Often conversations around homelessness focus on the state of shelter and how to provide shelter for all the people currently experiencing homelessness – whether temporarily or permanently. Driving these conversations are various positions on what causes homelessness, why people are homeless, if it is a choice or not, and a variety of factors like that. However, a key aspect of the homeless experience that is often overlooked is the role health and homelessness play in influencing each other.
As a shelter provider that is a part of a larger homelessness system, understanding how homelessness is a public health issue is vital in providing grounded, client centered care. Our services not only need to account for how homelessness affects the health outcomes of clients, but how homelessness exacerbates existing health crises. This post is a part of a 3-part series; the first of which discusses the impact of homelessness on health. In understanding how homelessness is a detriment to health, we can gain a fuller understanding of client experience as a whole.
The Impact of Homelessness on Health
In the early 1900s, homelessness as an experience was largely restricted to two ‘types’: social outcasts such as “vagrants and strays” and individuals that were the “destitute or helpless”. In retrospect, both ‘types’ were likely those suffering from mental illness, or physical illness that restricted their ability to be actively contributing to society in a way that was valued as meaningful at the time, forcing them onto the outskirts. When the Great Depression came through the U.S. in the late 1920s, the face of homelessness changed drastically, and post-WWII efforts focused on identifying ways to bring work and empower otherwise able-bodied people out of homelessness, an effort that was largely unsuccessful but continued to leave the sick and disabled without much support.
While the face of homelessness continued to change through the consequent decades, health issues have continued to plague the population. Having pre-existing conditions, or being medically vulnerable increases your risk of homelessness, and the austere or difficult nature of transience increases the overall stress the body endures, often exacerbating existing conditions or creating new ones. Tuberculosis (TB), with a prevalence of only 5 out of 100,000 in the general population, increases by a staggering 880% to 44 out of 100,000 in the homeless population, and the extended regiment required to treat TB means that many homeless will experience advanced TB if they are unable to abide by the treatment protocol – a difficult task to accomplish without shelter.
Other disorders and diseases disproportionately represented in the homeless population include:
Roughly 61% of the homeless population compared to 45% of the general U.S. population.
- Major Depressive Disorder
Specifically in women, 45% of homeless women, double the rate of the general U.S. population
- Hepatitis C
An enormous increase of 36% in the homeless population in comparison to roughly 1% of the general U.S. population.
Approximately 18% of the homeless population, double the rate of the general U.S. population.
These are only a few among countless ailments that plague the homeless population and contribute to continued homelessness. Lack of hygiene practices, inability to meet dietary requirements, and inaccessibility of shelter means that issues such as minor skin lesions can be exacerbated into multi-system health complications, and expensive health costs and lack of transportation often means treatment options can be limited or entirely inaccessible until the issue becomes emergent. This creates an incredible amount of stress on existing healthcare systems that results in roughly $20,000 dollars annually per client. With an approximate population of 11,000 homeless in the state of Arizona, this amounts to a public cost of over 200 million dollars to the state in healthcare management.
Maintenance of basic healthcare needs, insulin for diabetics, abiding by dietary restrictions for someone with Crohn’s disease, regular bathing for someone with eczema, or simply taking the proper medications every day to manage schizophrenia, can be incredibly difficult if not impossible for someone who is constantly transient or on the move. Lack of stable shelter can often remove a person’s ability to address otherwise simple needs to stay healthy. The large increase in disease and disorder in this population makes it clear that maintaining health while experiencing homelessness can be extremely difficult, if not impossible for some.
Being unable to manage these ailments means clients are not in the best condition to engage with services, will suffer more from fatigue making them less likely to be able to handle the often arduous and stressful task of looking for housing. Homelessness is a health issue because it contributes to new and existing health conditions, and prevents healing necessary to end homelessness. Health and shelter are inextricably related, and working with our clients means understanding that an overwhelming percentage of our client population has some health condition that they will need support in managing. The enormous economic cost, compounded with the complex needs to be addressed make it difficult to dispute that homelessness is a healthcare crisis.
The next posts will talk about how homelessness is also a public health issue, and finally what Central Arizona Shelter System does to help address these problems.
Homelessness and Health —James D. Wright and Eleanor Weber
Founded in 1984, CASS is the largest and longest serving homeless emergency shelter provider in Arizona. Our adult and family shelters, as well as our temporary senior shelter operate at full capacity, 365 days of the year. CASS’ provides shelter, case management and housing support to a truly vulnerable community, from around the state and beyond.