Marginally housed or marginally homeless?

The English homelessness scheme has been lauded as being one of the most progressive in the world for offering an individually legally enforceable right to housing to those people who meet the statutory criteria. Its definition of homelessness is also liberal by comparison with many other countries within Europe and beyond, extending significantly beyond the stereotypical rooflessness experienced by rough sleepers. Nevertheless, the scheme is highly selective and targeted, and assesses homelessness through a test of relative need, rather than enshrining a minimally acceptable standard of housing. It thereby creates a category of the marginally housed whose housing needs are assessed as insufficiently poor to be officially categorised as homeless, yet who are living in severely inadequate housing. To reduce the uncertainty and contingency of the current test, the paper proposes the adoption of a new test of habitability.

How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa.

BACKGROUND: The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. METHODS: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. RESULTS: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. CONCLUSION: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in 'normal' circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.