Background: The role of housing as a social determinant of health is well-established, but the causal pathways are poorly understood beyond the direct effects of physical housing defects. For low-income, vulnerable households there are particular challenges in creating a sense of home in a new tenancy which may have substantial effects on health and wellbeing. This study examines the role of these less tangible aspects of the housing experience for tenants in the social and private rented sectors in west central Scotland. Methods: The paper analyses quantitative data from a mixed methods, longitudinal study of tenants from three housing organisations, collected across the first year of their tenancy. The paper postulates causal hypotheses on the basis of staff interviews and then uses a Realist Research approach to test and refine these into a theoretical framework for the connections between tenants' broader experience of housing and their health and wellbeing. Results: Housing service provision, tenants' experience of property quality and aspects of neighbourhood are all demonstrated to be significantly correlated with measures of of health and wellbeing. Analysis of contextual factors provides additional detail within the theoretical framework, offering a basis for further empirical work. Conclusions: The findings provide an empirically-informed realist theoretical framework for causal pathways connecting less tangible aspects of the housing experience to health and wellbeing. Applying this within housing policy and practice would facilitate a focus on housing as a public health intervention, with potential for significant impacts on the lives of low-income and vulnerable tenants. The framework also offers a basis for further research to refine our understanding of housing as a social determinant of health.

This article presents an analysis of the causes of homelessness in the UK, and develops the notion that the bulk of the research has focused on 'discrete' causes of homelessness, which has been important for enhancing our knowledge, but has also led to gaps in our understanding. To this end, the article begins outlining the benefits of the pathways approach, acknowledging the potential contributions of this approach rather than fully developing the argument, and placing it in a wider context. This article concludes by discussing implications for a more dynamic explanation of homelessness and the impact that it is likely to have on both policy and research in the UK.

Background Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. Method The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. Results Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. Conclusions These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.

The experience of homelessness not only affects physical health, but can also constrain access to required health care. In a number of European countries, national strategies to tackle homelessness have sought to deliver integrated solutions across housing, health and other social policy areas. This article examines approaches to meeting the health care needs of homeless people in relation to such strategies, drawing upon recent research in Norway and Scotland. The article presents a comparative analysis of approaches to service provision in relation to welfare models and the concepts of universal and specialist provision. The analysis suggests a cross-national shift in the conceptualisation of appropriate responses to the health care needs of those who experience homelessness. The provision of some specialist health services, while reflecting a selective model of welfare, need not be solely interpreted as conflicting with a more universal model of ensuring access to mainstream services. Rather, the challenge is to recognise the need for a process approach which supports an effective transition from the (sometimes necessary) use of specialist services for this group, towards (the ideal of) full integration into mainstream health care.

This paper presents a medium-long term analysis of the policy process in relation to tackling street homelessness in Scotland, through the Rough Sleepers Initiative. After setting the Scottish context in terms of governance and homelessness, the paper takes a chronological approach to policy review, drawing on empirical evaluative data and other documentary evidence. The paper then considers the overall effectiveness of the initiative in terms of its policy aims and in relation to the broader context of housing and welfare. The paper concludes by drawing some lessons which may have relevance beyond Scotland and the United Kingdom. This paper is concerned with a specific policy initiative designed to address the problem labeled as "rough sleeping" in the UK. This refers to those who have absolutely no shelter and are sleeping out of doors or in cars or other such locations. The terms rooflessness or street homelessness are also used to describe this, most acute, aspect of homelessness. In the UK, the term homelessness on its own has a broader meaning, incorporating those living in emergency or temporary accommodation, but lacking a secure home. The terms rough sleeping and rough sleeper have become embedded in UK policy and practice discourse on street homelessness.While this author does not consider these terms appropriate for describing those who experience street homelessness, their use in relation to policy initiatives cannot be avoided.The introduction, evaluation and review of the Rough Sleepers Initiative (RSI) in Scotland is documented, drawing on detailed empirical data from official evaluations and other published materials. The paper sets out the goals of the policy initiative, mechanisms for implementation and the range of assistance and services provided for homeless street people.From the available evidence it is possible to evaluate the initial effectiveness of the policy

This paper presents an overview of some of the key trends emerging from homelessness research to date, lessons to be learned, and some thoughts on the future prospects for homelessness research. Homelessness research draws on a number of academic disciplines, in an international context, and using a wide range of research methods. There is a significant theoretical and empirical research evidence base for understanding the nature and causes of homelessness, and a developing body of research on the impact of intervention strategies. Key challenges for the future include the development of truly multi-disciplinary research and truly international comparative research, as well as greater scientific rigor in both policy oriented and scholarly led research on homelessness

Background: While people who are homeless often experience poor mental and physical health and problem substance use, getting access to appropriate services can be challenging. The development of trusting relationships with non-judgemental staff can facilitate initial and sustained engagement with health and wider support services. Peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are homeless and using drugs and/or alcohol. In the proposed study, we will develop and test the use of a peer-to-peer relational intervention with people experiencing homelessness. Drawing on the concept of psychologically informed environments, it will focus on building trusting and supportive relationships and providing practical elements of support such as access to primary care, treatment and housing options.

Recent government policies to tackle single homelessness have been expressly concerned to reduce the incidence of rough sleeping, particularly in central London. This paper sets the issue of street homelessness in its policy and legislative context; examines available evidence of the rise in street homelessness in Britain; and presents a critical overview of the Single Homelessness Initiative