Homelessness and Informality (Part 3)

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Homeless people have a harder time accessing medicine than the general population. While there are homeless people who simply cannot access formal medicine, there are many reasons why they more proactively choose informal medicine. The overarching reason they choose informal medicine is because they see it as an alternative form of treatment that allows them to be self-sufficient and keep a strong social network. More specifically, homeless people choose informal medicine such as herbs because it fits an alternative lifestyle. Others find more practical reasons for informal medicine: they simply cannot buy formal medicine and lack insurance. In addition, informal medicine is cheap and using it is a survival skill to cope with the violence, abuse, and isolation that comes with being homeless. Finally, homeless people distrust hospitals and other formal medicine, feeling unwelcome, discriminated, and that doctors did not understand their choices.

Whatever the reason, many homeless people urgently need healthcare. 75% of Homeless people have at least one unmet healthcare need.[1] They are very often uninsured, with two or medical conditions. 48% of them have a mental illness and, among them, 26% of them have difficulty finding treatment for their mental illness.[2] Homeless peoples’ food insufficiency correlates to their difficulty in accessing formal medicine, whether it be prescriptions, therapy, or surgery. However, lack of medical care correlates with many other factors besides food insufficiency. What can be concluded from the research is that the less food a homeless person has the more likely she will neglect medical treatment and instead focus on just getting enough food to survive.[3]

With such dire health, homeless people tent to take one of two options. They either seek informal medicine to treat themselves with the limited resources they have or they wait until they become morbidly ill and are taken to ER. In the latter situation, the hospital pays for treating homeless people from their own pocket, since homeless people are uninsured and lack the money to pay for their healthcare. While hospitals are generous to patients in immediate need, their generosity cans only go so far. Nurses volunteer to treat homeless people to try to fill in the void, providing informal medicine to those in need, their work unaccounted for in their salaries.[4]

Homeless youth are especially resourceful in using informal medicine. While they do encounter a formidable barrier to formal healthcare, they also use informal medicine because they have alternative or counterculture values.[5] Homeless youth have many informal options to choose from and take full advantage of their opportunities. “The most frequently used forms of CAM therapies were vitamins (76.4%) and herbs (73.6%). Other forms of treatments frequently used were diet (40.9%), massage therapy (38.2%), exercise (31.8%), acupuncture (27.2%), meditation (26.4%), aromatherapy (21.8%), homeopathy (17.3%), and chiropractic (11.8%). Slightly more than 7% of the youth used shamans, psychic healers, magic spells, and flower teas.”[6]

How homeless youth acquired informal medicine was as varied as the very medicine they take. Friends advised 53% of homeless youth and physicians and nurses advised 21.8%, bleeding the formal sector into the informal sector. Family members helped 20.4% of homeless youth, social workers aided 14%, while 18% of homeless youth discovered informal medicine themselves. While embracing alternate and counterculture values, homeless youth still had other smaller reasons within their larger one. Their most common reason, 43.9% of the time, was because they found informal medicine to be “natural” and “organic”. Homeless youth used informal medicine 28% of the time because of the low cost, 26.1% of the time because it had high chances of working, 24.2% of the time because they had bad experiences with physicians in formal medicine, 20% of the time because their friends recommended it, and 19% of the time because they severely mistrusted physicians.[7]

Unlike their young counterparts, homeless adults are less idealistic. They are much less interested in living an alternative lifestyle and more interested in having a reliable community, resisting the isolation homelessness brings. Homeless women in particular form communities with each other and informal doctors to access different kinds of medicine. Homeless women are innovative and self-reliant, preferring to go to a library or bookstore to learn about the illnesses they have before going to a doctor. They would also call a nurse in a volunteer counseling service, available in most major cities. Two young women in particular asked advice from a herbalist, read extensively on herbs, and consulted an allopathic practitioner for a diagnosis, before treating themselves.[8]

Social networks, such as the ones formed by homeless women, give homeless people extra resilience to deal with the many stresses of street life.[9] Strong social bonds from family and close friends had a protective influence over homeless peoples’ health. “Specifically, perceived financial support was related to better physical health status; perceived emotional support was related to better mental health status, and perceived instrumental support was associated with lower likelihood of victimization.”[10] The research from Dr. Hwang and his colleagues shows that a strong social network not only gives homeless people access to informal medicine but also acts as a kind of medicine itself, protecting the homeless, making it less likely for them to get physical and mental illnesses.

