POLICY BRIEF

Using Street Medicine to Reach
Highly Marginalized Populations

Street medicine, defined as the delivery of healthcare directly to individuals experiencing unsheltered homelessness and other forms of extreme marginalization in their own environments, is grounded in equity, human rights, and dignity. It offers essential services such as wound care, mental health support, chronic disease management, and harm reduction, while helping to bridge access to more structured healthcare systems. Street medicine aligns with the World Health Organization (WHO) principles of Universal Health Coverage (UHC) and contributes to the realization of Sustainable Development Goal (SDG) 3 to “ensure healthy lives and promote well-being for all at all ages”) and SDG 10 to “reduce inequality within and among countries”). It also reinforces the WHO Constitution’s foundational assertion that the highest attainable standard of health is a fundamental right of every human being, regardless of housing status. This Fast-Track Health Policy Brief highlights five case studies illustrating best practices in street medicine, explores challenges and opportunities, and provides actionable recommendations for municipal, national, and regional health authorities.

Los Angeles Street Medicine Collaborative in the United States: The Los Angeles Street Medicine Collaborative (LASMC) is a multi-institutional initiative providing mobile primary care, mental health services, and medication-assisted treatment (MAT) to individuals living in encampments and on sidewalks. The model uses a trauma-informed, nonjudgmental approach, with care teams composed of physicians, nurses, social workers, and peer navigators. In addition to improving health outcomes, LASMC has facilitated direct linkage to housing programs and reduced unnecessary emergency department utilization. This model demonstrates how cross-sector partnerships and dedicated outreach can effectively engage chronically unsheltered populations. (Journal of Health Care for the Poor and Underserved, 2023)

Doctors of the World in Greece: In Athens and Thessaloniki, Doctors of the World has deployed street medicine teams to care for refugees, migrants, and undocumented individuals, providing vaccinations, acute care, and maternal health services. Operating in the context of austerity and systemic exclusion from formal healthcare, the program combines medical support with legal and psychosocial counseling. It has served as a critical health safety net for people navigating homelessness, displacement, and statelessness. Greece’s example underscores the importance of street medicine in upholding the right to health amid humanitarian crises. (Doctors of the World Annual Report, 2023)

Mobile Street Outreach in South Africa: In Cape Town, a mobile clinic operated by a local NGO and the municipal health department delivers HIV testing and linkage to antiretroviral therapy, tuberculosis screening, and mental health services to individuals in informal settlements and on the streets. The program uses peer outreach workers with lived experience, increasing trust and uptake. It has significantly improved viral suppression rates among homeless people living with HIV, and functions as an entry point to comprehensive health and social services. This model highlights the potential for integrating infectious disease management into street-based care delivery. (South African Medical Journal, 2023)

Rome Street Medicine Initiative in Italy: Led by the Community of Sant’Egidio and municipal health partners, Rome’s street medicine program provides preventive and curative services to unhoused individuals living in parks, train stations, and temporary encampments. With a focus on the winter months, when mortality risks are highest, the program delivers care via backpacks and mobile clinics and has included COVID-19 vaccinations and flu shots in its scope. Rome’s approach illustrates how street medicine can be embedded within broader emergency preparedness and public health strategies. (The Lancet Regional Health – Europe, 2023)

Outreach Mental Health and Harm Reduction in Australia: Melbourne’s co-located street medicine and harm reduction outreach teams provide mental health crisis intervention, opioid substitution therapy, and naloxone distribution to unsheltered individuals with substance use disorders. The program is closely linked with community pharmacies and drop-in centers and has improved continuity of psychiatric care for individuals with dual diagnoses. Melbourne’s experience shows how mental health integration within street medicine can reduce crisis events and improve recovery trajectories. (Australian & New Zealand Journal of Psychiatry, 2023)

Street medicine programs face multiple barriers in their efforts to reach and sustain care for marginalized populations. Lack of dedicated funding and limited reimbursement mechanisms make many programs dependent on charitable support or short-term grants. Institutional resistance and legal barriers, including criminalization of homelessness and displacement policies, can obstruct outreach efforts. Stigma within healthcare systems often results in discriminatory treatment when patients are referred to formal care settings, undermining trust. Workforce burnout and safety concerns affect sustainability, particularly in high-need, high-trauma environments. Additionally, the absence of interoperable health records and care coordination tools limits the ability to track health outcomes or link individuals to long-term care and housing solutions.

Despite these challenges, there are powerful opportunities to scale and integrate street medicine into broader health and social protection frameworks. Formal recognition and financing mechanisms, including the inclusion of street medicine in UHC schemes and national health strategies, can ensure sustainability. Advances in digital health tools, portable diagnostics, and mobile electronic health records enable better tracking, case management, and continuity of care. Street medicine can play a key role in epidemic preparedness, acting as a frontline defense for vaccine delivery, syndromic surveillance, and infection control in hard-to-reach groups. Training clinicians and public health professionals in street-based care models and trauma-informed practices can professionalize and normalize this essential service. Moreover, linking street medicine with housing-first initiatives and community reentry programs offers pathways to address the root causes of health inequities among unsheltered populations.