{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T14:23:03Z","timestamp":1782829383516,"version":"3.54.5"},"reference-count":61,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T00:00:00Z","timestamp":1574294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Chester, QR Funding","award":["23006742"],"award-info":[{"award-number":["23006742"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories\u2014education, employment, and health\u2014emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one\u2019s way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.<\/jats:p>","DOI":"10.3390\/ijerph16234620","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T02:49:27Z","timestamp":1574390967000},"page":"4620","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1350-7065","authenticated-orcid":false,"given":"Mzwandile A.","family":"Mabhala","sequence":"first","affiliation":[{"name":"Department of Public Health and Wellbeing, Faculty of Health and Social Care, University of Chester, Riverside Campus, Chester CH1 1SL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmait","family":"Yohannes","sequence":"additional","affiliation":[{"name":"Asmait Skin Care, Southfield Ave, Stamford, CT 06902, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,21]]},"reference":[{"key":"ref_1","unstructured":"Homeless Link (2017). 2017 Rough Sleeping Statistics, Homeless Link."},{"key":"ref_2","unstructured":"Department of Housing Communities and Local Government (DCLG) (2018). Rough Sleeping Statistics Autumn 2017, England (Revised)."},{"key":"ref_3","unstructured":"Government Legislation (2017). Homelessness reduction act 2017, c.13."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/casp.721","article-title":"Synthesizing homelessness research: Trends, lessons and prospects","volume":"13","author":"Anderson","year":"2003","journal-title":"J. Community Appl. Soc. Psychol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/casp.714","article-title":"Causes of homelessness in the UK: A dynamic analysis","volume":"13","author":"Anderson","year":"2003","journal-title":"J. Community Appl. Soc. Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s12939-017-0646-3","article-title":"Social conditions of becoming homelessness: Qualitative analysis of life stories of homeless peoples","volume":"16","author":"Mabhala","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e024748","DOI":"10.1136\/bmjopen-2018-024748","article-title":"Indigenous and non-indigenous people experiencing homelessness and mental illness in two canadian cities: A retrospective analysis and implications for culturally informed action","volume":"9","author":"Bingham","year":"2019","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1080\/07399332.2014.989437","article-title":"Sex work and motherhood: Social and structural barriers to health and social services for pregnant and parenting street and off-street sex workers","volume":"36","author":"Duff","year":"2015","journal-title":"Health Care Women Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/1468-0009.12108","article-title":"Creating a science of homelessness during the reagan era","volume":"Volume 93","author":"Jones","year":"2015","journal-title":"The Milbank Quarterly"},{"key":"ref_11","first-page":"105","article-title":"Poverty, homelessness, and family break-up","volume":"94","author":"Shinn","year":"2015","journal-title":"Child Welf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1177\/0090591716682290","article-title":"To the edge of the urban landscape: Homelessness and the politics of care","volume":"46","year":"2018","journal-title":"Polit Theory"},{"key":"ref_13","unstructured":"Gaetz, S., O\u2019grady, B., Kidd, S., and Schwan, K. (1970, January 01). Without a Home: The National Youth Homelessness Survey. Available online: https:\/\/homelesshub.ca\/sites\/default\/files\/WithoutAHome-final.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3138\/cjccj.46.4.423","article-title":"Safe streets for whom? Street youth, social exclusion and criminal victimization","volume":"46","author":"Gaetz","year":"2004","journal-title":"Can. J. Criminol. Crim. Justice"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1177\/0706743717702076","article-title":"The 2015 national canadian homeless youth survey: Mental health and addiction findings","volume":"62","author":"Kidd","year":"2017","journal-title":"Can. J. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1080\/09297049.2016.1207758","article-title":"A sysyematic review of cognitive functioning among young people who have experienced homelessness, foster care, ot poverty","volume":"23","author":"Fry","year":"2017","journal-title":"Child. Neuropsychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1080\/15325020701769105","article-title":"Personal resources and homelessness in early life: Predictors of depression in consumers of homeless multiservice centres","volume":"13","author":"Deforge","year":"2008","journal-title":"J. Loss Trauma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1177\/1557988315609110","article-title":"Transactional sex with regular and casual partners among young men who have sex with men in the detroit metro area","volume":"11","author":"Bauermeister","year":"2017","journal-title":"Am. J. Men\u2019s Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Skosireva, A., O\u2019Campo, P., Zerger, S., Chambers, C., Gapka, S., and Stergiopoulos, V. (2014). Different faces of discrimination: Perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Serv. Res., 14.","DOI":"10.1186\/1472-6963-14-376"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.socscimed.2015.04.008","article-title":"Negotiating structural vulnerability following regulatory changes to a provincial methadone program in Vancouver, Canada: A qualitative study","volume":"133","author":"McNeil","year":"2015","journal-title":"Soc. Sci Med."