n any given night, more than half a million people in the United States 1 and more than 35 000 in Canada 2 experience homelessness. Homelessness has always been associated with poor health outcomes, 3 but its risks to health have only been heightened by coronavirus disease 2019 (COVID-19), with consequences extending to the broader community. People experiencing homelessness are at increased risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and spreading the virus to others. 4,5 Many people experiencing homelessness stay in congregate living settings such as shelters, where it is difficult to practise social distancing. Others live rough, on the street or in encampments, and do not have access to basic hygiene supplies or showering facilities. In any of these scenarios, selfisolation is not possible. People who experience homelessness also have higher rates of chronic conditions such as diabetes and hypertension, which puts them at increased risk of complications if they acquire the infection. 3,6 Recent data from Boston suggest that people experiencing homelessness have a higher prevalence of SARS-CoV-2 positivity 7 and more severe

Our findings can inform new interventions that focus on employment as a social determinant of health. Although hiring a dedicated employment specialist may not be feasible for most primary care organizations, pathways using existing resources with links to external agencies can be created. As precarious work becomes more common, helping patients engage in safe and productive employment could improve health, access to health care, and well-being.

Background Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. Objective Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. Methods This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19–29) no longer in school, precariously employed adults (age 30–55) and older adults near retirement (age 55–64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. Results Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. Conclusions In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.