Homeless women turn to informal medicine instead of formal medicine from physicians in hospital for negative reasons also. Overall, they distrusted hospital physicians, thinking they would not understand the needs of their lifestyle. They also had little confidence in physicians’ abilities to keep information confidential. If a homeless woman or one of her friends was lesbian, she would strongly prefer the physician to be nonjudgmental towards gay people. Homeless women also strongly prefer if the physician was female, thinking female doctors will understand their lives better since they are both women and will be knowledge and sensitive towards female anatomy during intrusive physical examinations.[11] Many homeless women expressed how they wished physicians would give them more advice about how to medically take care of themselves and thought of visiting physicians only as a last resort.[12]

Homeless people throughout the United States, not only homeless women, feel misunderstood by physicians. In general, homeless people are painfully aware of their situation. Knowing they are society’s outcasts, they often perceive unwelcome and discriminated against in hospitals, frequently complaining of not being listened to and feeling disempowered.[13] This news is especially troubling since homeless people frequently have at least two medical conditions and one illness untreated. Homeless people have an especially high risk of premature death compared to the general population.[14]

In their accounts, different homeless people felt unwelcome in different ways. Michael felt people in the hospital thought of him as a freeloader. Luke said he felt discriminated against in most places, including hospitals, claiming just being in a mall for half an hour was enough to get a security guard to accost him. Michael said he was discriminated against the very first time he went to hospital when homeless.[15] Such hostility and prejudice is a very bad influence, making them less likely to seek professional care. It also makes them distrustful of all sorts of formal medicine and at times even experienced a form of stereotype threat, overly consciences of “looking and talking homeless”.[16]

Fortunately, there are relatively small but helpful volunteer nurses and hospice caregivers who try to provide some care to homeless people, making informal medicine more accessible. One form of informal medicine is telephone-based counseling where the caregiver or volunteer counsels the homeless person with advice.[17] Both caregivers and volunteers did more than give homeless people medical advice. They frequently fill the role of a kind of informal therapist, fulfilling several areas of need by providing homeless people with emotional support, advising them about self-care and logistical issues, and helping them cope with bereavement of lost ones and other crises.[18]

Telephone services provide other benefits to homeless people. For one, they are extremely convenient, eliminating transportational and geographical barriers that would otherwise prevent homeless people from speaking to caregivers and volunteers. Telephone-based counseling, like psychotherapy, helps treat depression and phone support groups alleviate the stress of homeless people with dementia.[19] There are several small downsides to telephone-based counseling, for both homeless people and volunteers. Telephone-based counseling ultimately exists only as a supplement to “real” healthcare. It can compliment but not duplicate hospital services.[20]

Caregivers and volunteers expressed how difficult their work was. Their work strained their relationships with their loved ones, especially having a hard time shifting from caregiver or volunteer back to a parent, spouse, or child. Most importantly, they felt frustrated at having such little information on the very homeless people they tried to help, and felt they could never be impartial or objective in their advice no matter how hard they tried.[21] Nevertheless, caregiving and volunteering is rewarding as it is challenging and it bears repeating how invaluable it is. When people are homeless any help, any sincere effort to reach out to them is better than none at all.


Overall, homeless people choose informal housing, informal economy, and informal medicine, for a diverse number of reasons that encompass three overarching broad ones. First, homeless people see informality as a way of being self-sufficient and taking control over their lives. Second, homeless people try to escape from a desperate situation to find an alternative route that could help them. Third, homeless people are simply forced into informality such as being unable to access the formal sector at all. All three overarching reasons are the result of both the pressures of extreme poverty and a lifestyle forged by abusive upbringing, poor socioeconomic status, mental illness, and drug addiction. They reflect the deep socioeconomic cracks in United States society and the millions of people who fall in them. They reflect the United State’s failure in being a free and equal society.

Wherever there are homeless people there is an informal network they are a part of, whether in large and bustling cities, suburban neighborhoods, or isolated areas deeper in the country. We like to believe our developed “first world” United States, a world superpower and one of the richest countries in the world, is the center of a global civilized world. However, it holds an entire informal underworld rivaling those of any developed country. The civilized world is only the surface level of our country. Beneath it lies a wild and uncertain world as in everywhere else. Homeless people in the United States and the informal networks they rely on show that informality is does not exist somewhere far away. Informality exists in our backyard.


“Economically Distressed Areas Program (EDAP).” Economically Distressed Areas Program. Texas Water Development Board, n.d. Web. 05 Dec. 2015.

“Shantytown In Hoboken Hills Houses Nearly 50 Homeless People.” CBS New York. CBS, 1 Apr. 2015. Web. 05 Dec. 2015.

Baggett, Travis P., James J. O’connell, Daniel E. Singer, and Nancy A. Rigotti. “The Unmet Health Care Needs of Homeless Adults: A National Study.” Am J Public Health American Journal of Public Health 100.7 (2010): 1326-333. Web.

