Abstracts
Abstract
Homelessness and inadequate housing affect approximately 1.6 billion people worldwide. Despite making up a fraction of the population, people experiencing homelessness (PEH) have higher rates of physical and mental health complications compared to the rest of the population with increased barriers to accessing necessary health care services. Therefore, this comparative policy analysis explores healthcare access for PEH and how this differs in low-, middle-, and high-income countries using the representative countries of Rwanda, Colombia, and Canada respectively. Comparisons and contrasts were made by analyzing the homelessness situation and the healthcare access barriers for PEH in each of these nations. Analysis was conducted using a combination of scientific and grey literature to understand each country’s experiences and the Voluntary National Review (VNR) reports to understand governmental perspectives. Through analysis, it became evident that the challenges PEH face regarding healthcare access are similar across countries. However, legal regulations and attitudes by the public and governmental bodies influence specific situational treatments and what is being done to combat these barriers, creating differences in PEH’s experiences.
Keywords:
- homelessness,
- healthcare access,
- social determinants of health,
- policy analysis
Appendices
Bibliography
- Alexander, L. (2023). Health care in Rwanda: Everything you need to know. The Borgen Project. https://borgenproject.org/healthcare-in-rwanda-2/
- Aloisea, I. (2012). The situation of street children in Rwanda: Prevalence, causes, and remedial measures. Kigali; Republic of Rwanda | National Commission for Children. Retrieved Jan 27 2026 from https://www.nrs.gov.rw/fileadmin/user_upload/The_situation_of_street_children_in_rwanda_2012.pdf
- Aykanian, A. (2022). How transportation disadvantage hinders mobility, service access, and exiting homelessness. International Journal on Homelessness, 3(2), 1–16. https://doi.org/10.5206/ijoh.2022.2.14811
- Baspineiro, R. (2023). Bogotá’s indigenous street children are the face of Colombia’s unrelenting cycle of violence. Equal Times. https://www.equaltimes.org/bogota-s-indigenous-street?lang=en
- Behmerwohld, S. (2023). Domestic violence and homelessness. Human Options. https://humanoptions.org/domestic-violence-and-homelessness/
- Benedicta Solf, L. G. (2024). Global affordable housing shortages can harm migrant reception and integration. migrationpolicy.org. https://www.migrationpolicy.org/article/housing-crisis-immigrants-integration#:~:text=Lack%20of%20affordable%20housing%20worldwide,to%203%20billion%20by%202030.
- Blair, N. (2024). Homelessness statistics in Canada. Made in CA. https://madeinca.ca/homelessness-statistics-canada/#:~:text=Homelessness%20is%20a%20problem%20that,the%20figure%20has%20been%20rising.
- Bojorquez-Chapela, I., Flórez-García, V., Calderón-Villarreal, A., & Fernández-Niño, J. A. (2020). Health policies for international migrants: A comparison between Mexico and Colombia. Health Policy OPEN, 1, 1-7. https://doi.org/10.1016/j.hpopen.2020.100003
- Buckley, R. (2025). Affordable housing in Rwanda: Opportunities, options, and challenges: Some perspectives from the International Experience. Advisory Center for Affordable Settlements and Housing. https://www.acash.org.pk/topics/affordable-housing-in-rwanda-opportunities-options-and-challenges-some-perspectives-from-the-international-experience-3/
- Butler, M., McNamee, C. B., & Kelly, D. (2021). Risk factors for interpersonal violence in prison: Evidence from longitudinal administrative prison data in Northern Ireland. Journal of Interpersonal Violence, 37(15–16), 14610–14632. https://doi.org/10.1177/08862605211006363
- Campo-Arias, A., Ceballos-Ospino, G. A., & Herazo, E. (2020). Barriers to access to mental health services among Colombia outpatients. International Journal of Social Psychiatry, 66(6), 600–606. https://doi.org/10.1177/0020764020925105
