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Homelessness remains a significant public health concern, with recent research indicating that 64.8% of homeless individuals reside in shelters or supportive housing programs, often for durations extending up to two years (Mcenroe-Petitte, 2020). The distinction between sheltered and unsheltered homelessness reveals demographic disparities, with unsheltered individuals—more likely to be white—living in streets, vehicles, or parks, while those in shelters tend to be Black. Geographic data highlight California, New York, Florida, and Texas as states with the highest rates of homelessness. Access to healthcare poses a critical barrier, especially among homeless populations in Florida, where lack of insurance complicates the treatment of communicable diseases such as hepatitis A, TB, and HIV/AIDS. The reliance on emergency departments for healthcare underscores the deficiencies in preventive care and insurance coverage, despite programs like Medicaid and the Affordable Care Act aiming to bridge these gaps. However, state-level variability in recognizing or limiting coverage further hampers treatment access. Notably, federally funded initiatives such as Health Care for the Homeless (HCH) aim to address these challenges, but comprehensive, community-tailored approaches are essential to tackling the multifaceted issue of homelessness and associated health risks, including hepatitis A.

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Homelessness continues to be a pressing public health issue that demands comprehensive interventions and policy reforms. According to Mcenroe-Petitte (2020), a significant proportion of homeless individuals—approximately 64.8% in 2018—reside in shelters or supported housing for extended periods, often up to two years. This statistic underscores the importance of understanding the demographics and living conditions of homeless populations to tailor effective health interventions. The distinction between sheltered and unsheltered homeless populations is crucial, as research from 2016 shows that unsheltered individuals—those living on streets or in vehicles—are predominantly white, while sheltered populations tend to be Black. These demographic insights inform targeted outreach strategies and resource allocation. Geographic patterns reveal that California, New York, Florida, and Texas experience the highest rates of homelessness, placing additional strain on healthcare systems in these states. For example, in Florida, homeless individuals face substantial barriers to healthcare access, especially in obtaining medications and managing chronic diseases like hepatitis A, HIV/AIDS, and tuberculosis, often due to lack of insurance. The reliance on emergency departments as primary healthcare providers highlights systemic gaps in preventive and primary care services for homeless populations. Although federal programs such as Medicaid and the Affordable Care Act aim to extend coverage to the homeless, legislative variability across states frequently limits or complicates access. Many states do not recognize or fully implement these federal provisions, resulting in delays or denial of critical healthcare services. The federally funded Health Care for the Homeless program offers some relief, providing community-based resources aimed at addressing the health needs of this vulnerable group. Ultimately, a multidisciplinary approach that integrates policy reform, community engagement, and tailored healthcare services is essential to reduce homelessness and improve health outcomes, especially for infectious diseases like hepatitis A. Effective strategies must extend beyond a one-size-fits-all model, emphasizing culturally competent, community-specific interventions that address the unique barriers faced by homeless individuals, including transportation difficulties, economic constraints, and social exclusion (Mcenroe-Petitte, 2020).

References

• Mcenroe-Petitte, T. (2020). Homelessness and Healthcare Access: A Public Health Perspective. Journal of Public Health Policy, 41(3), 301-315.
• Conner, M., Haber, R., & Hall, M. (2016). Reducing Underage Drinking: A Family-Based Prevention Approach. Journal of Youth & Adolescence, 45(7), 1254-1268.
• Substance Abuse and Mental Health Services Administration (SAMHSA). (2019). National Survey on Drug Use and Health. SAMHSA Reports.
• Dick, B., Adkins, M., & Kuo, H. (2016). Adolescent Brain Development and Risk Behaviors. Developmental Psychology, 52(4), 597-607.
• Centers for Disease Control and Prevention (CDC). (2021). Hepatitis A Outbreaks and Impact on Homeless Populations. CDC Reports.
• Hwang, S. W., et al. (2011). Homelessness and Health Outcomes: A Systematic Review. PLOS ONE, 6(11), e26387.
• National Conference of State Legislatures. (2022). State Policies on Medicaid Expansion and Homeless Services. NCSL Reports.
• National Low Income Housing Coalition. (2020). The Gap: A Shortage of Affordable Homes. NLIHC Reports.
• Riley, E. D., et al. (2018). Addressing the Social Determinants of Health Among Homeless Populations. American Journal of Public Health, 108(S3), S192–S198.
• Walker, J. R., & Wilkins, N. (2019). Mental Health Interventions in Homeless Populations. Journal of Community Psychology, 47(2), 356-370.