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Homelessness Kills
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The results of a recent study in England confirm what decades of research in the United States and worldwide have found: homelessness kills. People who experience homelessness have a morality rate four times that of the general population. They die decades earlier, often from treatable medical conditions. Women who experience homelessness are especially vulnerable.
Homelessness Kills

The interim findings of a study investigating homeless mortality in England from 2001 to 2009 revealed that the average age of death of a homeless person is 47. This compares to 77 for the general population. Homeless women die even younger, at an average age of 43. Additional findings include:

  • Drugs and alcohol abuse account for just over a third of deaths
  • Homeless people are over nine times more likely to commit suicide than the general population

The authors of the report note that these health disparities exist despite significant investment in the National Health Service. They state: “That homeless people die at such a young age is a tragedy. That homelessness could be easily prevented and is not is a scandal.”

Similar Results in the United States and Worldwide

A review of research over the past 40 years reveals similar findings. Author James O’Connell, M.D., notes that the relationship between homelessness and early mortality is remarkably consistent. Despite different methodologies and cultures, studies reveal:

  • People who experience homelessness have a mortality rate three to four times that of the general population
  • The average age at death of a person who is homeless is between 42 and 52 years of age
  • Younger women who are homeless have a mortality rate that is 4 to 31 times higher than that of women who are housed
  • Premature death for people who are homeless is more highly associated with acute and chronic medical conditions than with either mental illnesses or substance abuse
  • Deaths of people who are homeless occur at all times of year; death from hypothermia is rare
  • Individuals living with AIDS, street youth, veterans with mental illnesses, and those who are chronically homeless are especially vulnerable

The Role of Adverse Childhood Experiences

Trauma is a factor in premature death. A study of homeless persons who used hostels (shelters) in Copenhagen found that predictors of early death included adverse childhood experiences, especially the death of the father (Nordentoft & Wandall-Holm, 2003). In this country, the Adverse Childhood Experiences (ACE) study reveals that childhood experiences of abuse and neglect are common and highly destructive. They exert a powerful impact on adult emotional health, physical health, and major causes of mortality in the United States. In fact, studies have shown that adverse childhood experiences are considerable risk factors for adult homelessness.

The Relationship between Physical and Behavioral Health Conditions

Physical illnesses are a larger contributor to premature deaths than substance use or mental illnesses. In the winter of 1998-1999, 13 people who were homeless died on the streets of Boston. Two-thirds of them had mental illnesses and all but one suffered from chronic alcohol use. However, their deaths were primarily related to complications of chronic medical illnesses, not their substance use or mental illnesses.

Early mortality due to treatable medical problems is common among all individuals who have serious mental illnesses, not just those who are homeless. In addition, a recent study in the British Medical Journal revealed that even low levels of psychological distress are associated with increased risk of mortality from several causes, including cardiovascular disease.

Individuals Who Are Known to the System

People who experience homelessness who die at a young age often are known to the health care system. Dr. O’Connell cites the results of a study of 119 chronically homeless individuals living on the streets of Boston from 2000 to 2004 (O’Connell & Swain, 2005). During the five-year study period, more than a quarter of the individuals died. This is despite the fact that these individuals had a total of 18,384 emergency room visits during the study period. More than 80 percent had some type of health insurance.

“The disparities in health care outcomes for homeless persons are profound and humiliating to all of us who provide care for this population,” Dr. O’Connell writes. “This public health crisis will not be ameliorated until housing, health care, and other supports become fundamental rights for every human being.”

What You Can Do Today

  • Emphasize health and wellness. SAMHSA’s Wellness Initiative includes tools and resources to promote physical and behavioral health for all individuals.
  • Promote integrated care. Pursue formal or informal relationships with health care providers or join a medical home. Highlight the need for gender-specific health care resources.
  • Work to eliminate health disparities. Share information about early mortality with policymakers, researchers, and funders. Help individuals who are newly eligible for Medicaid connect to health care providers.

References:

Nordentoft, M., & Wandall-Holm, N. (2003). 10 year follow up study of mortality among users of hostels for homeless people in Copenhagen. British Medical Journal, 327(7406), 81. http://homeless.samhsa.gov/Resource/10-year-follow-up-study-of-mortality-among-users-of-hostels-for-homeless-people-in-Copenhagen-37893.aspx

O’Connell, J. J., & Swain S. E. (2005). A five-year prospective study of mortality among Boston’s rough sleepers, 2000-2004. National Resource and Training Conference, SAMHSA. Washington, DC.

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