Men, women, and young people who live on the streets face a number of unique challenges and many of these are either directly related to health or have an effect on health. It is not uncommon for homeless people to be in poor health because access to medical care, medications, and mental health care is limited.
Of particular concern for the homeless are addictions, mental health conditions, infections, environmental exposure, violence and physical injuries, domestic abuse and emotional trauma, and vulnerability to harmful medications. There are resources available in many cities to help the homeless, but often these focus on the immediate needs of housing and food. What many homeless need more of is good medical care, health education and prevention, and access to treatment and medications.
Drug and Alcohol Addiction
Health issues may be problems for the homeless, but too often they are the underlying causes that lead to homelessness. Addiction is one example of this phenomenon. When a person succumbs to the disease of addiction, it can lead to job loss, resulting financial issues, and ultimately losing a home. Rates of addiction are higher among the homeless. For instance, one survey of homeless users of a free health clinic found that the rate of alcohol dependence was eleven percent, as compared to two percent in non-homeless populations. All types of substance abuse disorders occur more in homeless populations than in the general population.
Substance abuse and addiction are health problems in themselves, but they also cause other health complications, including mental health conditions and fatal overdoses. One study found that overdose accounted for 17 percent of homeless deaths. Alcohol addiction and chronic use of alcohol leads to liver disease. Rates of liver disease among the homeless are significantly higher than among non-homeless people. Not only do substance abuse problems lead to more health problems, but they also make it more difficult for a homeless person to get housing.
Mental health conditions are also a serious concern for homeless people. The Substance Abuse and Mental Health Services Administration has found that between 20 and 25 percent of the homeless population in the U.S. suffer from one or more severe mental illnesses. Even more people living on the streets likely struggle with milder forms of mental illness. Like substance abuse, mental health conditions can be one reason a person loses a home and ends up on the streets. The main mental illnesses seen in homeless people are schizophrenia, major depressive disorder, and bipolar disorder. The rate of depression in homeless women has been estimated to be as high as nearly 50 percent.
Infections that non-homeless people get treated for easily or rest and recover from within a few days or weeks can become serious health problems for those that are homeless. Reasons that homeless people are more vulnerable include living in crowded or unsanitary conditions, environmental stress and exposure, poor nutrition, and lack of access to preventative health care or treatment. Respiratory infections that are issues among the homeless include tuberculosis, chronic bronchitis, and pneumonia.
Chronic Health Conditions
A study of health among the homeless published in 2011 found that 85 percent of homeless people suffered from some type of chronic health condition. These include heart disease, diabetes, high blood pressure, and chronic obstructive pulmonary disease. Other studies have found that the incidence of chronic disease is two times or higher than that of the general population and that half or less of homeless people describe themselves as well and in good health as compared to non-homeless people.
Chronic disease is important to consider because these are conditions that are not curable, that require regular medical care and healthy lifestyle habits to control, and that get worse with time. When not treated adequately, these conditions can make a person’s overall health worse and can contribute to other health issues as well as decrease quality of life.
Exposure to the Elements
Living without adequate shelter puts homeless people at risk for health problems related to environmental exposure that non-homeless people do not need to consider. Cold temperatures, for instance, put homeless people at risk for hypothermia, frostbite, and even dying from exposure. In hot climates, summer conditions can lead to heat stroke and sunburn. Being exposed to the elements can also exacerbate existing health conditions.
Malnutrition and Food Insecurity
Not getting enough to eat is a constant concern for people who are homeless. They also face issues associated with malnutrition, or not getting adequate or varied nutrients, even when they do get enough food to survive. Malnutrition can cause conditions like anemia, vitamin-specific deficiency disorders, and vulnerability to infectious diseases. Eating food that is not sanitary can further complicate health by introducing parasites or infections.
What also may be surprising to some is that rates of obesity are just as high in the homeless population as among the non-homeless. Obesity is a nutrition-related health condition because it results from eating poor quality food. For the homeless, options are limited and eating cheap, nutritionally-poor, but calorically-dense foods is common. Obesity may also be related to the body’s adaptation to food shortages: storing energy as fat. Of course, obesity puts this population at risk for health problems like high blood pressure, heart disease, diabetes, and cancer among others.
Getting adequate health care for a homeless person is hard enough, but getting dental care is also overlooked. Research has found that rates of tooth loss and other dental issues are much higher in homeless populations. Homeless people are also more likely to have serious or severe dental issues. Poor dental health can increase the risk of a person developing cardiovascular disease and other seemingly unrelated health problems. Homeless children are particularly at risk for the consequences of poor dental health. They miss school because of dental problems, struggle to eat or speak, and may even have delayed development because of dental pain and discomfort.
