Homelessness is a complex and multifaceted issue intertwined with numerous societal challenges, particularly in healthcare. Individuals experiencing homelessness face significant health challenges and often rely on emergency services for care, even for minor ailments. Understanding this relationship is crucial for developing effective policies and interventions that address both healthcare access and homelessness.
Individuals experiencing homelessness are at heightened risk for various physical and mental health conditions. Statistics reveal that nearly 50% of homeless individuals suffer from chronic health conditions, including respiratory infections and cardiovascular diseases (National Health Care for the Homeless Council, 2021). Mental health disorders, such as depression and anxiety, are also prevalent, with estimates suggesting that about 30% of homeless individuals experience severe mental illness (Fischer et al., 2018).
Over my 12 years of working with this population, I have witnessed how health issues escalate from manageable concerns to emergencies. Many 911 calls I have observed are for issues ranging from a simple cough to someone being unconscious. Alarmingly, these calls often stem from what would be considered minor health issues by the average person, such as headaches or allergies.
The harsh realities of living without stable housing contribute significantly to these health challenges. Exposure to the elements, lack of sanitation, and insufficient nutrition all take a toll on physical health. A study indicated that homeless individuals have a life expectancy of just 48 years, highlighting the severe impact of unstable living conditions (Hwang et al., 2009). Mental health problems can be exacerbated by the stress and trauma of homelessness, leading to a further decline in overall well-being. Substance abuse often emerges as a coping mechanism, complicating health issues and creating barriers to treatment.
Accessing healthcare is a significant challenge for many homeless individuals. Factors such as lack of health insurance, transportation issues, and the stigma associated with being homeless all contribute to this barrier. According to the National Health Care for the Homeless Council (2021), over 40% of homeless individuals report avoiding medical care due to fear of discrimination. In my experience, many individuals resort to calling 911 out of desperation, as they see no other options available. For them, any health issue is a crisis, particularly when hospitals are far away or public transportation options are limited late at night.
Many individuals have been on the streets for so long that their immediate concerns revolve around food and shelter, making their health issues secondary. For example, in 2007, after a major surgery, I found myself homeless and couch surfing. My priority was finding somewhere to sleep, and it wasn’t until I was in a McDonald’s, running a fever and covered in a rash, that I discovered I had a serious MRSA infection.
To effectively address the healthcare needs of homeless populations, targeted services must be developed. Recently, we partnered with Audubon Area Community Care Clinic to establish a clinic addressing healthcare needs at the Daniel Pitino Shelter and the surrounding community. This clinic is open to the public, allowing anyone to walk in and receive care, thereby reducing barriers to access. By providing services directly within the shelter, we aim to make it easier for individuals to seek care.
Homeless shelters provide vital support that can significantly improve the health of individuals experiencing homelessness. Shelters offer a safe environment that protects individuals from harsh weather conditions and potential violence, allowing them to focus on their health rather than survival. Moreover, shelters often provide essential services such as meals, hygiene facilities, and healthcare access. Regular meals improve nutrition, which is critical for physical health, while hygiene facilities help prevent the spread of infections (Kushel et al., 2006). Shelters also serve as a gateway to healthcare resources, connecting individuals with medical professionals, mental health services, and substance abuse treatment.
Additionally, shelters foster a sense of community and support, reducing feelings of isolation that can exacerbate mental health issues. A survey indicated that individuals in supportive environments are 50% more likely to seek healthcare services (Padgett et al., 2016). The stability and resources offered by shelters enable individuals to address their health concerns more effectively, making it easier to prioritize medical care and recovery.
It is essential to emphasize the importance of financially supporting shelters, as they play a pivotal role in improving the health and well-being of their residents. Funding can enhance services, provide staff training, and ensure that shelters can meet the growing needs of their communities.
Integrated care models that combine physical health, mental health, and social services have proven effective in improving outcomes for homeless individuals. A case that stands out involved a man who checked into the shelter with a severe cellulitis infection in his legs, which had been untreated for months. When I asked him why he hadn’t seen a doctor, his response — “I haven’t had time” — was revealing. The relentless pursuit of food and shelter had consumed his thoughts, leaving little room for health concerns.
The following day, after a good night’s rest, he called 911. When I inquired whether he was okay, he stated, “No, you’re out of bus passes, and I didn’t realize how bad it hurt until today.” This response underscored two critical points: like many others, he had prioritized survival over health, and to him, emergency medical services served as a transportation solution rather than true healthcare.
Addressing the intersection of healthcare and homelessness requires comprehensive policy solutions. Policymakers must prioritize funding for programs targeting healthcare access for homeless individuals. Expanding Medicaid and other insurance options can help ensure that more individuals have access to necessary medical care. According to the National Alliance to End Homelessness (2020), investing in affordable housing initiatives is essential, as stable housing is often the first step toward achieving better health outcomes.
Moreover, training healthcare providers to understand the unique challenges faced by homeless populations can foster a more empathetic approach to care. Implementing training programs focusing on cultural competency can create a more welcoming environment for individuals seeking care. Community engagement is also vital. Involving homeless individuals in planning and implementing services can lead to more effective solutions. Their firsthand experiences can inform healthcare providers and policymakers about the barriers they face and the types of services that would be most beneficial.
Public awareness campaigns can also reduce stigma and foster understanding within the broader community. Educating the public about the challenges of homelessness and the importance of accessible healthcare can build support for initiatives aimed at addressing these issues.
The intersection of healthcare and homelessness is a critical area that requires urgent attention. By understanding the unique health challenges faced by homeless individuals and addressing the barriers to healthcare access, we can work towards breaking the cycle of homelessness and poor health. Integrated care models, supportive policies, and community engagement are essential components of a comprehensive strategy to improve health outcomes for this vulnerable population. Ensuring that all individuals have access to quality healthcare is not only a moral imperative but also a necessary step toward building healthier communities.
Written by
Harry E. Pedigo, MSSW, MHFAI, CENL
Executive Director
St. Benedict’s and Daniel Pitino Shelters
References
- Fischer, P. J., et al. (2018). Health of homeless individuals in a transitional housing program. Journal of Social Distress and the Homeless.
- Hwang, S. W., et al. (2009). Mortality among homeless people: A cohort study. Canadian Medical Association Journal, 181(12), 895-899.
- Kushel, M. B., et al. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of Health Care for the Poor and Underserved, 17(4), 661-676.
- National Alliance to End Homelessness. (2020). State of Homelessness: 2020 Edition.
- National Health Care for the Homeless Council. (2021). Health Care for the Homeless: Understanding the Issues.
- Padgett, D. K., et al. (2016). The role of social support in reducing mental health disparities among homeless individuals. American Journal of Orthopsychiatry.