- Canadian Human Rights Commission. (2023). What are human rights? https://www.chrc-ccdp.gc.ca/en/about-human-rights/what-are-human-rights
- Canadian Poverty Institute. (2023). “Psychology works” fact sheet: Homelessness - canadian psychological association. Canadian Psychological Association - The national voice for psychology in Canada. https://cpa.ca/psychology-works-fact-sheet-homelessness/
- Canham, S. L., Bosma, H., Mauboules, C., Custodio, K., Good, C., Lupick, D., Seetharaman, K., & Humphries, J. (2019). Supporting partnerships between health and homelessness. Vancouver; Simon Fraser University, Gerontology Research Centre. https://hsa-bc.ca/_Library/Resource_Library/Supporting-Partnerships-Between-Health-and-Homelessness.pdf
- Castañeda-Orjuela, C., Hilarion Gaitan, L., Diaz-Jimenez, D., Cotes-Cantillo, K., & Garfield, R. (2023). Maternal mortality in Colombia during the COVID-19 pandemic: Time series and social inequities. BMJ Open, 13(4), e064960. https://doi.org/10.1136/bmjopen-2022-064960
- Castellanos-Canales, A. (2023). The reasons behind the increased migration from Venezuela, Cuba, and Nicaragua. National Immigration Forum. https://immigrationforum.org/article/the-reasons-behind-the-increased-migration-from-venezuela-cuba-and-nicaragua/#:~:text=Since%202015%2C%20more%20than%207,world’s%20second%2Dlargest%20refugee%20crisis.
- Claude, N. J. (2023). Rwanda’s population reaches 13,2 million in 2022. National Institute of Statistics Rwanda. https://www.statistics.gov.rw/publication/Rwanda_population_2022#:~:text=The%20ratio%20of%20Rwandan%20urban,lowest%20urban%20population%20(14.8%25).
- CMPA. (2022). Responding to a patient without a health card. https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2018/responding-to-a-patient-without-a-health-card#:~:text=A%20patient%20without%20a%20health%20card%20may%20be%20insured%20through,covered%20under%20private%20insurance%20plans
- Consortium for Street Children. (2020). The facts about street children. https://www.streetchildren.org/about-street-children/#:~:text=Economic%20poverty%20plays%20a%20major,at%20home%20or%20within%20communities.
- Cronin, J. (2024). Colombia Healthcare System. International Citizens Insurance. https://www.internationalinsurance.com/health/systems/colombia.php
- Diaz, J., Taboada, I., Abreu, A., Vargas, L., Polanco, Y., Zorrilla, A., & Beatty, N. (2023). Evaluating rural health disparities in Colombia: Identifying barriers and strategies to advancing Refugee Health. International Journal of Environmental Research and Public Health, 20(20), 6948. https://doi.org/10.3390/ijerph20206948
- Dixon, R. (2015). In Rwanda, “reeducation” means detention for homeless, hawkers and other undesirables. Los Angeles Times. https://www.latimes.com/world/africa/la-fg-rwanda-transit-center-20150924-story.html
- Emeli, I. (2024). The Rwandan healthcare system: Can a shifting burden of disease threaten a post-war success story? Cureus, 16(2), e53957. https://doi.org/10.7759/cureus.53957
- Evason, N. (2018). Colombian - religion. Cultural Atlas. https://culturalatlas.sbs.com.au/colombian-culture/colombian-culture-religion
- Gamba, L. (2024). Colombia sees decade’s 1st decline in migration from Venezuela. Anadolu Ajansı. https://www.aa.com.tr/en/americas/colombia-sees-decades-1st-decline-in-migration-from-venezuela/3161360
- Gibson, D. (2024). Can people experiencing homelessness get access to medical care?. Regen Outreach Community. https://regenbrampton.com/can-people-experiencing-homelessness-get-access-to-medical-care/
- Goody, H. T. (2019). Illness and homelessness. Citygate Network - Illness And Homelessness. https://www.citygatenetwork.org/NewsBot.asp?MODE=VIEW&ID=2083
- Gould, K., & Sajjan, H. S., (2023) Canada’s 2023 Voluntary National Review. United Nations. https://hlpf.un.org/sites/default/files/vnrs/2023/VNR%202023%20Report%20Canada%20EN.pdf
- Government of Canada. (2017). Health care - Refugees. Canada.ca. https://www.canada.ca/en/immigration-refugees-citizenship/services/refugees/help-within-canada/health-care.html
