understanding of these social sides of stigma and their complexity, but not enough to understand how to respond and prevent it. Efforts to prevent stigma could support people who are homeless in accessing health, housing and other forms of welfare and support. If we could prevent stigma our public health and health care responses can be more effective and efficient, improving health and increasing potential to end homelessness for individuals. This research aims to improve our theory and explanations for the complexity of stigma. Based on that explanation, the research will develop an intervention that will try and prevent stigma across the many systems that cause it. A focus for the research will be in-depth study in London to understand the complexity of stigma that people who are homeless face. We will spend time with people who are homeless using interviews to understand their experiences, and also study the systems that support them (or stigmatise them). Researchers who have experience of homelessness themselves will be part of the research team. The team working to develop an intervention response will involve experts from across south London. Stigma is a problem around the world. To try and ensure our research in London has impact in other places (and also learns from experiences elsewhere), we will work closely with a research team in Canada. Through comparing experiences we can develop better explanations of stigma and the complex systems behind it. Through working with the team in Canada we also want to develop ideas and ways of working that we can expand to include other places; including low and middle income countries around the world. Throughout the research we will work closely with people who are homeless, policy makers and the general public. This close public engagement will ensure the study is actually responding to the important questions and needs people have, but also to make people aware of our findings, and so through that ensure the study has positive impact on people's lives, health and welfare. The final output of the research programme will be to work with people, policy makers and other stakeholders to develop a 'complex intervention'; this will be a strategy to make changes across the many systems that influence the lives of people who are homeless. Through multiple and coordinated changes we hope to be able to make significant impacts on stigma and prevent it. We will initially develop an intervention in south London, and then after working to understand its impacts, we will try and scale-up any success to other places, across the UK but also globally.