Homelessness Is A Public Health Crisis Requiring Action On Multiple Fronts: Staying Warm During Winter Is But The Tip Of The Iceberg For Homeless People
By Paul Bennett, Volunteer Blog Writer at Mentor A Promise
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| Homeless man sleeping on a bench By Belish |
I often ride the subway from Brooklyn into Manhattan on Friday mornings with my son, who attends high school near Union Square. During the recent bout of frigid weather I’ve noticed a woman sleeping on a bench underneath a large pile of comforters and blankets. They are worn and tattered and no doubt soaked from snow and rain. She has burrowed into her makeshift shelter, though I wonder how well all those layers keep out the cold and the damp. Needless to say, a bench is hardly a comfortable place to sleep and rejuvenate.
Seeing her made me wonder about not only the challenges she faces to stay warm and fed, but about how long she is likely to survive living unhoused in the city. Does being homeless affect mortality? Research suggests the answer is a resounding “yes.” Homelessness is a major public health crisis.
First, some statistics. The Nineteenth Annual Report on Deaths Among Persons Experiencing Homelessness, published by the New York City Department of Health and Mental Hygiene and the New York City Department of Social Services/Department of Homeless Services, reports that from July 2022 through June 2023, there were 734 deaths among persons experiencing homelessness in the metropolis. The city’s Human Resources Administration separately reported 106 deaths during its 2023 fiscal year. Leading causes of death include drug use, heart disease, accidents (excluding drug overdoses), alcohol misuse or dependence, and suicide.
According to the Journal of the American Medical Association, “Homelessness is a strong risk factor for premature death. Adults who experience homelessness have higher mortality rates than the general population, with mortality rate ratios ranging from 1.5 to 11.5, depending on age, gender, shelter status, and comorbidity levels. Homelessness exposes individuals to a number of adverse factors such as infections, extreme weather, substance misuse, and violence.”
Granted, inclement weather alone isn’t the cause of death in most cases—other factors, such as drug overdose, homicide, and suicide predominate among younger homeless adults, while heart disease and cancer are leading causes among older homeless adults, notes JAMA.
The Centers for Disease Control and Prevention reports that people experiencing homelessness are also at increased risk for infectious and non-infectious diseases. Homelessness is known to increase the risk of viral hepatitis, tuberculosis, human immunodeficiency virus, and COVID-19. The homeless also grapple with mental illness, alcohol and substance abuse disorder, diabetes, and heart and lung disease.
According to the CDC, several challenges increase the risk of disease for homeless people:
Among numerous organizations in New York City seeking to help homeless people manage their health are NYC Health + Hospitals, which has enhanced its Street Health Outreach + Wellness primary care capacities with the addition of point-of-care lab testing, point-of-care ultrasound, and blood-draw services on board its five mobile health units. SHOW clinicians work across New York City to offer medical, social, and behavioral health services to New Yorkers historically disconnected from care and those experiencing homelessness.
New York City’s Department of Homeless Services Joint Command Center works with existing homeless outreach and prevention programs to identify, engage, and transition homeless New Yorkers to services and, ultimately, permanent housing. It conducts daily canvassing of streets and subways, responds rapidly to 311 homeless assistance requests, and provides a case management system to monitor mentally ill people with a history of violent behavior.
These efforts may increase now that newly elected mayor Zohran Mamdami has vowed to make homelessness and housing a central part of his administration’s focus.
Seeing her made me wonder about not only the challenges she faces to stay warm and fed, but about how long she is likely to survive living unhoused in the city. Does being homeless affect mortality? Research suggests the answer is a resounding “yes.” Homelessness is a major public health crisis.
First, some statistics. The Nineteenth Annual Report on Deaths Among Persons Experiencing Homelessness, published by the New York City Department of Health and Mental Hygiene and the New York City Department of Social Services/Department of Homeless Services, reports that from July 2022 through June 2023, there were 734 deaths among persons experiencing homelessness in the metropolis. The city’s Human Resources Administration separately reported 106 deaths during its 2023 fiscal year. Leading causes of death include drug use, heart disease, accidents (excluding drug overdoses), alcohol misuse or dependence, and suicide.
According to the Journal of the American Medical Association, “Homelessness is a strong risk factor for premature death. Adults who experience homelessness have higher mortality rates than the general population, with mortality rate ratios ranging from 1.5 to 11.5, depending on age, gender, shelter status, and comorbidity levels. Homelessness exposes individuals to a number of adverse factors such as infections, extreme weather, substance misuse, and violence.”
Granted, inclement weather alone isn’t the cause of death in most cases—other factors, such as drug overdose, homicide, and suicide predominate among younger homeless adults, while heart disease and cancer are leading causes among older homeless adults, notes JAMA.
The Centers for Disease Control and Prevention reports that people experiencing homelessness are also at increased risk for infectious and non-infectious diseases. Homelessness is known to increase the risk of viral hepatitis, tuberculosis, human immunodeficiency virus, and COVID-19. The homeless also grapple with mental illness, alcohol and substance abuse disorder, diabetes, and heart and lung disease.
According to the CDC, several challenges increase the risk of disease for homeless people:
- Staying in congregate settings like homeless shelters increases risk for respiratory infections like tuberculosis and COVID-19
- Stress, uncertainty, and threats to safety increase the risk for mental illnesses such as anxiety, depression, and post-traumatic stress disorder
- Injection drug use and limited access to safe use supplies increase risk for Viral Hepatitis, HIV, and other bloodborne pathogens
- Structural and social barriers to health care and other social services can lead to worsening health outcomes, severe illness, or death
Among numerous organizations in New York City seeking to help homeless people manage their health are NYC Health + Hospitals, which has enhanced its Street Health Outreach + Wellness primary care capacities with the addition of point-of-care lab testing, point-of-care ultrasound, and blood-draw services on board its five mobile health units. SHOW clinicians work across New York City to offer medical, social, and behavioral health services to New Yorkers historically disconnected from care and those experiencing homelessness.
New York City’s Department of Homeless Services Joint Command Center works with existing homeless outreach and prevention programs to identify, engage, and transition homeless New Yorkers to services and, ultimately, permanent housing. It conducts daily canvassing of streets and subways, responds rapidly to 311 homeless assistance requests, and provides a case management system to monitor mentally ill people with a history of violent behavior.
These efforts may increase now that newly elected mayor Zohran Mamdami has vowed to make homelessness and housing a central part of his administration’s focus.
At Mentor a Promise, we do our part by helping the children of homeless and housing-insecure people succeed in school and prepare for successful lives as adults. Parents can take comfort knowing their children can stay on track academically and not lose ground because of their housing situations. To find out more about our work or join the conversation, follow us on social media at @mentorapromise or visit https://mentorapromise.org.
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