- Government of Canada. (2022). Government of Canada. Housing, Infrastructure and Communities Canada. https://housing-infrastructure.canada.ca/homelessness-sans-abri/reports-rapports/data-newcomers-donnees-nouveaux-arrivants-eng.html#:~:text=Over%20the%202017%2D2019%20period%2C%20newcomers%20were%20less%20likely%20to,claimants%20occurred%20in%20urban%20locations
- Government of Ontario. (2023). Ontario reducing wait times for publicly funded surgeries and diagnostics. Ontario newsroom. https://news.ontario.ca/en/release/1002732/ontario-reducing-wait-times-for-publicly-funded-surgeries-and-diagnostics
- Government of UK. (2022). Rwanda prisoner pack. GOV.UK. https://www.gov.uk/government/publications/rwanda-prisoner-pack/rwanda-prisoner-pack
- Guliver, T. (2014). How can we improve healthcare access for the homeless?. The Homeless Hub. https://www.homelesshub.ca/resource/how-can-we-improve-healthcare-access-homeless
- Gutwinski, S., Schreiter, S., Deutscher, K., & Fazel, S. (2021). The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLOS Medicine, 18(8). https://doi.org/10.1371/journal.pmed.1003750
- Hassan, T. (2023). World Report 2023: Rights trends in Colombia. Human Rights Watch. https://www.hrw.org/world-report/2023/country-chapters/colombia
- Health Canada, (2019). Canada’s Health Care System. Canada.ca. https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html
- Homeless Hub. (n.d.). About homelessness | Racialized communities. The Homeless Hub. https://www.homelesshub.ca/about-homelessness/population-specific/racialized-communities#:~:text=Youth%20who%20end%20up%20experiencing,the%20Canadian%20average%20of%2019.1%25.
- Hwang, S., Stergiopoulos, V., & O’Campo, P. (n.d.). At home/chez soi. MAP Centre for Urban Health Solutions. https://maphealth.ca/at-home-chez-soi/
- Institute of Medicine. (1988). Homelessness, health and human needs. National Academies Press.
- International Citizens Insurance. (2024). Health insurance in Canada for foreigners. https://www.internationalinsurance.com/health/north-america/canada.php#:~:text=Foreigners%20will%20receive%20emergency%20care,an%20international%20health%20insurance%20plan.
- Jensen, H., & Miller, A. (2023). Ontario connecting people experiencing homelessness in Toronto to more convenient care. Government of Ontario Newsroom. https://news.ontario.ca/en/release/1003838/ontario-connecting-people-experiencing-homelessness-in-toronto-to-more-convenient-care
- Kalisa, C. (2016). Rwanda housing rights and human rights brief. Geneva; UN Habitat.
- Kopec, A. (2024). The interactive effects of policies: Insights for policy feedback theory from a qualitative study on homelessness. Policy Studies Journal, 53(2), 243–262. https://doi.org/10.1111/psj.12532
- Lelyveld, N. (2020). Column: When homeless people lose their possessions, they end up further from leaving the streets. Los Angeles Times. https://www.latimes.com/california/story/2020-02-29/homeless-population-stolen-possessions-cleaning-sweep
- Liu, M., & Hwang, S. W. (2021). Health Care for homeless people. Nature Reviews Disease Primers, 7(1), 1-2. https://doi.org/10.1038/s41572-020-00241-2
- Londoño-Vélez, J., & Querubin, P. (2020). The impact of emergency cash assistance during the COVID-19 pandemic in Colombia. IPA. https://poverty-action.org/study/impact-emergency-cash-assistance-during-covid-19-pandemic-colombia
- Lorenzo, E. (2022, May 18). How homelessness is addressed in different countries. HomeMore. https://thehomemoreproject.org/how-homelessness-is-handled-in-different-countries/
- Macleod, S. L., MacRae, P., & Pimenta, J. (2023). Children in street situations’ access to healthcare: Qualitative findings from the Street Child World Cup 2022. BMJ Paediatrics Open, 7(1), 1-10. https://doi.org/10.1136/bmjpo-2023-002101
- Márquez, I. D., (2021). Acelelar La Implementación para una Recuperación Sostenible. United Nations.https://hlpf.un.org/sites/default/files/vnrs/2021/282902021_VNR_Report_Colombia.pdf
- Martini, M. (2023). Migrant’s Right to Health. Nairobi: International Organization for Migration.
