Dr Lynnette Kelly
Dr Maria Stuttaford
Professor Gillian Lewando Hundt
Professor Panos Vostanis
Institute of Health seminar
14 th December 2005

• The homeless people and service providers who have given of their time to teach us about their lives
• The study Advisory Group
• The study reported on here was funded by the
ESRC (RES-000-22-0618A)

• Introduction
• Research aims
• Methods
• The right to health
• Locating the right to health
• Meaning of health
• Ideas of rights to health
• Hostel environment
• Responsibilities and rights
• Conclusions

• To develop a conceptual framework of collective rights to health
• To explore the extent to which homeless families access their rights to health care services
• To explore these through dialogue with both service providers and homeless families
• To advance frameworks for supporting the right to health

• Interviews with a purposive sample of 23 hostel residents from two hostels
• 21 interviews with service providers
• Mixture of direct and indirect services, based inside and outside hostels
• 3 Participatory events bringing interviewees together

• WHO (1946) definition of health: “state of complete physical, mental and social well-being, and not merely the absence of disease of infirmity”
• ICESCR (1966) right to health “the right to the highest attainable standard of physical and mental health”
• Government obligations: respecting, protecting, fulfilling

• Individuals can be seen as sites for rights.
• Responsibilities for fulfilling rights can be located in different agencies
• The right to health is laid out in agreements at different geographical scales
• Also various scales of agency
• Need to examine substantive and procedural rights

“I am not homeless, I have a place here.” (B1, refugee recently joined by family)
I: Because it's like I'm staying at my own house. No one is coming to see me, to ask me what to do to ... I do what I want. Even if I've got visitors they can come any minute. No restrictions. (B5, single mother no longer able to stay with friends)
“Home is home. You are more happy in a home… At least we have a roof, thank god for that, you can’t stay in someone’s house all this time. Some people don’t even have this, they sleep outside all the time, at least we are here.” (B6, woman with medical reasons for needing rehousing)
“To me homeless is horrible. You keep moving from place to place, you just get into a routine and you move again, and have to get into another one.” (B12, woman fleeing domestic violence)

• Some considered health to mean purely physical health
• Many others, though thought it meant general well-being, including mental well-being
• Some considered health to encompass issues which impinge upon health, such as eating, and living conditions

“L: And you were saying earlier on about rights. Have you ever heard about the right to health?
Have you ever heard of the right to health?
No.
What do you think it might mean?
I don't know. (B12)
“I: Being well I suppose. Erm, being able to see a doctor when you need it.” (K3)
A: Oh dear. That’s quite broad isn’t it?... Because it could mean anything about health isn’t it? …It could even go to safety wise, its about health rights isn’t it? … So it’s quite a broad subject. But with me my right to health would be like eating right and staying healthy. Erm, exercise I think. And what else? Living in a house which is not going to give me any health problems. If I’ve got something which I feel is going to affect a health problem I don’t know?” (B2)

“I don’t know, I’ve never heard of that, how can I know my rights I only just got here, someone got to tell me my rights I don’t know nothing here.” (comment made at coffee morning)
I: I don't know, I don't know anything like that. I told you, I never went to school here, how could
I learn things like that?” (B13)

• Most had heard of the right to health
• Related to access to healthcare and health facilities, but also to conditions necessary for health
• Some considered link to equity, and rights meaning provision of specialised services, though no consensus on this
• Link between rights and responsibilities

I have a life, I feel I have freedom. I am sleeping more freely and less fitfully, I do what I want to. I go to the corner club, I have made some friends there, that was denied me before. I wasn't allowed to go anywhere I didn't have friends. I am beginning to learn more
English. B3
I’m safer in [hostel] because every door you go in, the outer door and the inner door, they’ve both got buzzers on them. So, plus you have to, if they’ve never seen you before, you have to say who you are at the door before you come in.…And if you’ve got a description not to come in they won’t let you in. So that’s why I’m safe here. I’m in a safe, very safe place here. K1
I:.. for a start off I'm going to this stress group. So when [my son] does start, now that we've got our own rooms…and try and relax a bit.
Before I would have just shouted and yelled at him back. Yeah. But
I try and relax a bit now and well is it necessary to come back at him the way he's come back at me? Because that just carries it on.

I cannot say there was much effect on health, but they don’t let us sleep in the morning, people come and check on us, they change the sheets, its like living in a camp with people checking, you can’t just go out, people are in control of us. B1
There's no carpet here, its not our own house, we can't be free, we can't do what we want. Sometimes its dangerous for the baby when he's crawling and walking.
The floor is too hard. B13
M: Well, its limited what you can do here isn’t it really, .
…you know what I mean? It’s just like with [daughter] I could do a lot more things to entertain her. Because she’s just stuck in the room and its not a very big room, its just limited. I don’t like, I don’t like the fact that, I don’t know. You’re not your own person because you’re having to ask permission for everything, its not nice. K10

• International agreements may guarantee the right to health, but local institutions are needed to deliver it
• Skills may be needed to negotiate access
• Residents rely on intermediaries – support workers - to negotiate
• Landscape itself can inhibit access to health rights

• Procedures for delivering services locally part of partnership or collective approach
• Interviewees saw responsibilities for health as a partnership between agencies and themselves
• BUT there has been blurring of boundaries and it is not always clear where responsibilities lie
• Some felt they were solely responsible for their health

• Rights are a product of individual and collective agency
• Rights are located in the individual and collective context
• Concept of ‘sites for rights’ allows consideration of diversity of interaction between individual and collective
• Takes into account shifting boundaries of needs, responsibilities and rights

• Despite declarations of rights to health, there are spaces where individuals and collectives are denied procedural rights
• This will also then deny substantive rights to health
• Regulation of landscapes may limit access to health care and inhibit conditions for health
• They can become sites for invoking rights through individual and collective agency