The health outcomes of homeless people are poor, with higher rates of acute and chronic conditions than the general population (Hwang et al., 2011). Even more troubling is that people experiencing homelessness are subject to premature death (Frankish, 2005; Hwang, 2009). It is well known that the conditions under which homeless people live, such as having a lack of permanent and stable housing, inadequate income combined with food insecurity, social isolation, discrimination and marginalization contribute to poor health and early death (Hwang, 2009). The dearth of resources for health care means that people who are homeless are increasingly vulnerable to specific health risks, including contracting communicable diseases during outbreaks. This is evident in the higher rates of HIV and Hepatitis C among homeless populations (Holton, Hwang, & Gogosis, 2010), as it is often difficult to manage and contain disease transmission in compromised and inadequate living situations.
During the past decade, events such as the SARS outbreak have raised serious public health concerns about the challenges of taking measures to reduce disease transmission during pandemics (or potential pandemics) for both the general population and those who are homeless. One such event was the 2009–2010 concern about a potential pandemic caused by the H1N1 virus. While the pandemic did not materialize as feared, it offered significant learnings. In this chapter, we focus on learnings related to the needs of people who are homeless. These learnings arise from the unique social conditions and circumstances that contribute to homeless people’s heightened vulnerability to communicable disease transmission, and they offer insights into how to mitigate this population’s potential vulnerability in a communicable disease outbreak.