- Meehan, K., Beresford, M., Amador Cid, F., Avelar Portillo, L. J., Marin, A., Odetola, M., & Pacheco‐Vega, R. (2023). Homelessness and water insecurity in the Global North: Trapped in the dwelling paradox. WIREs Water, 10(4), 1-11. https://doi.org/10.1002/wat2.1651
- Mgwedli, M., Geyer, S., & Crafford, G. (2025). The quality of life of South African Homeless adults aged 50 and older in Housing First Facilities: Implications for service delivery. International Journal on Homelessness, 5(2), 238–257. https://doi.org/10.5206/ijoh.2023.3.20171
- Mudge, L. (2020). Rwanda should stop locking up the poor. Human Rights Watch. https://www.hrw.org/news/2020/12/21/rwanda-should-stop-locking-poor
- OCHA. (2021). Rwanda: Street children find education, shelter and hope - rwanda. ReliefWeb. https://reliefweb.int/report/rwanda/rwanda-street-children-find-education-shelter-and-hope#:~:text=UNICEF%20estimates%20that%20there%20are,exacerbated%20many%20of%20these%20issues.
- Olah, M. E., Gaisano, G., & Hwang, S. W. (2013). The effect of socioeconomic status on access to primary care: An audit study. Canadian Medical Association Journal, 185(6). https://doi.org/10.1503/cmaj.121383
- Ormiston, C. K. (2022). LGBTQ youth homelessness: Why we need to protect our LGBTQ youth. LGBT Health, 9(4), 217–221. https://doi.org/10.1089/lgbt.2021.0324
- Osei Asibey, B., Conroy, E., & Marjadi, B. (2020). Health Problems and healthcare service utilisation amongst homeless adults in africa- a scoping review. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-08648-y
- Padgett, D. K. (2020). Homelessness, housing instability and Mental Health: Making The Connections. BJPsych Bulletin, 44(5), 197–201. https://doi.org/10.1192/bjb.2020.49
- Pandey, M., Kamrul, R., Michaels, C. R., & McCarron, M. (2021). Identifying barriers to healthcare access for new immigrants: A qualitative study in Regina, Saskatchewan, Canada. Journal of Immigrant and Minority Health, 24(1), 188–198. https://doi.org/10.1007/s10903-021-01262-z
- Peixoto do Nascimento, A. C., Bórquez, A., & Gallassi, A. D. (2024). Housing first for people experiencing homelessness in Brazil and worldwide: An integrative literature characterizing similarities and differences. Journal of Social Distress and Homelessness, 1–17. https://doi.org/10.1080/10530789.2024.2433292
- Pleace, N., Baptista, I., & Knutagård, M. (2019). (rep.). Housing First in Europe an Overview of Implementation, Strategy and Fidelity. Housing First Europe Hub. Retrieved 2025, from https://www.homelesshub.ca/sites/default/files/attachments/2019-10-10-HFinEurope_Full-Report2019_final.pdf.