Sexually Transmitted Diseases
Due to many factors, homeless people have higher rates of sexually transmitted diseases, or STDs. One reason is that high-risk behaviors that put people at risk for STDs may be higher among homeless people. These include drug use with shared needles and unprotected sex. Homeless people may also be more vulnerable to sexual assault that could lead to the transmission of disease. Young people may be the most vulnerable to STDs. Homeless youths are more likely than their non-homeless peers to have an STD and to get pregnant.
Homeless Women and Domestic Abuse
Women and children living on the streets may be there because of domestic violence. Some estimates find that more than 80 percent of homeless women have experienced domestic abuse and more than half of these women report that abuse was the direct cause of their homelessness. These women end up homeless because they do not have the social or financial resources to leave their abusive partners and find a safer place to live. They may end up at women’s shelters or out on the street as the only alternatives to living at home with domestic violence.
Domestic abuse may be a major cause of homelessness, but it also impacts the health of homeless women and children. Homeless women who were abused may be struggling with physical injuries as well as mental health issues triggered or worsened by abuse. Children may also be victims of domestic violence or may experience mental health conditions or trauma from witnessing the abuse of their mothers.
Medical Care and Housing
Housing for the homeless is the first step in providing better health care. Simply being off the streets and having enough nutritious food to eat is important in improving health in this vulnerable population. It is not enough for most homeless people, though. They need health check-ups, access to dental care, access to treatment for chronic illnesses and infections, access to health education and preventative care, and access to medications.
Homeless people may find access to these kinds of resources through government programs, such as those supported by the Department of Housing and Urban Development. They may also access health care through community programs. Mobile health care units may serve the homeless by providing vaccinations, health screenings, and dental care. Some organizations also offer free health centers serving homeless people, such as those run by the National Health Care for the Homeless Council. Homeless may always rely on emergency rooms for treatment, but this is only a temporary solution, as this kind of medical treatment does not provide ongoing care.
Access to Prescriptions
People who are not homeless and who have health insurance often take for granted how easy it is to get access to medications, including prescriptions. These are so important for treating medical conditions, ranging from antidepressants to treat depression to life-saving drugs that lower chronically high blood pressure. Homeless people suffer from symptoms and deteriorating health when they do not get access to prescription medications.
Those programs that offer health care services to the homeless, either through community groups and non-profits or the government, often also offer access to medications. There are problems, though, with homeless being able to get regular access to drugs. Issues associated with homelessness may prevent them from returning regularly to the health care center that provides medication, for instance.
Certain medications are particularly important for the homeless to get access to: these include antibiotics like Zithromax and fluoroquinolones to treat infections, antidepressants like Prozac and antipsychotics like Risperdal to treat mental health conditions, and drugs to treat chronic conditions like medications for type 2 diabetes and heart disease. Painkillers may be given to homeless people as part of overall health care, and these come with serious risks of causing or worsening substance abuse and addiction.
Like anyone else, homeless people may be vulnerable to the negative effects of dangerous drugs. Access to medications is important, but they may not realize that some of the medications they are given can cause serious harm as well as provide benefits. They may also not realize what to do about the risks or if they experience side effects. For example, antidepressants may be very important for homeless people living with mental illness, but these can cause serious side effects like serotonin syndrome or suicidal behaviors in younger people.
Antibiotics used to treat infections may also cause damaging side effects in homeless people. It is important to battle infections, but homeless people can be put at risk for aneurysms, tendonitis, peripheral neuropathy, liver failure, and heart failure because of antibiotics. Because these vulnerable patients do not have regular doctors, they can be at an even greater risk of suffering from the side effects of dangerous drugs than other people.
Resources for Homeless Veterans
Veterans represent a population that is particularly vulnerable to homelessness. Too many veterans come home from active service with no money, without a job, and without any supportive family to help them with a place to live and financial support. Veterans are also more at risk for mental health conditions than the general population. They are vulnerable to all kind of mental illnesses, but especially post-traumatic stress disorder and these can make it very difficult to find a job or to keep a job.
When veterans find themselves with no housing options, the Veterans Administration (VA) is one important resource for both health care and housing. The VA runs special programs designed to help homeless veterans get shelter, job training, employment opportunities, health care, and other important services. The Department of Housing and Urban Development also works with the VA to offer special programs providing housing for veterans who are homeless. Community programs and non-profits may also offer assistance for homeless veterans.
The homeless population in the U.S. is a vulnerable group of people. Often through no fault of their own these people lose their homes and once homeless it is very difficult to get back into permanent housing, to get a job, or to get adequate health care. There are many health conditions that homeless people are particularly susceptible to, from mental health conditions to malnutrition to infections and the physical injuries of domestic abuse. Resources are available but it is rarely enough to help the homeless experience the same level of health that the majority of people in the general population do. They continue to have worse health than other Americans and that trend is likely to continue.