June 28, 2019 ⋅ 10:30 A.M ⋅ Guadalupe Sandoval ⋅ Devika Shenoy
Increasingly noticeable in some of the United States’ biggest cities, the homeless population in America is on the rise. And it appears as if the relationship between homelessness and health is becoming more complex. While generally homelessness has a negative impact on health, health issues can also lead to homelessness: as people’s health deteriorates, the high costs of medical expenses can force people with lower financial security onto the streets. In fact, 9% of homeless individuals in Long Beach said they were homeless due to medical reasons. But because it is difficult to locate and survey the homeless population, it is estimated that this number is even higher. A study published by the National Institutes of Health divided the types of interactions between health and homelessness into three different categories. First, “some health problems precede and causally contribute to homelessness, [second,] others are consequences of homelessness, and [last], homelessness complicates the treatment of many illnesses” [4].
Some Health Problems Are Consequences of Homelessness
Homelessness can result in a spike of physical, sexual, and mental violence related to overpopulation and a diminished sense of security. With stable housing comes a privileged level of mental rest. And although people differ on a case by case basis, one generally no longer needs to prioritize finding a place to sleep each night and can allocate additional time to managing health, making time for doctors’ appointments, or adhering to medical advice and directions.
Not surprisingly, in an article written for Knock LA, an online newspaper, the life expectancy for the homeless is 48 years, in contrast to the average life expectancy of 80 years in California [3].
Living on the streets also increases both risk and exposure to communicable and contagious diseases, including but not limited to sexually transmitted diseases (STDs) and Tuberculosis (TB). In fact, the National Aids Housing Coalition estimates that 3-14% of all homeless individuals are HIV-positive and that their risk rate is 3 to 16 times higher than that of an individual with stable housing [3].
Homelessness Complicates the Treatment of Many Illnesses
The National Health Care for the Homeless Council states that certain chronic conditions “such as hypertension, asthma, diabetes, mental health problems, and other ongoing conditions, are difficult to manage under stressful circumstances and may worsen.” This is because homelessness can turn a relatively minor health problem into a serious illness. For instance, in homeless individuals, diabetic treatment is virtually impossible. Some types of insulin need to be refrigerated, or patients need to monitor their food intake to manage their diabetes. But “diet cannot be controlled because soup kitchens serve whatever they can get, which rules out special therapeutic diets” [4]. On the streets, syringes may even be stolen, especially in cities where IV drug abuse is common, because syringes have a high street value. In some cases, the homeless diabetic may even be mistaken for an IV drug abuser. Diabetic patients also have to take special care of their feet, which is extremely difficult to do while homeless. Among homeless individuals socks are of high value and are hard to come across.
Social media has actually highlighted many of these issues by sharing some of the horrors that can await a homeless diabetic. A simple google image search of “homeless diabetic” is enough to close your browser tab. But to break this relationship between homelessness and health issues, the issue needs to be addressed on a larger scale. For this case specifically, a feasible intervention might include a homeless medical center that grants access to medications (such as insulin) that have strict temperature regulations or require proper sterilization. This does not apply to diabetes alone, there are many other health problems that need to be addressed within the homeless population.
Some Health Problems Precede and Causally Contribute to Homelessness
One of the populations which is most vulnerable to homelessness includes youth who battle with mental health and substance abuse. A study in Washington found that two-thirds of the “1,800 young people who became homeless or unstably housed ... in [the] fiscal year 2015” came from inpatient mental health treatment programs. [7] After treatment, children are returning to a world that threatens their progress. Many patients have lost contact with family due to their mental health or substance abuse and have nowhere to find support. It is hard enough for patients to admit they need care, and failing to provide safe and reliable housing after their treatment is an injustice. New legislation, like the efforts Governor Jay Inslee has passed for Washington state, is needed in California in order to break the wheel of mental health, substance abuse, and homelessness. Governor Jay Inslee has put aside specific budgeting for affordable housing and local mental health facilities in order to promote a healthy environment for mental health and substance abuse patients as well as homeless individuals.
While hundreds of platforms and nonprofits have analyzed and reported about the relationship between homelessness and health, homelessness in Los Angeles continues to grow. An article published by the LA times reported that homelessness surged around 75% in just six years[9]. Three out of four homeless people, around 41,000 of 55,188 people, are unsheltered homeless, meaning that they live in cars, campers, tents, and on the streets. Their living condition increases their susceptibility to poor health conditions for which they cannot afford treatment. As such, the government and nonprofits need to implement a multi-faceted solution, where they address not only the relationship between health and homelessness, but also the inaccessibility of supportive services. For example, the National Health Care for the Homeless Council combines free/low-cost medical care for homeless people with legal services, funding for secondary education through the One Family Scholars program, income and healthcare education, and beyond [2]. Thus, certain nonprofits have made active efforts to provide free healthcare to at-risk people in places that have high concentrations of homeless individuals, but the root of the problem is yet to be addressed: the increasing cost of basic medical care. Brainstorming solutions to this problem may take a lifetime, but the first step all of us can take is educating our communities about the problem to avoid it from being overlooked.
References:
National Health Care For the Homeless Council : https://www.nhchc.org/faq/relationship-health-housing-homelessness/
National Health Care for the Homeless Council : https://www.nhchc.org/resources/consumer/need-help-now/
Knock LA: https://knock-la.com/in-los-angeles-homelessness-means-death-25a884ef595e
National Institutes of Health: https://www.ncbi.nlm.nih.gov/books/NBK218236/
Health Interventions for People who are Homeless: https://www.ncbi.nlm.nih.gov/pubmed/25390579
Problems of Homeless People: https://www.ncbi.nlm.nih.gov/books/NBK218236/
Study: Youth moving from mental health treatment to homelessness: https://www.realchangenews.org/2019/02/27/study-youth-moving-mental-health-treatment-homelessness
Black Voice News: https://blackvoicenews.com/2019/04/30/the-homeless-are-dying-in-record-numbers-on-the-streets-of-l-a/
LA Times: https://www.latimes.com/local/lanow/la-me-homeless-how-we-got-here-20180201-story.html
About the Writers
Guadalupe Sandoval is the Writing Director for Speak Out for Surgery at University of California - Los Angeles. Devika Shenoy is an undergraduate student at University of California - Los Angeles.
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