The Bridge Between Health Literacy and Health Outcomes: California’s Unhoused Population

By: Smiraa Misra & Rabo Ebieroma

Introduction

In a case study of California’s houseless population, the following numbers can be found: 

39% reported no ambulatory care use over the past year (when needed), 34% reported an unmet healthcare need, and 23% reported an unmet medicinal need. African Americans, Native Americans, and Hispanics/Latinx people are disproportionately overrepresented in these numbers. Even amongst those in the unhoused population with health insurance–California does a better job than many states in providing health insurance to those who are unhoused–these statistics go nearly unchanged (Fields et al., 2025). 

Why?

While the causes of healthcare barriers for unhoused people are undoubtedly complicated with various political and social factors influencing them, the lack of access to information remains an overarching cause. 

More specifically, in studies of California’s homeless population’s health literacy, the data is similarly conclusive: California’s unhoused population suffers from a distinct lack of health literacy, a major contributing factor for inaccessible health resources. 

Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services for appropriate health decisions” (Sentell & Braun, 2012). The reality is that healthcare barriers within the unhoused population of Los Angeles (LA) are directly correlated with a lack of health literacy in a cyclical manner: healthcare barriers feed into an inability to obtain health information resources, and a lack of health literacy exacerbates difficulties in accessing healthcare because the unhoused population is barricaded from learning about the (limited) healthcare resources they have. 

Causes

The problem is evident, but the reasons are less so. There are many undeniable socioeconomic and intersectional factors that contribute to the lack of health literacy that are undeniable. In general, two of the most general causes are medical mistrust and acute care burdens. 

First, the pervasiveness of medical mistrust remains a heavy burden. The medical system has failed and betrayed many unhoused individuals before, cultivating a culture of distrust and hesitation to the extent that people avoid health-related information because they do not trust healthcare institutions. The lack of culturally sensitive medical information is a part of this problem, one that is exemplified among the Hispanic population. The Hispanic/Latinx population of California is overrepresented amongst homeless demographics; compounding existing inequities in health literacy with systemic discrimination based on language. Even English as a first language speakers face barriers to achieving health literacy in the present day: for Spanish-speaking individuals who may not speak English or who may speak it limitedly, improving their health literacy is near impossible in an English-centered American society that doesn’t invest in culturally-sensitive practices like it ought to (Sentell & Braun, 2012). Beyond language barriers, this sense of medical mistrust within unhoused people remains a significant cause of a lack of health literacy, thus generating a barrier to tangible healthcare. 

Second, most governmental and nonprofit health initiatives serve as a Band-Aid over the wound. It’s why unhoused people have much higher rates of using acute or emergency care, instead of seeking long-term, preventative care (Benzer et al., 2025). To put it simply, the limited healthcare available for the homeless population is reactive, not proactive. Homeless health programs don’t aim to teach health literacy because they’re designed to react to an already existing problem, not to teach the information behind consistent care. This design flaw limits health literacy. 

Implications

The implications of a lack of health literacy are undeniable when analyzing health outcomes for unhoused peoples: statistically speaking, among unhoused populations, increased health literacy is critical in improving an unhoused person’s own sense of health confidence. This means an unhoused person, with simple health literacy interventions, is able to fill out medical forms, advocate for their own medical decisions, and know where to seek critical long-term care for better long-term health (Odoh et al., 2021), all of which are simultaneously major barriers for healthcare access in California. Those who report better health literacy also report less mortality for future generations, revealing generational knowledge being passed along. This begs the question: how can we maximize health literacy for California’s unhoused population and call for better health outcomes?

Solutions

Expanding health literacy initiatives within the unhoused population of LA – whether that be grassroots organizations and nonprofits providing pamphlets and/or run health education programs – is the first step in providing a solution. Closer to home, initiatives like the Mobile Clinic Project at UCLA do wonders to both increase health literacy and provide accessible healthcare resources for long-term betterment of our neighbors. These solutions can be extended further to the sphere of policy, where the LA City Council can invest in preventative health literacy measures to minimize burden on the acute care system and maximize long-term health for the unhoused populations. These include potentially requiring shelters and agencies that serve unhoused individuals to host classes focused on practical skills for enhancing health literacy and/or providing navigation services. In addition, ensuring there are culturally-sensitive and language-sensitive teachings for those who have difficulty communicating in English is absolutely essential to dismantle medical mistrust.

By implementing and advocating for better health literacy programs for the homeless population of LA and California, California can not only improve health outcomes for its residents, but also set up a more just healthcare system for all. 

References

Benzer, L.R, McNeil, J.K, M.F. et al. (2025) Integrated care for people experiencing homelessness: changes in emergency department use and behavioral health symptom severity. BMC Health Serv Res 25, 777. https://doi.org/10.1186/s12913-025-12860-0 

Fields, J. D., Assaf, R. D., Nguyen, K. H., Platamone, C. C., Pottebaum, J. M., Giannola, J., & Kushel, M. B. (2025). Health Care Access and Use Among Adults Experiencing Homelessness. JAMA health forum, 6(5), e250820. https://doi.org/10.1001/jamahealthforum.2025.0820

Odoh, C., Vidrine, J. I., Businelle, M. S., Kendzor, D. E., Agrawal, P., & Reitzel, L. R. (2019). Health Literacy and Self-Rated Health among Homeless Adults. Health behavior research, 2(4), 13. https://doi.org/10.4148/2572-1836.1055

Sentell, T., & Braun, K. L. (2012). Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of health communication, 17 Suppl 3(Suppl 3), 82–99. https://doi.org/10.1080/10810730.2012.712621