- Purkey, E., & MacKenzie, M. (2019). Experience of healthcare among the homeless and vulnerably housed a qualitative study: Opportunities for equity-oriented health care. International Journal for Equity in Health, 18(1), 1-7. https://doi.org/10.1186/s12939-019-1004-4
- Rech, N. (2019). Homelessness in Canada. The Canadian Encyclopedia. https://www.thecanadianencyclopedia.ca/en/article/homelessness-in-canada
- Rojas, L., Bernal, V. A. V., & Herzog, A. (2023). Strengthening housing and urban development in Colombia. World Bank Blogs. https://blogs.worldbank.org/en/latinamerica/vivienda-desarrollo-urbano-colombia
- Rugema, L., Krantz, G., Mogren, I., Ntaganira, J., & Persson, M. (2015). “A constant struggle to receive mental health care”: Health Care Professionals’ acquired experience of barriers to mental health care services in Rwanda. BMC Psychiatry, 15(1). https://doi.org/10.1186/s12888-015-0699-z
- Rwema, J. O. T. (2023). Addressing the health and social challenges of people who inject drugs in Rwanda is a public health and moral imperative: IIE - The Power of International Education. IIE. https://www.iie.org/programs/iie-centennial-fellowship/centennial-fellows-blogs/2021-blog/jean-olivier-twahirwa-rwema-blog-2/
- Sabet, C. J., Hammond, A., Bajaj, S. S., & Rugwizangoga, B. (2023). Rwanda’s health-care success holds lessons for others: Think global health. Think Global Health. https://www.thinkglobalhealth.org/article/rwandas-health-care-success-holds-lessons-others
- Sheidu, P. (2024). Health Care in colombia: Improving accessibility. The Borgen Project. https://borgenproject.org/health-care-in-colombia/
- Shelterproject. (2024). The benefits and challenges of adopting a housing first approach in Nigeria - shelter origin. Shelter Origins - Affordable Homes. https://shelterorigins.org/2024/07/22/the-benefits-and-challenges-of-adopting-a-housing-first-approach-in-nigeria/
- Shepard, D. S., Halasa-Rappel, Y. A., Zeng, W., Rowlands, K. R., & Musange, S. F. (2023). Cost-effectiveness of expanding access to primary health care in rural Rwanda by adding laboratory-equipped health posts: A prospective, controlled study. The American Journal of Tropical Medicine and Hygiene, 108(5), 1042–1051. https://doi.org/10.4269/ajtmh.22-0519
- Stankova, T., & Botero, M. C. (2018). Colombia. Bogota; Habitat for Humanity. Retrieved Jan 27 2026 from https://www.habitat.org/sites/default/files/colombia-2016.pdf
- Thistle, J. (2017). Indigenous definition of homelessness in Canada. Toronto; Canadian Observatory on Homelessness Press.
- Tipple, A. G. (n.d.). The nature and extent of homelessness in developing countries. Newcastle; University of Newcastle upon Tyne. Retrieved Jan 27 2026 from https://assets.publishing.service.gov.uk/media/57a08d04e5274a27b2001595/R7905.pdf
- UN Habitat. (2023). The world is failing to provide adequate housing. https://unhabitat.org/news/13-jul-2023/the-world-is-failing-to-provide-adequate-housing
- UNHCR. (2024). Colombia situation. The UN Refugee Agency Global Focus. https://reporting.unhcr.org/operational/situations/colombia-situation
- Uwera, C. (2023) Rwanda Voluntary National Review. United Nations. https://hlpf.un.org/sites/default/files/vnrs/2023/VNR%20Rwanda%20Report.pdf
- Webster, P. C. (2012). Health in Colombia: Treating the displaced. Canadian Medical Association Journal, 184(6), 291–292. https://doi.org/10.1503/cmaj.109-4125
- WHO. (2017). World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. World Health Organization. https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
- WHO. (2022). Mental disorders. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
- WHO. (2023). Regional Office for Africa. World Health Organization. https://www.afro.who.int/photo-story/community-health-workers-lead-fight-against-malaria-rwanda#:~:text=Kigali%20–%20Over%20the%20past%20seven,89%25%20over%20the%20same%20period
- Wilson, R., Rourke, J., Oandasan, I., & Bosco, C. (2020). Progress made on access to rural healthcare in Canada. Canadian Journal of Rural Medicine, 66(1), 31–3. https://doi.org/10.4103/cjrm.cjrm_84_19
- Wintour, P. (2023). US calls conditions in Rwanda’s detention centres harsh to life-threatening. The Guardian. https://www.theguardian.com/politics/2023/mar/21/us-describes-conditions-in-rwandas-detention-centres-as-harsh-to-life-threatening
- Zhao, E. (2022). The key factors contributing to the persistence of homelessness. International Journal of Sustainable Development & World Ecology, 30(1), 1–5. https://doi.org/10.1080/13504509.2022.212010