van Everdingen Coline, Peerenboom Peter Bob, van de Giessen Irene, van der Velden Koos, Delespaul Philippe A E G
Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, Netherlands.
Van Everdingen Health Care Research, Sittard, Netherlands.
Front Public Health. 2025 Jul 8;13:1585985. doi: 10.3389/fpubh.2025.1585985. eCollection 2025.
The opportunities of health and happiness are unequally distributed. Multiple triggers lead to social exclusion and can result in homelessness. Efforts are still failing to counter health inequity. Our ethnographic research explores the social pathways of citizens deprived of a home. How can we sustainably promote fair opportunities for all?
Urgent information needs prompted field research among Dutch homeless service users. In semi-structured interviews, we collected information on health and needs. A transdiagnostic, generic strategy is used. Our focus is on the three themes of recovery (meaning, symptoms, and the social dimension), and their evolution over time. From a human rights perspective, the study examines the interactions between homeless service users and their environments. Case descriptions are added for a better understanding of dynamics.
The dual snowball sampling resulted in a representative sample of Dutch homeless service users in 2015-2017 (16 facilities, 436 users). The health and needs patterns reveal many interrelations of multiple needs. The user-system interactions uncover a systemic failure to match vital needs of the neediest. The interactions over time expose how social decline occurs and identify opportunities for improvement. The survival strategies show that stress often generates communication barriers, conflict, alienation and neglect. This has a negative impact on the self-image, (in)formal networks and place of users in society. A "deadlocked case" from a local experiment demonstrates how community relations can overcome modern system obstacles, while creating stable conditions for growth.
Despite abundant care and welfare facilities, many shelter users feel abandoned. Our rights-based ecosystem approach leads to the root causes of unfairness, inherent in the healthcare system and culture. The findings disclose that the resilience of Dutch society suffers (but can withstand) significant erosion. By extension, this applies to modern care systems in high-income countries. Fostering resilience requires meaningful social relationships that offer creative solutions. Exploring dynamics stimulates shared learning in safe and public spaces. Providing networks with concrete tools, the approach can foster a coherent, systematic commitment to enrich fair opportunities and pathways toward thriving.
健康与幸福的机会分配不均。多种诱因导致社会排斥，并可能导致无家可归。为应对健康不平等所做的努力仍未成功。我们的人种志研究探索了无家可归者的社会轨迹。我们如何才能可持续地为所有人促进公平机会？
迫切的信息需求促使我们对荷兰无家可归服务使用者进行实地研究。在半结构化访谈中，我们收集了有关健康和需求的信息。采用了一种跨诊断的通用策略。我们关注康复的三个主题（意义、症状和社会维度）及其随时间的演变。从人权角度来看，该研究考察了无家可归服务使用者与其环境之间的相互作用。添加了案例描述以更好地理解动态情况。
双重雪球抽样产生了2015 - 2017年荷兰无家可归服务使用者的代表性样本（16个机构，436名使用者）。健康和需求模式揭示了多种需求之间的许多相互关系。使用者与系统的互动揭示了系统未能满足最弱势群体的关键需求。随着时间的推移，这些互动揭示了社会衰退是如何发生的，并确定了改进的机会。生存策略表明，压力常常会产生沟通障碍、冲突、疏离和忽视。这对使用者的自我形象、（非）正式网络以及他们在社会中的地位产生负面影响。一个来自当地实验的“僵局案例”展示了社区关系如何能够克服现代系统障碍，同时为成长创造稳定条件。
尽管有丰富的护理和福利设施，但许多收容所使用者仍感到被遗弃。我们基于权利的生态系统方法揭示了医疗保健系统和文化中固有的不公平的根本原因。研究结果表明，荷兰社会的复原力受到了（但能够承受）重大侵蚀。由此推断，这适用于高收入国家的现代护理系统。培养复原力需要有意义的社会关系，提供创造性的解决方案。探索动态情况能促进在安全和公共空间中的共同学习。通过为网络提供具体工具，这种方法可以促进对丰富公平机会和通往繁荣之路的连贯、系统的承诺。
