January - Homelessness Causes Lifespan Inequality
As twilight faded on the longest night of the year, Philadelphians gathered to hold a vigil and remember the lives of homeless and formerly homeless individuals who passed away in the last year. Recognized in more than 150 cities around the country, this year’s Homeless Memorial Day honored thousands of individuals who lost their lives after an experience with homelessness—including over 250 people in Philadelphia alone. Since it began in 1990, Homeless Memorial Day has unified calls upon cities and communities to end homelessness and to address the health disparities that make mortality rates so much higher amongst individuals with a current or past experience of homelessness.
According to the Center for Disease Control (CDC), individuals experiencing homelessness are four to nine times more likely to die in any given year than the general population. For people experiencing homelessness, this means the average life expectancy is around 47 years, three decades less than the U.S. average, and lower than the life expectancy of any nation on earth.
This gap in life expectancy between citizens of the same city or even of the same block—those on the inside of a wall, versus those on the outside—stands as a glaring example of how social and economic factors determine health outcomes and quality of life.
Individuals experiencing homelessness are not only more likely to face increased risk of exposure to health and safety threats, but they are also more likely to experience both socioeconomic risk factors (like poverty, food insecurity, and lack of access to healthcare) and health risk factors (like preexisting chronic conditions and poor mental health) that may have caused their homelessness to begin with.
Poor health outcomes are both a cause and an effect of homelessness, requiring any real solution to lifespan inequality to offer solutions both through supporting access to healthcare and supporting pathways to housing.
Heightened Health Risks for Individuals Experiencing Homelessness
The National Health Care for the Homeless Council (NHCHC) describes many of the health risks that individuals experiencing homelessness face: exposure to communicable disease in crowded shelters, violence, malnutrition, and extreme weather. Similarly, the CDC reports that individuals experiencing homelessness are at higher risk for infectious and chronic illness, poor mental health, substance abuse, and violence.
These risks are a direct effect of the homeless condition which involves high stress, close contact with many others, inconsistent access to hygiene needs, and often a poor diet. The NHCHC points out that these conditions can make it harder to recover once sick, injured, or put under psychological stress: Without proper care and rest, cuts and colds can turn into infections and pneumonia, and depression or addictive issues can get worse. Inability to rest, properly store and use medications, and stay at a comfortable temperature can make illness more severe.
Poor Health as a Cause of Homelessness
For those experiencing homelessness, the risk is not just that they will become unhealthy; rather for many people, health challenges have long been a part of their life. In fact, the NHCHC reports that “poor health is a major cause of homelessness.” When illness or injury keeps someone from working, it can cause them to lose their health insurance plan. As medical debt, responsible for 62% of all bankruptcy, piles up, homelessness can be hard to avoid.
Thus according to the NHCHC, individuals experiencing homelessness are three times as likely to have a liver condition and twice as likely to have a severe mental illness when compared to other low-income populations; moreover, 38% of homeless individual report multiple chronic conditions. While treating these conditions becomes more difficult when homeless, lack of housing can become a symptom of poor health, rather than the cause; making those on the street both disproportionately vulnerable to health hazards, and disproportionately in need of consistent care.
Even After Housing, the Risk Persists
Since homelessness makes treating chronic illness so much more difficult, lowering homeless mortality requires supporting individuals in their access to housing. But while getting proper rest and treatment is undoubtedly easier with stable shelter, a 2015 study in BioMed Central Public Health showed that it is not enough. According to the study “adverse health outcomes associated with homelessness persist even after individuals obtain housing.”
For some, lapses in treating chronic conditions during a period of homelessness could lead to persistent poor health. For others, stress their body and mind went through while homeless continue to impact health. The health impacts of homelessness cannot easily be erased, but must rather be prevented, by doing everything we can to prevent homelessness in the first place.
The solution to the issue of homeless mortality lies necessarily at the intersection of housing and healthcare, and it must begin with prevention. In short, the best way to prevent the detrimental effects that homelessness has on health and safety is to prevent homelessness from occurring, and in many cases, preventing homelessness means addressing a healthcare system that leaves those with chronic conditions vulnerable to bankruptcy and eviction.
As we call for an end to homelessness, we must call for a healthcare system that can adequately meet the needs of those without housing, and those at risk of losing their homes. We must focus on keeping people in their homes—as the NHCHC writes, “no amount of healthcare can substitute for stable housing”—and securing permanent housing for those who seek it.
As concerned citizens gathered around the country to mourn, to pray, and to remember, they held close those who had passed away; while in each of those cities, many others persist, struggling against the same odds to secure health and home. As we remember, we continue to fight—to advocate, volunteer, donate, and build relationships—and we continue to push for solutions so that next year the list of names will be shorter.