This article compares patterns of homeless shelter use in Denmark and the USA. Combining data from homeless shelters in Denmark with population registers, we find that the prevalence of shelter use is substantially lower in Denmark than in the USA. A cluster analysis of shelter stays identifies three types of users similar to findings from US research: the transitionally, episodically and chronically homeless. However, the transitionally homeless in Denmark have a higher tendency of suffering from mental illness and substance abuse than the transitionally homeless in the USA. The results support Stephens and Fitzpatrick' hypothesis that countries with more extensive welfare systems and lower levels of poverty have lower levels of homelessness, mainly amongst those with complex support needs, whereas in countries with less extensive welfare systems homelessness affects broader groups and is more widely associated with poverty and housing affordability problems.

Background Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. Method The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. Results Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. Conclusions These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.

This article analyses the risk of homelessness in the Danish adult population. The study is based on individual, administrative micro-data for about 4.15 million Danes who were 18 years or older on 1 January 2002. Homelessness is measured by shelter use from 2002 to 2011. Data also cover civil status, immigration background, education, employment, income, mental illness, drug and alcohol abuse, and previous imprisonment over five years prior to the measurement period. Prevalence of shelter use shows a considerable risk of homelessness amongst individuals experiencing multidimensional social exclusion. Nonetheless, even in high-risk groups such as drug abusers and people with a dual diagnosis, the majority have not used shelters. A multivariate analysis shows significantly higher use of homeless shelters amongst immigrants and individuals with low income, unemployment, low education, mental illness, drug or alcohol abuse, or a previous imprisonment. The highest risk of shelter use is associated with drug abuse, alcohol abuse, mental illness and previous imprisonment, whereas the risk associated with low income is smaller than for the psychosocial vulnerabilities. The results show that homelessness in Denmark is widely concentrated amongst individuals with complex support needs, rather than associated with wider poverty problems.

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