Homelessness and Health: A Call to Action for Health Professionals in the CESPHN Region

Homelessness in the CESPHN region has profound and multifaceted health impacts, demanding urgent attention from health professionals and primary care services. On Census night in 2021, 11,496 people experienced homelessness within CESPHN, accounting for 35% of New South Wales’ homeless population and the highest proportion in the state.

Homelessness in CESPHN is driven by intersecting factors:

• Rental unaffordability and housing stress
• Family and domestic violence
• Mental illness and substance use
• Exit from institutions (e.g., prisons, hospitals, out-of-home care)

Health Impacts of Homelessness in CESPHN

• People experiencing homelessness in CESPHN face significantly higher rates of chronic diseases (including cardiovascular and metabolic syndromes), infectious diseases, mental illness (notably depression, anxiety, and PTSD), problematic alcohol and substance use, and trauma-related conditions.
• Early onset ageing is common, with earlier development of cognitive impairment and frailty.
• Barriers to managing chronic conditions, accessing preventive care, and maintaining continuity of treatment are widespread, resulting in increased hospitalisations and preventable morbidity.
• Key social determinants—such as exposure to violence, unstable housing, and limited social supports—increase risks of injury, psychological distress, and poor oral and physical health.

CESPHN’s Role: Strategy, Innovation, and Commissioning

CESPHN plays a pivotal role in shaping regional responses to homelessness through leadership, collaboration, and commissioning of targeted health services.

Strategic Framework:

CESPHN is a key partner in the Intersectoral Homelessness Health Strategy 2020–2025, alongside SESLHD, SLHD, St Vincent’s Health, NGOs, and local councils. This strategy identifies five priorities:

1. Improving access to the right care at the right time
2. Strengthening prevention and public health
3. Increasing access to primary care
4. Workforce development
5. Collaborative governance and shared planning

Targeted Programs and Partnerships:

• PHN Homelessness Access Program (2025–): CESPHN is the national lead agency, coordinating with the Australian Alliance to End Homelessness to improve health access through commissioning, integration, and cross-sector collaboration.
• Mobile and after-hours GP clinics: Delivered in crisis accommodation and public spaces, particularly through partnerships with St Vincent’s Hospital Homeless Health Service and Kirketon Road Centre—serving over 1,950 clients in 2022–23 alone.
• Infectious disease control: Immunisation and hepatitis screening programs embedded in outreach settings.

Call to Action for Primary Care: Engagement and Next Steps

“Every contact counts. The pathway to stable housing often begins with a health conversation.”

• Health professionals are urged to:
  • Prioritise accessible and trauma-informed care for people experiencing or at risk of homelessness.
  • Strengthen collaboration with housing and specialist homelessness services, embedding health support within outreach and accommodation contexts^[1].
  • Use opportunities (such as vaccinations, health screenings, and mental health reviews) to proactively address health needs and connect patients to supports.
  • Advocate for systems integration and participate in local strategies targeting this vulnerable population.
  • Support data collection and health promotion for high-need cohorts in coordination with CESPHN.

The burden of homelessness on health is substantial and preventable. Primary care providers are well-placed to improve outcomes through collaboration, advocacy, and leadership—ensuring that health equity is a central focus during Homelessness Week and beyond.