Health care providers who see homeless or street-involved youth can help to reduce the impact of many risk factors – physical, mental, emotional and social – pertaining to street culture. The present statement describes the types and scale of homelessness in Canada, and reviews reasons why youth turn to the street, risks of the ‘street economy’ and barriers to health care. Common physical and mental health problems are considered, along with legal and ethical issues that may affect care. Principles of care, including accessibility, confidentiality and harm reduction, and strategies to target and engage this population lead to recommendations for improving services, outcomes, advocacy and increased governmental support.