In the context of growing concerns about the seeming inevitability of an influenza pandemic, all levels of government in Canada, as well as a broad range of institutions, have been working to develop disaster management plans. The H1N1 pandemic of 2009–2010 put such plans to the test in many ways, as governments, institutions and community agencies had to respond, either through rolling out existing plans, or by developing ad hoc strategies. Homelessness presents a key challenge to effective pandemic preparedness because of homeless people’s vulnerability to disease and their socially marginal status and, most significantly, because of the inherent weaknesses in a response to homelessness that relies mostly on the provision of emergency services and supports.
We know that at the best of times, the health of homeless people is compromised by situational factors (such as nutritional vulnerability and compromised immunity), structural factors (such as lack of income and inadequate housing), and pre-existing health conditions. Yet ultimately what underlies their vulnerability is not simply the characteristics and behaviours of the population. We need to consider the ways in which the infrastructure we have built to respond to homelessness — in particular, our reliance on emergency services that are often characterized by overcrowding, congregate living and resources inadequate to maintaining hygiene — organize the lives of people who are homeless to exacerbate this vulnerability and create the possibility of potential disaster in the event of a serious infectious disease outbreak. A key question to ask is whether we are prepared — or more to the point, is it possible to prepare — to adequately respond to the risks faced by the homeless population in the event of a serious pandemic?