In my present project I began with research showing that homeless and other very disadvantaged people have poorer health and use fewer health services. I considered this in the context of the Social Determinants of Health (Marmot & Wilkinson), that there is a direct health gradient related to income level. In addition, there is a relationship with non-economic factors, the social determinants, especially, social isolation, high stress and lack of control over one’s life circumstances. Whilst accepting that  ‘housing first’ might well be the best health outcome for people living homeless, as a health social worker worker I was interested in the human rights, social justice aspect of equitable access to health services and how this might be improved at a local level. I was thinking about strategies health providers could implement – the barriers and opportunities locally, based on previous research that revealed people active in entry systems were able to indicate quite specific factors that enabled or discouraged access (Duncombe, 2017).

Whilst the project has identified some opportunities for improvements in local service entry practices another aspect has arisen too. Research participants living homeless reported a range of episodes of unkind treatment, by police, rangers, private practices and charity staff. Their recounting of these stories directly linked them with episodes of anger, resentment, distrust, distress and despair.

‘Karlie’:
One of my mates needed some undies. He hadn’t had any clean undies, and it was just making him feel really bad. I said, “Let’s just go to one of the oppies and if there’s something good there, I’m sure we can sort something out.” So he found some stuff in Lifeline there, and I went up to the lady and I said, “He’s got no money, but he’s had all his stuff stolen. He’s a homeless guy.” She went, “No. We make money here for our telephone service.”
‘Rocko’:
Oh yeah, I know the person.
‘Karlie’:
Yeah, and then she started going on about, “I see them drink on the street. They’ve got money to spend on the drink” kind of thing, and I was just like, “You know nothing.” A lot of people in the community donate really awesome stuff and they’re thinking it is going to the needy. It’s not. It’s going to make them money so they can pay their managers.

OR

‘Silvia’:
Yeah, the feeling, like, when I went through the next day and got told the rangers are coming and went and stopped at someone’s house, came through the next day and all my stuff was gone: my tent, my tarp, it was all set up, my stuff, it was a very harrowing experience and feeling. Even though I’m used to it and it has been a [unclear] of let it go, it’s just that gutting feeling of, like, total dishonour.
Karlie:
It’s the lack of respect.
Silvia:
Yeah, it’s lack of respect that I came back to my space to see what was left and it’s completely vacant.

OR

Karlie:
Like when the boys lost their stuff last week, had their stuff stolen the fact that they weren’t responded to that day, by the community, Vinnies said come back Thursday, this was Monday. Instead of getting a bag with new clothes – they’d lost … what I’ve found with the guys especially, they’ve got a lot more drug and alcohol problems than I’ve found with the women, they lose…the stuff they have, and have kept is really precious stuff. One of the guys was going on about a nail clipper, but that he was given by his grandmother who has died… it’s really memorable important stuff to them
If Vinnies had just been able to give them a backpack, some new clothes, a blanket, here’s a tent I know they wouldn’t have gone on this roll of extreme drug taking which they are both on at the moment because of the pain. There was a day of crying, three days of crying, a bad stomach ache because they hadn’t eaten and the stress and the loss and because they weren’t responded to and it triggered them.

I am viewing this at an intersection of sociology, psychology and epidemiology. Sociologically we have explanations of marginalisation. Functionalists see it as people with less to offer functioning at their own level at the outskirts of society (Talcott Parsons), interactionists see it as socially negotiated labelling of people as deviant or stigmatised (Goffman, Garfinkel) and critical theorists as well-resourced people actively protecting their interests from claims by people who are worse off (Chicago School).

Psychology identifies micro-aggressions (Sue) as those possibly unintentional but persistent unkindnesses that collectively grind down people living on the margins whether by virtue of race, disability, religion, or, in this case, homelessness. These are in addition to the historic abusive or neglectful childhoods of many homeless people and in addition to physical aggressions often experienced by people sleeping out. The trauma like symptoms that develop as a consequence include, self-medicating substance use, reactivity, distrust and self-exclusion. These in turn make this population ’hard to reach’, not least because many lose faith in mainstream systems and policies that effectively work against them.

The marginalisation, and abuse, which encourages alienation as people further withdraw to protect themselves, feeds into the epidemiological underpinnings of the Social Determinants of Health: little control over their circumstances, impoverished social networks and high levels of stress. The upshot of all this is, I think, that we can all make a contribution to people who live homeless. By acknowledging them through eye contact and conversation. All positive social exchanges provide an alternative to all those negative experiences and imply that at least from you and me, there is acceptance, not rejection. Small kindnesses are a small but simple gambit for challenging the victim blaming and unnecessary cruelty our society metes out.