Riley Anthony J, Harding Geoffrey, Underwood Martin R, Carter Yvonne H
Centre for Health Informatics and Multiprofessional Education, Royal Free and University College Medical School, London, University College London, Fourth Floor, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW.
Br J Gen Pract. 2003 Jun;53(491):473-9.
Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness.
无家可归是一个影响当代社会各个方面的社会问题。本文从历史背景以及普遍存在的“指责受害者”意识形态的主导地位方面探讨了无家可归的概念，这种意识形态与导致国家财政危机的全球经济变化以及由此产生的政策和环境一起，导致了“新无家可归者”数量的增加。本文试图挑战关于无家可归问题的主流政治话语。无家可归者广泛存在的健康问题和异质性对医疗服务有特殊影响，许多无家可归者因阻碍获得适当初级保健的障碍而不适当地前往当地的事故和急救（A&E）部门就诊。已经成功实施了一些初级保健计划，以使无家可归者能够更好地获得适当的护理。然而，英国各地的服务水平并不一致，服务创新并不普遍，而且本质上是临时的。尽管这些计划取得了成功，但许多无家可归者仍然不恰当地获得医疗保健。在无家可归者完全融入初级保健之前，情况不会改变。问题仍然存在，如何才能建立适当的就医途径？可以从在初级保健中已经开展的一些积极工作的基础上起步，但实际上，除非采取更综合的政策方法来解决无家可归问题，全科医生（GPs）将“逆水行舟”。