},{"key":"ref_21","first-page":"19","article-title":"Homelessness, poverty and social exclusion in the united states and europe","volume":"4","author":"Shinn","year":"2010","journal-title":"Eur. J. Homelessness"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Patterson, M.L., Moniruzzaman, A., and Somers, J.M. (2015). History of foster care among homeless adults with mental illness in vancouver, british columbia: A precursor to trajectories of risk. BMC Psychiatry, 15.","DOI":"10.1186\/s12888-015-0411-3"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1332\/175982717X14842281240539","article-title":"Welfare conditionality, benefit sanctions and homelessness in the UK: Ending the \u2018something for nothing culture\u2019 or punishing the poor?","volume":"25","author":"Reeve","year":"2017","journal-title":"J. Poverty Soc. Justice"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1186\/1745-6215-14-365","article-title":"Vancouver at home: Pragmatic randomized trials investigating housing first for homeless and mentally ill adults","volume":"14","author":"Somers","year":"2013","journal-title":"Trials"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.puhe.2016.05.017","article-title":"Social exclusion, health and hidden homelessness","volume":"139","author":"Watson","year":"2016","journal-title":"Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.chiabu.2013.08.018","article-title":"A history in-care predicts unique characteristics in a homeless population with mental illness","volume":"38","author":"Roos","year":"2014","journal-title":"Child Abus. Negl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S275","DOI":"10.2105\/AJPH.2013.301323","article-title":"Relationship between adverse childhood experiences and homelessness and the impact of axis i and ii disorders","volume":"103","author":"Roos","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/hsc.12314","article-title":"High school incompletion and childhood maltreatment among street-involved young people in vancouver, canada","volume":"25","author":"Barker","year":"2017","journal-title":"Health Soc. Care Community"},{"key":"ref_29","unstructured":"Charmaz, K. (2006). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis, Sage Publications."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1475-9276-12-46","article-title":"Health inequalities as a foundation for embodying knowledge within public health teaching: A qualitative study","volume":"12","author":"Mabhala","year":"2013","journal-title":"Int. J. Equity Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12939-015-0146-2","article-title":"Public health nurse educators\u2019 conceptualisation of public health as a strategy to reduce health inequalities: A qualitative study","volume":"14","author":"Mabhala","year":"2015","journal-title":"Int. J. Equity Health"},{"key":"ref_32","unstructured":"Mabhala, M. (2014). The Social and Health Inequalities Agenda, McGraw Hill Open University Press."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"284","DOI":"10.21767\/2049-5471.100064","article-title":"Understanding the determinants of homelessness through examining the life stories of homeless people and those who work with them: A qualitative research protocol","volume":"13","author":"Mabhala","year":"2016","journal-title":"Divers. Equal. Health Care"},{"key":"ref_34","first-page":"284","article-title":"Mind your language: Discursive practices produce unequal power and control over infectious disease: A critical discourse analysis","volume":"13","author":"Mabhala","year":"2019","journal-title":"Int. J. Prev. Med."},{"key":"ref_35","unstructured":"Wilson, F., Mabhala, M.A., and Massey, A. (2015). Social justice and global perspectives on health improvement. Health in Improvement and Wellbeing Strategies and Actions, McGrow Hill."},{"key":"ref_36","unstructured":"Strauss, A., and Corbin, J. (1998). Basics of Qualitative Research: Tecniques and Procedures for Developing Grounded Theory, Sage Publications."},{"key":"ref_37","first-page":"42","article-title":"Interpretive research aiming at theory building: Adopting and adapting the case study design","volume":"2","year":"2009","journal-title":"Qual. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Dey, I. (1999). Grounding Grounded Theory: Guidelines for Qualitative Inquiry, Academic Press.","DOI":"10.1016\/B978-012214640-4\/50011-5"},{"key":"ref_39","unstructured":"Economic and Social Research Council (2019, July 19). Esrc Framework for Research Ethics (fre). Available online: http:\/\/www.esrc.ac.uk\/about-esrc\/information\/research-ethics.aspx."},{"key":"ref_40","unstructured":"HM Government (2017, June 05). Mental Capacity Act 2005, Available online: http:\/\/www.legislation.gov.uk\/ukpga\/2005\/9\/pdfs\/ukpga_20050009_en.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Corbin, J., and Strauss, A. (2008). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, Sage Publications.","DOI":"10.4135\/9781452230153"},{"key":"ref_42","unstructured":"Krieger, N., and Birn, A.E. (2009, February 26). A Vision of Social Justice as the Foundation of Public Health: Commemorating 150 Years of the Spirit of 1848, Available online: http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1508556\/pdf\/amjph00023-0009.pdf."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S0140-6736(07)61385-3","article-title":"Achieving health equity: From root causes to fair outcomes","volume":"6736","author":"Marmot","year":"2007","journal-title":"Lancet"},{"key":"ref_44","unstructured":"Powers, M., and Faden, R. (2006). Social Justice: The Foundations of Public Health and Health Policy, Oxford University Press."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Rawls, J. (1971). A Theory of Justice, Harvard University Press.","DOI":"10.4159\/9780674042605"},{"key":"ref_46","first-page":"1075","article-title":"Health and social justice","volume":"364","author":"Ruger","year":"2004","journal-title":"Lancet Public Health"},{"key":"ref_47","unstructured":"Department for Communities and Local Goverment (2015). The English Indices of Deprivation 2015."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.chiabu.2016.10.001","article-title":"Is there a complex trauma experience typology for australians experiencing extreme social disadvantage and low housing stability?","volume":"61","author":"Keane","year":"2016","journal-title":"Child Abus. Negl."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2105\/AJPH.87.2.241","article-title":"Homelessness in female-headed families: Childhood and adult risk and protective factors","volume":"87","author":"Bassuk","year":"1997","journal-title":"Am. J. Public Health"},{"key":"ref_50","unstructured":"Tierney, W.G., Gupton, J.T., and Hallett, R.E. (2018, April 24). Transitions to Adulthood for Homeless Adolescents: Education and Public Policy, Available online: https:\/\/files.eric.ed.gov\/fulltext\/ED503645.pdf."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1353\/hpu.2011.0081","article-title":"A typology of childhood problems among chronically homeless adults and its association with housing and clinical outcomes","volume":"22","author":"Tsai","year":"2011","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s10643-015-0691-8","article-title":"Developmental status and social-emotional functioning of young children experiencing homelessness","volume":"44","author":"Haskett","year":"2016","journal-title":"Early Child. Educ. J."},{"key":"ref_53","unstructured":"Department of Education (2019, July 19). Unlocking Talent, Fulfilling Potential a Plan for Improving Social Mobility Through Education, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/667690\/Social_Mobility_Action_Plan_-_for_printing.pdf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.2105\/AJPH.2005.063321","article-title":"Risk factors for long-term homelessness: Findings from a longitudinal study of first-time homeless single adults","volume":"95","author":"Caton","year":"2005","journal-title":"Am. J. Public Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1002\/casp.2343","article-title":"A latent class analysis of self-identified reasons for experiencing homelessness: Opportunities for prevention","volume":"28","author":"Barile","year":"2018","journal-title":"J. Community Appl. Soc. Psychol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1111\/j.1553-2712.2001.tb01114.x","article-title":"The epidemiology of the homeless population and its impact on an urban emergency department","volume":"8","author":"Hung","year":"2001","journal-title":"Acad. Emerg. Med."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Laporte, A., Vandentorren, S., D\u00e9trez, M.-A., Douay, C., Le Strat, Y., Le M\u00e9ner, E., Chauvin, P., and The Samenta Research, G. (2018). Prevalence of mental disorders and addictions among homeless people in the greater paris area, france. Int. J. Environ. Res. Public Health, 15.","DOI":"10.20944\/preprints201712.0098.v2"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.2196\/publichealth.9020","article-title":"Predicting sexual behaviors among homeless young adults: Ecological momentary assessment study","volume":"4","author":"Padhye","year":"2018","journal-title":"JMIR Public Health Surveill"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"30467","DOI":"10.2807\/1560-7917.ES.2017.22.8.30467","article-title":"Twenty years and counting: Epidemiology of an outbreak of isoniazid-resistant tuberculosis in england and wales, 1995 to 2014","volume":"22","author":"Smith","year":"2017","journal-title":"Eurosurveillance"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/ofid\/ofw280","article-title":"Use of activity space in a tuberculosis outbreak: Bringing homeless persons into spatial analyses","volume":"4","author":"Worrell","year":"2017","journal-title":"Open Forum Infect. Dis."},{"key":"ref_61","unstructured":"Seedhouse, D. (1986). Health: The Foundations for Achievement, John Wiley Ltd."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/23\/4620\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:36:16Z","timestamp":1760189776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/23\/4620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,21]]},"references-count":61,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["ijerph16234620"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16234620","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,21]]}}}