This question came from Sara via our latest website survey.
Over the past two decades, much research has been dedicated to exploring the relationship between health and homelessness. This relationship is a two-way street: experiencing poverty and/or homelessness can contribute to health issues, while health issues can contribute to poverty and homelessness. People experiencing homelessness are susceptible to the same issues as people who are not, but their living conditions tend to make treating and coping with issues much more difficult.
In one study, more than 8 out of 10 people (85%) experiencing homelessness reported having a chronic health condition. And it isn’t just people on the street who are affected—a multi-city, long-term Canadian study found that being vulnerably housed also contributes to poor health.
While there are no concrete numbers on the health of Canada’s homeless populations, what we know is that some conditions are more common amongst them than others. Dr. Stephen W. Hwang’s article, Homelessness and health, gives a detailed overview of these, but I’ll summarize the ten most prominent.
1. Mortality and unintentional injuries (bruises, cuts, burns, etc.)
People experiencing homelessness have a significantly higher risk of death. From our section on mortality: “Unintentional injuries are a leading cause of morbidity and mortality, especially among homeless men. Injuries are often the result of falls or being struck by a motor vehicle. Deaths due to an unintentional overdose of drugs or alcohol, or both, are also common. Exposure to the elements is a major hazard. In cold weather, the risk of frostbite and hypothermia is substantial, and deaths due to freezing are not uncommon. In hot weather, severe sunburn and heatstroke can occur.” Suicides among homeless people are also common.
Violence is also a factor in death and injuries. One Toronto survey found that in the year prior, 40% of people who were homeless had been assaulted, and 21% of homeless women had been raped. Another study from the same city found that homeless men are about 9 times more likely to be murdered than men who are housed.
The harsh conditions of being homeless often lead to serious injury or death. Just this past January, a homeless man died from a fire in his makeshift shelter, where he was trying to stay warm.
2. Musculoskeletal disorders and chronic pain
Disorders that affect joints, ligaments and tendons (like arthritis) are common among people experiencing homelessness. One study on managing chronic pain among homeless persons found that treatment is a challenge due to stressful living on streets or in shelters, inability to afford prescription medications, and poor sleeping conditions. Some refuse to see doctors for their pain because of how they have been treated in the past, and some use drugs or alcohol to cope with their pain because their history of missed appointments or drug use prevents doctors from prescribing over-the-counter pain medication. As a result, much chronic pain in this population goes untreated.
3. Hunger and nutrition
In a developed country like Canada, it can be tough to recognize hunger as an issue. Yet according to the Ontario Association of Food Banks, in 2014 the number of households in Ontario visiting food banks increased by 20%. Poor nutrition can contribute to a number of chronic conditions over time, and issues like fatigue and weakness in the short term.
4. Skin & foot problems
People experiencing homelessness are often out and about for long periods of time, sometimes in ill-fitting shoes and worn-out socks. As Dr. Hwang notes; “Foot disorders such as onychomycosis, tinea pedis, corns and callouses, and immersion foot are usually the result of inadequate footwear, prolonged exposure to moisture, long periods of walking and standing, and repetitive minor trauma.”
Also according to Dr. Hwang’s research: ”People living on the street are particularly prone to develop skin diseases such as cellulitis, impetigo, venous stasis disease, scabies and body lice.” The inability to shower often and maintain good hygiene often adds to existing health issues.
5. Infectious diseases
People who are homeless are often at risk of infectious diseases—like hepatitis A, B, and C, tuberculosis, and HIV/AIDS—due to compromised immune systems, poor nutrition and hygiene, and frequent overcrowding at shelters.
Furthermore, some activities that some homeless people engage in, such as survival sex or intravenous drug use, also increases the risk of the spread of disease. This, combined with barriers many homeless people face in getting treatment, make avoiding infectious diseases difficult.
6. Dental problems
Periods of prolonged homelessness are often detrimental to people’s oral health. This is because, in the words of Bruce. B. Wallace: “Oral health care in Canada is not based on one’s need, but rather on one’s ability to pay.” The inability to access preventative and restorative care, combined with poor hygiene, often results in tooth decay and other oral health issues.
7. Respiratory illness
Chronic obstructive pulmonary disease, emphysema, bronchitis and other forms of respiratory disease are also common among people experiencing homelessness.
8. Chronic diseases and disorders
Many chronic diseases and disorders, like hypertension and diabetes, are common in homeless populations.
Homelessness has also been associated with seizures. In one 2006 study, 49.3% of people in the sample group were diagnosed with epilepsy and 40.7% with alcohol-related seizures. In the latter group, other factors like sleep deprivation, anxiety, and stress also contributed to the seizures.
9. Sexual & reproductive care
This is an area of health with a growing research base, especially among young people who are most at risk. Youth who are homeless tend to have more sexual partners and at younger ages, making them more at risk of sexually transmitted diseases. Being homeless makes reproductive conditions like pregnancy even more stressful, due to already having compromised health and lacking support systems.
10. Mental health issues
A large part of the homeless population has serious mental health issues. From our write-up on mental health: “30-35 percent of the homeless, in general, and up to 75 percent of homeless women specifically, have been diagnosed with a mental illness. 20-25 percent of homeless people suffer from concurrent disorders (severe mental illness and addictions). People who have a severe mental illness are over-represented in the homeless population, as they are often released from hospitals and jails without proper community supports.”
Depression rates are also higher amongst the homeless population, with "22-46 percent having attempted suicide and up to 61 percent having had suicidal thoughts".
This blog has been updated to reflect new research and data. See the updated version here.