For one nursing leader, Debra Cerasa, the recent Vinnies CEO Sleepout was an opportunity for reflecting upon the importance of the social determinants of health, and the role of nurses in working with the homeless.

Meanwhile, registrations are already being sought for next year’s Vinnies CEO Sleepout.


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Supporting better health for the homeless

Debra Cerasa writes:

When staff first “encouraged” me to participate in the CEO Sleepout by registering my name and then advising me later, we all thought it was a bit of fun.

Now, having completed my third consecutive year supporting this awareness campaign, I am a passionate advocate of this cause, and the need to do what we can to eliminate this concern in our communities.

The Vinnies CEO Sleepout, entitled Rise to the challenge, is an annual and now national event that raises funds for the St Vincent De Paul Society to continue delivering services to homeless people.

Debra Cerasa...battling the elements on 21 June

As CEO of Australia’s peak professional nursing organisation, I was keen to raise awareness of homelessness not just as a social issue, but also as a particular at-risk group for poor health outcomes, and a demographic that often has very complex health needs.

As an advocate for nurses and for informing our communities of the role of nurses in Australia, I jumped at the opportunity to highlight the essential role nurses play in managing the health care needs of this specific group, and to profile this often ‘invisible’ but critical specialty of nursing.

To my mind, the need for increased awareness of the social determinants of health is clear.

Health outcomes for the homeless population in our community are inextricably linked to and largely determined by their social disadvantage. Nurses deal with many prevalent non-communicable diseases and risk factors such as obesity, diabetes and smoking, all of which can correlate to low socio-economic status and poverty.

44% of homeless persons in Australia are female, approximately half of which have escaped domestic violence. 12% are children under the age of 12. Nurses play a significant role in ensuring that such hardship does not translate into negative health outcomes.

Homelessness is associated with much higher rates of mental health issues and substance abuse than is found in the general population, which compounds the severity of homeless people’s circumstances. Approximately 80% of clients who access St Vincent de Paul Society’s accommodation suffer from some form of mental health issue.

As such, I believe work towards the provision of basic services to homeless people cannot be considered as independent of the nursing profession’s tireless efforts to improve the health and wellbeing of socially disadvantaged persons.

Maslow’s hierarchy of needs is the simple model I reflect upon as an explanation for the poor health outcomes of homeless people in Australia.

According to Maslow, people are only able to focus on their long-term interests such as chronic health conditions and preventive health once more basic needs such as food and shelter are satisfied. As a result, homeless people are forced to neglect their health in order to focus on their daily struggle for security and survival. It is well documented that the first significant correction that will assist homeless people is access to affordable emergency housing.

Nurses assist homeless people to think beyond their immediate basic needs and give attention to their health and wellbeing. In many cases, nurses are the primary link that homeless people have to social, community and health groups.

I am aware of so many programs that support homeless people around Australia and when it comes to health issues, it is nurses who offer the contact, care and support.

To give up one night in the cold is such a small sacrifice if it supports and promotes the plight of homeless people and brings attention to this issue in our community.

At the same time, it inspires recognition of the work nurses do when they care for homeless people to improve their health and wellbeing.

• Deb Cerasa, CEO of Royal College of Nursing, Australia, December 2008 – June 2012




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Peter Fray
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