People living in poverty and/or those who are homeless face many more challenges and obstacles than the average person. This includes their increased vulnerability for poor health, multiple social problems, diminished quality of life, higher morbidity and premature mortality (Guirguis-Young, McNeil & Hwang, 2014;  Mills, C., Zavaleta, D. & Samuel, K., 2014; Phipps, 2003). They also face social exclusion and isolation (Mills et al., 2014), inequality, discrimination and stereotyping by landlords, health and support providers and the general public in their communities (Khandor, E., Mason, K., Chambers, C., Rossiter, K., Cowan, L. & Hwang, S. W., 2011). Their experiences walking into public facilities, accessing traditional health and social services, renting and being considered for employment are often negative. In many instances there are discrepancies between what people who are homeless need or want, what service providers can offer and what the provincial or local governments can afford or support as best practices (Shinn, 2007). In this chapter, we refer to these conditions as the ‘determinants of homelessness’ – a term that is deliberately similar to the term, ‘determinants of health.’ The term invokes the multiple and interlocking social and structural factors that impact the capacity and resilience of individuals or families living in poverty and/or homelessness/housing insecurity. There is a direct relationship between the determinants of homelessness and the determinants of health. Both include income status, housing, personal and environmental factors. Both impact on health and well-being of individuals and families. Exploring how best to manage or balance the determinants of health and homelessness is an essential part of preventing or ending homelessness.

By investigating the experiences of individuals and families experiencing homelessness, the complexity of homelessness, the challenges living with it or addressing it and the lack of public policies to support a systems approach to successfully resolve it are revealed (Hulchanski, D. J., Campsie, P., Chau, S., Hwang, S. W. & Paradis, E., 2009). Although different Canadian cities had their own community plans with various housing and support programs (e.g. emergency shelters as well as supportive, transitional, social and affordable housing), to address the various challenges and needs of people who were at risk of becoming homeless and those who were currently homeless, the Housing First strategy was the first opportunity to pilot the systems approach across multiple cities in Canada with federal, provincial and municipal supports for the goal to end homelessness in 10 years.