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

应对无家可归、多重排斥和耻辱：制定复杂的公共卫生干预方法

• 批准号: MR/T040688/1
• 负责人: Andrew Guise
• 金额: $ 100.95万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT040688%2F1
• 关键词: RESPONDING; HOMELESSNESS; MULTIPLE; EXCLUSION; STIGMA

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.

在英国，无家可归是一个日益严重的挑战，特别是因为它对健康有严重影响：无家可归者的寿命比人口平均寿命短30年。特别是伦敦，无家可归的人数量很高，而且还在不断增加，其中包括露宿街头的人，也包括住在旅馆和临时住所的人。无家可归和健康状况不佳的原因很复杂，可能包括一个人的生活史，也可能包括住房供应等社会过程。这项研究将集中在这种复杂性的一个组成部分：耻辱。污名指的是人们被“标记”-在社会的眼中-作为较小的，不值得或耻辱。这种耻辱往往集中在无家可归者身上，是解决健康不良和无家可归问题的一个持续障碍。这可能意味着人们不寻求照顾和支持，如果他们这样做，就会得到质量差的支持;结果是健康状况恶化，结束无家可归的机会减少。污名化是一个横跨医疗保健、福利支持和社会其他部分以及人们所依赖的系统的问题。重要的是，这些独立领域的污名化联系在一起并导致复杂的问题;例如，福利问题可能导致获得医疗保健的问题。我们对污名化的这些社会方面及其复杂性有一定的了解，但还不足以了解如何应对和预防污名化。防止污名化的努力可以帮助无家可归者获得医疗、住房和其他形式的福利和支持。如果我们能够防止污名化，我们的公共卫生和卫生保健对策就可以更加有效和高效，改善健康状况，增加结束个人无家可归的可能性。本研究旨在完善我们对污名复杂性的理论和解释。基于这一解释，该研究将开发一种干预措施，试图在导致耻辱感的许多系统中预防耻辱感。该研究的一个重点将是在伦敦进行深入研究，以了解无家可归者面临的耻辱感的复杂性。我们将花时间与无家可归的人进行访谈，了解他们的经历，并研究支持他们（或侮辱他们）的系统。有无家可归经历的研究人员将成为研究小组的一部分。致力于制定干预对策的团队将包括来自伦敦南部的专家。污名化是一个世界性的问题。为了确保我们在伦敦的研究在其他地方产生影响（并借鉴其他地方的经验），我们将与加拿大的一个研究团队密切合作。通过比较经验，我们可以更好地解释污名及其背后的复杂系统。通过与加拿大团队的合作，我们还希望发展我们可以扩展到其他地方的想法和工作方式，包括世界各地的低收入和中等收入国家。在整个研究过程中，我们将与无家可归者、政策制定者和公众密切合作。这种密切的公众参与将确保这项研究实际上回应了人们的重要问题和需求，同时也让人们了解我们的研究结果，从而确保这项研究对人们的生活、健康和福利产生积极影响。研究方案的最终成果将是与人民、决策者和其他利益攸关方合作，制定一项“综合干预”;这将是一项战略，在影响无家可归者生活的许多系统中进行变革。我们希望通过多种协调的变革，能够对污名化产生重大影响并加以预防。我们将首先在伦敦南部开展干预，然后在努力了解其影响后，我们将尝试将任何成功扩大到英国乃至全球的其他地方。

项目成果

Stigma and discrimination and its homeless and health system contexts in south London: an ethnographic case study

伦敦南部的耻辱和歧视及其无家可归者和卫生系统背景：民族志案例研究

• DOI: 10.1016/s0140-6736(23)02059-7
• 发表时间: 2023
• 期刊: The Lancet
• 作者: Guise A

Stigma is stopping an evidence based response to drug overdose deaths in the UK.

耻辱正在阻止英国对药物过量死亡采取基于证据的应对措施。

• DOI: 10.1136/bmj-2023-074934
• 发表时间: 2023
• 期刊: BMJ (Clinical research ed.)
• 作者: Guise A