Homelessness & Health

Health and homelessness are inextricably linked. Health problems can cause a person’s homelessness as well as be exacerbated by the experience.

Homeless people are at relatively high risk for a broad range of acute and chronic illnesses.

Interactions between Health and Homelessness

In examining the relationship between homelessness and health, there are three different types of interactions:

 (1) Some health problems precede and causally contribute to homelessness,

(2) Others are consequences of homelessness, and

(3) Homelessness complicates the treatment of many illnesses. Of course, certain diseases and treatments cut across these patterns and may occur in all three categories.

According to the U.S. Department of Housing and Urban Development, people living in shelters are more than twice as likely to have a disability compared to the general population.

Conditions such as diabetes, heart disease, and HIV/AIDS are found at high rates among the homeless population, sometimes three to six times higher than that of the general population.

Health Problems That Cause Homelessness

·        Major mental illnesses, especially chronic schizophrenia. As mentally ill people's disabilities worsen, their ability to cope with their surroundings—or the ability of those around them to cope with their behavior—becomes severely strained. In the absence of appropriate therapeutic interventions and supportive alternative housing arrangements, many wind up on the streets.

·        AIDS. As the disease progresses and leads to repeated and more serious bouts with opportunistic infections, the individual becomes unable to work and may be unable to afford to continue paying rent. 

·        Alcoholism and drug dependence

·        Disabling conditions that cause a person to become unemployed,

·        Any major illness that results in massive health care expenses

·        Accidental injury, especially job-related accidents.

·        Degenerative diseases that accompany old age

Some of the common health problems that people experiencing homelessness may have include:

·        HIV/AIDS.

·        Lung diseases, including bronchitis, tuberculosis, and pneumonia.

·        Malnutrition.

·        Mental health problems.

·        Substance use problems.

·        Wounds and skin infections.

·        Trauma

Homelessness as a Complicating Factor in Health Care

For even the most routine medical treatment, the state of being homeless makes the provision of care extraordinarily difficult.

Even the need for bed rest is complicated, if not impossible, when the patient does not have a bed or, as is the case in many shelters for the homeless, must leave the shelter in the early morning. Diabetes, for example, usually is not difficult to treat in a domiciled person.

For most people, daily insulin injections and control of diet are adequate. In a homeless person, however, treatment is virtually impossible: Some types of insulin need to be refrigerated; syringes may be stolen (in cities where IV drug abuse is common, syringes have a high street value) or, sometimes, the homeless diabetic may be mistaken for an IV drug abuser.

Diet cannot be controlled because soup kitchens serve whatever they can get, which rules out special therapeutic diets. The following case illustrates the various problems involved in treating a homeless man with another common chronic medical problem, hypertension:

Housing as the Solution

When housing is a platform, people with a substance abuse disorder who are experiencing homelessness have the opportunity to engage in treatment fully without the additional stress of living on the streets. Housing stability is a key contributor to long-term recovery and reduces relapse for people who are homeless.

For chronically homeless people, the intervention of permanent supportive housing provides stable housing coupled with supportive services as needed – a cost-effective solution to homelessness for those with the most severe health, mental health and substance abuse challenges.