WP4 RD #2

Researchers have identified the lack of medical necessities unhoused folks face and determine that an evidence-based approach is needed; therefore, we must move forward in implementing proactive/reactive measures with providing items to prevent cutaneous injuries and develop consistent structures to aid in medical concerns.

The lack of derma care for the unhoused communities is created beyond the contemporary issues within today’s limited access to resources; originating from previous history of the employment seeking unhoused communities. Historically, from the late 19th century, the unhoused community underwent several names and demographics, namely White men seeking employment and removed from the typical notion of domestic life. The National Library Of Medicine’s reading, Permanent Supportive Housing: Down and Out in America: The Origins of Homelessness, explains the reasoning behind the change of community. With the occurrence of wars, the spread of the AIDS epidemic,the Great Depression period, deinstitualization of those mental ill, and unaffordable housing, spilling over into the 20th century, the demographic of those unhoused shifted to dependant on welfare, disabled, and typically people of color (Rossi PH, Jones MM). Due to social events being a catalyst of altering those unhoused, disparities such as receiving health and medical care quickly became evident. Unhoused communities must prioritize fundamental necessities over being proactive on health concerns leading to disparities. Specifically, one may need to prioritize traveling to find food over the fact of walking for several hours in undesirable environmental conditions with unsuitable clothing during the transition of the seasons or continuously cleaning after themselves. As historically marginalized communities now make up a large portion of the unhoused population, many are forced to live under undesirable conditions, unable to prioritize their hygienic or dermal care, contrasting to the early categorization of being an unemployed white man.

Today, unhoused communities continue to live in undesirable conditions and battle with skin care disparities increasing the prevalence of cutaneous injuries and infections; consequently leading to an overall decline of health. The article, Dermatologic Care of Persons Experiencing Homelessness, by Sarah J. Coates, explains the prevalence of wounds, stating, “Homelessness is associated with high overall morbidity and mortality, along with numerous specific poor health outcomes” (Coates). The associations of unhoused individuals having high over all morbidity and mortality outcomes is not a coincidence as Coates further explains that “PEH [People Experiencing Homelessness] experience high rates of ectoparasitic, fungal, and sexually transmitted infections; chronic wounds; skin cancer; malnutrition; and cutaneous consequences of injection drug use. In other words, unhoused communities are very likely to experience medical concerns listed above; in which, Many of these medical concerns are caused or at the very least exacerbated by lack of skin care. With the use of protective clothing, materials utilized to add a physical barrier for the skin, medical concerns such as chronic wounds also known as Cutaneous Diphtheria would be prevented.

The researcher, A Berih, explores the rate of individuals likely to receive chronic wounds in his writing, Cutaneous Corynebacterium diphtheriae: A traveller’s disease?, claiming “Few studies described higher incidence of cutaneous diphtheriae which is described as chronic, nonhealing ulcers due to physical trauma” (Berih). The higher rates of cutaneous diphtheria found in the unhoused population leads to the prevalence of infections. Researcher Coates asserts the notion, stating, “Prevalence of hepatitis C, tuberculosis, and HIV is higher among PEH than in the general population” (Coates). Open wounds create an entry for many infections or diseases such as HIV or fungal infection to enter the body. According to the Mayo Clinic’s section on Infectious Disease, “A few types of infections have been linked to a long-term increased risk of cancer: Human papillomavirus is linked to cervical cancer; Helicobacter pylori is linked to stomach cancer and peptic ulcers; and Hepatitis B/C have been linked to liver cancer” (Mayo Clinic). To put it in another way, the likelihood of an unhoused individual to get a wound and later get an infection is very possible as they do not have accessibility to adequate resources to respond and can lead to the overall decline in health as they become prevalent to serious conditions such as cancer. Additionally, Nicolas Dauby, corresponding author at: Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Rue Haute, in his research, Streptococcus pyogenes infections with limited emm-type diversity in the homeless population of Brussels, 2016–2018, announces “The homeless are disproportionately affected by GAS [Group A Streptococcus] and have a higher rate of abscesses and high mortality” (Dauby). Infections found in wounds similar to the GAS can lead to decline in health extending to the point of serious conditions like death as unhoused communities are limited to sparse reactive treatment to skin care concerns.

Current proactive skin care initiatives for distributing clothes and housing to unhoused communities have been sprouting; however, it is not enough. Strong conversations in regards to housing for unhoused communities has become a clear initiative for many as several disparities are exacerbated such as dermal care. Access to housing will welcome unhoused communities into more controlled environments mitigating the opportunity to endure cutaneous injuries/diseases. The access of clothing will add an additional barrier to prevent harm from undesirable conditions, being a great resource for preventative measures. Access to clothes and housing are proactive measures preventing the opportunity of cutaneous injuries through additional protective layers and removal of harsh environmental conditions.

