Fear and loathing in New England: examining the health-care perspectives of homeless people in rural areas.

Little anthropological research has been conducted on the health care perspectives of homeless people in rural areas. The aim of the present study is to elicit health-care beliefs, and examine overall health experience among a sample of current or recently homeless people in rural New Hampshire. Thirteen qualitative interviews were conducted, 11 with single men. Interviews were audio-recorded and transcribed, and analyzed using thematic analysis. Despite a massive burden of disease and illness, almost all participants reported an abiding aversion to doctors, hospitals and professional health care. Participants reported numerous negative encounters with doctors and health care professionals, often of a demeaning and disparaging nature. Participants noted that these encounters resulted in frequent cases of misdiagnosis and iatrogenesis. In contrast, participants spoke more fondly of other social and voluntary services, for example homeless organizations. Like other rural New Englanders, participants made their own individual efforts to maintain and promote health, for example by pursuing hobbies or prayer. The findings are contextualized within literature suggesting that these perspectives are generally shared by other poor rural people. Consistent with this literature, the findings suggest that homelessness in rural areas is often temporary and episodic. As such, this paper brings into question the distinctiveness and overall utility of the concept: 'the rural homeless'. The key determinant of negative attitudes to health care may not be recent homelessness. It may be entrenched socio-economic marginalization, and the resultant social stigma, that are shared amongst the rural poor, regardless of their current housing status.