Homelessness is a public health issue: why prevention must be everyone’s business

This week, we are marking National Housing Day by publishing this article from Public Health Scotland. A safe, secure and nurturing home is one of the most important foundations for health and wellbeing. It provides stability, safety, opportunity and connection writes Alison King, Senior Health Improvement Officer at Public Health Scotland. Yet for thousands of people across Scotland, that foundation is missing or under threat.

While homelessness is often viewed as a housing issue, it’s also a public health challenge. It both reflects and reinforces deep inequalities in health, income and opportunity. Preventing homelessness requires a coordinated response from housing, health, social care, education, justice and community services working together.

Looking beyond rough sleeping

Perceptions of homelessness often focus on people sleeping rough. In reality, homelessness takes many forms.

This includes people living in temporary accommodation, staying with friends or relatives in unstable arrangements, moving between insecure housing situations, sleeping in cars or tents, as well as those sleeping rough.

Many experiences of homelessness remain hidden. However, research suggests that at least 8% of Scotland’s population will experience homelessness at some point in their lives.

Recent statistics underline the continuing pressure on housing services. In 2024/25:

• More than 40,000 homelessness applications were made across Scotland.
• Over 34,000 households were assessed as homeless or threatened with homelessness – the highest level since 2011/2012.
• Around 18,000 households were living in temporary accommodation.
• More than 10,000 children were living in temporary accommodation.
• 2,465 households were reported as rough sleeping the night before a homeless application.

Often, these arrangements are not short-term. Individuals are spending an average of 238 days in temporary accommodation, with significant impacts on health, education, family relationships and wellbeing. 

Routes into homelessness

Homelessness rarely happens suddenly or in isolation. It‘s often the result of a combination of structural factors, life events and unmet support needs.

Poverty and trauma remain two of the strongest drivers of homelessness. Risk is closely linked to childhood poverty, labour market inequalities and housing pressures. 

Common triggers include:

• Relationship breakdown
• Domestic abuse and gender-based violence
• Being asked to leave the family home
• The loss of a tenancy

Certain groups face higher risks, including care leavers, people leaving prison or hospital, veterans, women experiencing violence, and migrants and asylum seekers.  LGBTQ+ people also face higher risks of homelessness, often linked to family rejection or discrimination.

Homelessness can occur alongside wider experiences of trauma, poor mental health, substance use or involvement with the criminal justice system. However, it’s important to recognise that homelessness is not always associated with severe and multiple disadvantage. Many people become homeless following a crisis event and may require targeted support.

Prevention works best when it happens early

Pathways into homelessness often involve identifiable transition points where timely intervention can make a significant difference. These might include leaving care, prison or hospital, experiencing relationship difficulties, financial hardship, deteriorating mental health or challenges maintaining a tenancy.

Support provided early – whether through housing advice, income maximisation, employment services, health interventions or social care – can prevent homelessness from occurring altogether or help people exit homelessness more quickly.

For local authorities, this means shifting the focus from crisis response to prevention and early action.

Homelessness and health: a two-way relationship

The relationship between homelessness and health is both complex and deeply interconnected.

Poor health can contribute to homelessness. Equally, homelessness can significantly worsen existing health conditions and create new challenges.

People experiencing homelessness are more likely to have:

• Long-term physical health conditions such as respiratory and cardiovascular illness.
• Mental health conditions.
• Harmful alcohol and drug use.
• Difficulties accessing healthcare.

Concerningly, recent data estimates that 231 people experiencing homelessness died in Scotland during 2024. Nearly half of those deaths were among people under the age of 45, demonstrating the profound and avoidable health inequalities experienced by this population.

A human rights issue

The right to health is a fundamental human right. It includes access to the conditions that enable people to achieve the highest attainable standard of physical and mental health, such as safe housing, education, food, employment, and social participation.

Yet people experiencing homelessness often face some of the greatest barriers to realising their rights.

Many encounter obstacles when accessing healthcare, including:

• Difficulties registering with GP services.
• Problems receiving correspondence.
• Lack of affordable transport.
• Fragmented service provision.
• Stigma and discrimination.

A rights-based approach means ensuring services are accessible, equitable and proportionate to need. 

No single organisation can prevent homelessness

The causes of homelessness span multiple systems, and so must the solutions. Effective prevention depends on strong collaboration between:

• Local authorities
• Housing providers
• Primary care and NHS services
• Health and social care partnerships
• Criminal justice services
• Domestic abuse services
• Third sector organisations
• Community groups.

Scottish Government’s Population Health Framework 2025-2035, Public Health Scotland’s Together We Can strategy, and public service reform programmes all recognise the importance of tackling the social determinants of health and intervening earlier to prevent crisis.

The role of local government

Local government is uniquely placed to bring partners together.

Key priorities include:

• Strengthening local homelessness health needs assessments.
• Designing services informed by evidence and lived experience.
• Identifying homelessness risks earlier.
• Developing clear referral pathways between services.
• Building workforce confidence to recognise and respond to risk factors.
• Supporting trauma-informed and psychologically informed practice.
• Coordinating services around individuals and families rather than organisational boundaries.

The proposed “Ask and Act” duties within the Housing (Scotland) Act 2025 further reinforce the importance of identifying risk early and taking action before homelessness occurs.

A shared responsibility

If Scotland is to reduce health inequalities and achieve its ambition of ending homelessness, prevention must become everyone’s business. By working together across services and sectors, we can create a system that not only responds to homelessness when it occurs but also helps prevent it from happening in the first place.

Because a safe and secure home is not simply a housing outcome – it’s a foundation for good health, dignity and opportunity for all.

Read the full briefing on the PHS website.