Adding insult to injury: homelessness and health service use

This qualitative study considers why homeless people in the least secure forms of accommodation make little use of the primary health care services provided by the National Health Service. Current approaches to this question have tended to develop in a sociological vacuum, unaffected by relevant developments in medical sociology and broader social theory. An approach informed by Alfred Schutz's phenomenology has been used in this article to develop a more theoretical account of homeless people's use of health services than has hitherto been offered. Running throughout this article is the claim that, amongst rough sleepers, there is a distinct culture which makes use of mainstream health services unlikely. Sleeping rough, it is argued transforms the way mainstream health services are seen and renders inappropriate the rules of thumb which govern health and illness behaviour in wider society. In developing these arguments, the view, presented in previous work, that homeless people do not value their health and are apathetic about seeking health care is rejected. Rough sleepers, it is suggested, will use health services if they feel these are provided in an accessible and sensitive way.