Bose, Rohit, and Stephen W. Hwang. “Income and Spending Patterns among Panhandlers.” CMAJ. N.p., 3 Sept. 2002. Web.

Breuner, Cora Collette, Paul J. Barry, and Kathi J. Kemper. “Alternative Medicine Use by Homeless Youth.” Arch Pediatr Adolesc Med Archives of Pediatrics & Adolescent Medicine 152.11 (1998): 1071–75. Web.

Case, Ben. “U.S.: Homeless ‘Tent City’ in Harlem Ends in Arrests.” – Global Issues. N.p., 25 Nov. 2015. Web. 05 Dec. 2015.

Durst, N. J., and P. M. Ward. “Measuring Self-help Home Improvements in Texas Colonias: A Ten Year ‘snapshot’ Study.” Urban Studies 51.10 (2013): 2143-2159. Web.

Ensign, Josephine, and Aileen Panke. “Barriers and Bridges to Care: Voices of Homeless Female Adolescent Youth in Seattle, Washington, USA.” J Adv Nurs Journal of Advanced Nursing 37.2 (2002): 166-72. Web.

Erickson, Amanda. “Here’s Why We Can’t Just Put Homeless Families In Foreclosed Homes.” Business Insider. N.p., 28 June 2012. Web.

Gwadz, Marya Viorst, Karla Gostnell, Carol Smolenski, Brian Willis, David Nish, Theresa C. Nolan, Maya Tharaken, and Amanda S. Ritchie. “The Initiation of Homeless Youth into the Street Economy.” Journal of Adolescence 32.2 (2009): 357-77. Web.

Hwang, Stephen W., Maritt J. Kirst, Shirley Chiu, George Tolomiczenko, Alex Kiss, Laura Cowan, and Wendy Levinson. “Multidimensional Social Support and the Health of Homeless Individuals.” Journal of Urban Health J Urban Health 86.5 (2009): 791-803. Web.

Knight, Heather. “The City’s Panhandlers Tell Their Own Stories.” SFGate. N.p., 27 Oct. 2013. Web. 07 Dec. 2015.

Kovner, Josh. “For Chronic Homeless, Vacant Buildings Provide Shelter, Danger .” Contact Reporter. N.p., 9 Aug. 2015. Web.

Kutner, Jean, Kristin M. Kilbourn, Allison Costenaro, Courtney A. Lee, Carolyn Nowels, Jenny L. Vancura, Derek Anderson, and Tarah Ellis Keech. “Support Needs of Informal Hospice Caregivers: A Qualitative Study.” Journal of Palliative Medicine 12.12 (2009): 1101-104. Web.
Lee, B. A., and C. R. Farrell. “Buddy, Can You Spare A Dime?: Homelessness, Panhandling, and the Public.” Urban Affairs Review 38.3 (2003): 299-324. Web.

Loftus-Farren, Zoe. “Tent Cities: An Interim Solution to Homelessness and Aordable Housing Shortages in the United States.” California Law Review 99.4 (2011): 1037-1081 Web.

Mulhearn, Jude Kevin. “How I Survived as a Homeless Crack Addict.” Pacific Standard. N.p., 8 Aug. 2014. Web. 07 Dec. 2015.

Toth, Jennifer. The Mole People: Life in the Tunnels beneath New York City. Chicago, IL: Chicago Review, 1993. Print.

Wen, Chuck K., Pamela L. Hudak, and Stephen W. Hwang. “Homeless People’s Perceptions of Welcomeness and Unwelcomeness in Healthcare Encounters.” J GEN INTERN MED Journal of General Internal Medicine 22.7 (2007): 1011-017. Web.

Whitbeck, Les B., and Ronald L. Simons. “A Comparison of Adaptive Strategies and Patterns of Victimization Among Homeless Adolescents and Adults.” Sociology Department, Faculty Publications (1993): 135-52. Web.

[1] Baggett et al, pg. 1332
[2] Baggett et al, pg. 1330
[3] Baggett et al, pg. 1332
[4] Ensign and Panke, pg. 170
[5] Breuner et al, pg. 1071
[6] Breuner et al, pg. 1075
[7] Breuner et al, pg. 1075
[8] Ensign and Panke, pg. 168
[9] Hwang et al, pg. 792
[10] Hwang et al, pg. 796
[11] Ensign and Panke, pg. 170
[12] Ensign and Panke, pgs. 168-169
[13] Wen et al, pgs. 1011-1012
[14] Wen et al, pg. 1012
[15] Wen et al, pgs. 1013-1014
[16] Wen et al, pgs. 1017
[17] Kutner et al, pg 1101
[18] Kutner et al, pg. 1102
[19] Kutner et al, pg. 1105
[20] Kutner et al, pg. 1102
[21] Kutner et al, pg. 1103


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