Additionally, Responsive measures of medical services for unhoused folks facing skin conditions provides aid as a reaction and mainly when dire. Medical care/services and health care/services are often interpreted as interchangeable; although, health care encompasses medical services and additional services of being proactive. Annapolis Internal Medicine, an independently-owned primary care medical practice that strives in providing comprehensive medical care to their patients, distinguishes the differences from the two difference services,“Health care is a much broader idea of which medical care is only a subset and [Health care] incorporates other elements such as Social Determinants (the circumstances under which you are born, live, play, socialize, work and die), genetics, behaviors such as eating, smoking, exercise and drinking, and a myriad of other factors” (Annapolis Internal Medicine). We can define the term Health care as a broader field including medical care and in return, medical care is displayed to be a specific sector. Medical care on its own is defined as “the management and care of a patient to combat disease or disorder”, as mentioned by the University of Wisconsin System, in their section, Medical treatment beyond first aid. In other words, Medical Care is found when patients have a medical problem; for instance, an injury or disease. The medical services given in reaction to injury or disease of the patient are only given as such — a reaction. As medical services are only viewed as reactive or responsive methods of health care, it naturally fails to be proactive and injured patients, unhoused people for example, typically hold off seeking care until dire situations. A study called Why do People Avoid Medical Care? A Qualitative Study Using National Data, led by Jennifer M. Taber, explores the medical field in order to grasp an understanding on the factors determining a patient’s decision to received medical care, highlights that “First, over one-third of participants (33.3% of 1,369) reported unfavorable evaluations of seeking medical care, such as factors related to physicians, health care organizations, and affective concerns. Second, a subset of participants reported low perceived need to seek medical care (12.2%), often because they expected their illness or symptoms to improve over time (4.0%)”(Taber). Undesirable evaluations of medical care and waiting over time are two reasons quickly identified among unhoused communities as several do not have the mobility in options to receive medical services. The restrictions of mobility forces unhoused individuals to experience treatment as given. Furthermore, due to the inability of medical care equipment at hand, many unhoused individuals must wait in hopes to heal or be forced to take action when dire. Medical services used to treat dermal injuries or disease in unhoused communities are provided as reactive measures, failing to prevent the problem and offers sparse ability for treatment options forcing unhoused communities between the potentiality of unfavorable treatment or dire conditions.

There should be consistent access to clothes, housing, and medical care/equipment — Implementing both proactive and reactive measures to combat the short and long term impacts of dermal care in unhouse communities. The access of clothing will add an additional barrier to prevent harm from undesirable conditions, being a great resource for preventative measures. Access to housing will welcome unhoused communities into more controlled environments mitigating the opportunity to endure cutaneous injuries/diseases. Treating and distributing unhoused communities with medical equipment/ aid will react to the current issues affecting them directly. Without both proactive or reactive initiatives, unhoused communities will continue to face cutaneous Injuries and disease and paltry prevention for future injuries. In regards to — -‘s work, they identify the problem to….

Having inconsistent housing only resolves sections of the larger dilemma at hand; therefore it’s important we continue to find more permanent housing solutions; an example is providing unused areas for public living with ample resources for shelter and public utilities. Creating a sector for public living will help in distributing medical equipment for cutaneous injuries and identify individuals in need.Researcher Tabe’s studies in exploring determining factors for receiving medical care illuminate the fact of mistrust and disparities of those providing help. In order to dismantle the mistrust in medical suppliers there should be ample understanding of entering and interacting with unhoused communities; in which organizations well experienced in unhoused communities can provide training. Simultaneous accessibility to clothing, housing, and medical treatment are vital in developing a well developed measure to distantly impact cutaneous injuries and diseases within the unhoused communities.

As historically marginalized communities now make up a large portion of the unhoused population, many are forced to live under undesirable conditions, unable to prioritize their hygienic or dermal care, contrasting to the early categorization of being an unemployed white man.Access to clothes and housing are proactive measures preventing the opportunity of cutaneous injuries through additional protective layers and removal of harsh environmental conditions.Medical services used to treat dermal injuries or disease in unhoused communities are provided as reactive measures, failing to prevent the problem and offers sparse ability for treatment options forcing unhoused communities between the potentiality of unfavorable treatment or dire conditions. Simultaneous accessibility to clothing, housing, and medical treatment are vital in developing a well developed measure to distantly impact cutaneous injuries and diseases within the unhoused communities.