103).
It is clear to see that negative short and long term health consequences as well as increases in mortality rates are a direct adverse affect of the living conditions of homeless people. And yet, the relationship between homelessness and ill health goes much deeper. Risk factors that may lead to homelessness, are also risk factors for ill health: for example, poverty and substance abuse. Other health conditions, such as mental illness, may act as a risk factor for homelessness, and can be aggravated by the experience of homelessness (Frankish, Hwang, & Quantz, 2005, p. S24).
Now, despite the fact that Canada has universal health care coverage (under which most homeless people are also insured,) this population experiences many barriers to accessing health care services. Under a universal health insurance system, all individuals covered should be provided with care regardless of their monetary status. A research study conducted in Toronto of 1169 homeless individuals however, found that nonfinancial barriers were persistent in keeping many from accessing care. The study found that 17% of the participants responded that they had unmet health care needs "a proportion much higher than that of the general population. This was due to a number of nonfinancial barriers that the researchers identified, including the constant need to secure food and shelter, lack of transportation, and feelings of stigmatization (Hwang, Ueng, Chiu, Kiss, Tolomiczenko, Cowan, Levinson, & Redelmeier, 2010, p. 3). The lack of a permanent address also prevents homeless people from obtaining a health card, which often gets in the way of obtaining medical treatment and making appointments.
As a result of barriers to accessing primary care and follow-up treatments, health care delivery to homeless individuals is largely concentrated in emergency departments (Power, 2008), which becomes a "last resort " for individuals that have unmet health care needs that progressively worsen and become life threatening due to the delay in accessing treatment.