Determinants of food insecurity in homeless people: evidence from the territory-wide Homeless Census in Hong Kong

With the re-emerging homelessness issue in Hong Kong given its least affordable housing, securing food to meet the basic physiological needs is of priority concern in the homeless. This study aims to examine the situation and determinants of food insecurity in the homeless of Hong Kong. Cross-sectional survey on food insecurity level, sociodemographic characteristics, homeless experiences, and health status and behaviours. 360 community hot spots of homeless people identified by NGOs and experienced social workers in different districts of Hong Kong in 2021. 711 individuals experiencing homelessness. The observed prevalence of low, medium, and high food insecurity levels were 37.4%, 20.4%, and 42.2%, respectively. Results from multivariable ordinal logistic regression showed that older, female, non-Chinese, and non-married respondents were inversely associated with food insecurity, whereas having sufficient savings for more proper housing was the primary determinant among socioeconomic indicators. In addition to reasons for homelessness, risk factors of food insecurity included living in guesthouses/hotels and difficulties due to government measures on homeless control. Except for disability, both self-rated physical and mental health statuses showed dose-response relationships with food insecurity level. The substantial individual variations in sociodemographic statuses, homeless experiences, and health deficits shaped the differential risks of food insecurity within the homeless community in Hong Kong. Targeted homeless programmes should go beyond the conventionally vulnerable groups but consider the multifaceted nature of homeless experiences in relation to food access, and integrate health assessments to holistically support the homeless.