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, 90% of homeless adults entering Permanent Supportive Housing (PSH) reported two or more chronic conditions (either physical or mental). However, it isn’t just people on the street who are affected—a Canadian Paediatric Society 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 this post summarizes the ten most prominent.
1. Mortality and unintentional injuries (bruises, cuts, burns, etc.)
Injury rates among people experiencing homelessness are greater than in the general population. For example, the prevalence of traumatic brain injuries alone among homeless individuals is between 2.5-4 times higher than the general population. The presence of a brain injury can lead to further injuries. Commonly reported injuries among people experiencing homelessness include: assault-related injuries, and injuries related to situations that they are exposed to (i.e., cooking with fire leading to burns).
The harsh conditions of being homeless often lead to serious injury or death. Just this past February, 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 linked Chronic pain and homeless individuals who were mentally ill. Chronic pain is a symptom of an underlying condition, although in many cases related to homelessness, it is not always possible to treat. It can negatively affect these individuals’ general activity, walking and sleeping. While the prevalence of chronic pain is significantly higher than in the rest of the population, the directionality is unclear. This means that it is unclear whether chronic pain causes homelessness, is an effect of it, or both.
3. Hunger and nutrition
In a developed country like Canada, it can be tough to recognize hunger as an issue. Yet according to PROOF research, 1 in 8 households in Canada experienced food insecurity over the course of a given year. Adjusting eating habits to correct nutrition can aid in the treatment and recovery from a number of chronic conditions over time.
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. Foot related problems (i.e., infections, pain, practical limitations, etc.) are more common among the homeless because of this. One study found that up to two-thirds of their sample population of homeless individuals reported an issue with their feet. These issues can include: nail pathologies, infections, injuries, bunions, hammertoes, gout, plantar warts, foot ulcers and frostbite.
Another study found the prevalence of skin conditions ranges from 16.6% to 53.5%. Conditions found in the homeless population include: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus.
5. Infectious diseases
Research suggests that individuals experiencing homelessness tend to be at greater risk during pandemic outbreaks due to compromised immune systems, poor nutrition and hygiene, and frequent overcrowding at shelters. For this reason, the health measures implemented to minimize the effects of pandemic outbreaks in homeless populations need to go beyond the “mainstream” solutions. A small study, conducted across homeless shelters in Hamilton, Ontario, found 1% of their residents to test positive for COVID-19 and 5% of their staff. This is a high infection rate, especially for individuals without access to health care or basic human needs.
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. The inability to access preventative and restorative care, combined with poor hygiene, often results in tooth decay and other oral health issues. Proactive dental care can prevent decay and catch dental problems early on but only 23% of people experiencing homelessness had visited a dentist in the past year.75% of these individuals also believe they have an untreated dental condition.
7. Respiratory illness
Chronic obstructive pulmonary disease, emphysema, bronchitis and other forms of respiratory disease are also common among people experiencing homelessness. People experiencing homelessness are more likely to be put on ventilators than homed-individuals, when in contact with the COVID-19 virus.
8. Chronic diseases and disorders
Many chronic diseases and disorders, like hypertension and diabetes, are common in homeless populations. Homeless adults are 2-4 times more likely to have hypertension than other cardiovascular diseases than the general population. Diabetes among homeless adults is around 4.1%, only slightly higher than the prevalence of 3.2% in the general population.
Homelessness has also been associated with seizures. In a UK study, 6% of people in the sample group were diagnosed with epilepsy. This is significantly higher than the prevalence in the general population (0.8%).
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. According to a study, 6% to 22% of young women who are experiencing homelessness may be pregnant. Being homeless makes reproductive conditions like pregnancy even more stressful, due to already having compromised health and lacking support systems.
10. Mental health issues
Mental health issues are quite common in the homeless population. A recent study revealed a prevalence of 20.8% for mental illnesses of any kind among people experiencing homelessness. This is only 1-3% higher than the prevalence in the general population.
Note: This post is an updated version of “What are the top 10 health issues homeless people face?” in 2015.