Health Disparities and the Homeless Population Explained

Introduction

The causes of homelessness are complex, but its tragic consequences are very clear. Homelessness is a significant problem in many rural areas, towns, and cities across the world, and it is also a pressing public health problem. The homeless are a vulnerable population. They not only live a poor quality of life on the streets, but they also face hunger and are at high risk of contracting preventable diseases, developing co-occurring conditions, and dying premature deaths. In developed countries like the United States and the United Kingdom, homelessness is closely interlinked with poverty. Most of the time, the working poor must work extremely hard or hold multiple jobs to avoid becoming homeless. Sometimes just one missed paycheck results in eviction and a return to the streets. Other times, illnesses, unexpected job losses, or accidents lead to a lack of money at month's end and subsequent evictions (Plumb, 2000).

Certain subgroups within poverty are more likely to become homeless. They include those with mental health conditions, those suffering from post-traumatic stress disorder, victims of abuse, victims of family violence, those struggling with substance abuse, and those who lack social support. Healthy People 2020 emphasizes the significance of addressing social determinants of health to promote good health for everyone. One of the ways of doing so is by building physical and social environments that support good health (Fajardo-Bullón et al., 2019).

Identifying Health Disparities in the Homeless Population

Homelessness is linked to significant health disparities, including higher morbidity, reduced life expectancy, and greater use of emergency hospital services. When viewed through the lens of social determinants, homelessness can be regarded as a primary driver of poor health among homeless individuals. However, homelessness itself is the result of adverse economic and social conditions. In the homeless, the social determinants of health disparities and homelessness are deeply interlinked, and continued homelessness typically leads to further deterioration of health. The number of health issues that homeless individuals face is compounded by other social determinants of health, including social disconnection, domestic violence, unemployment, poverty, and psychological trauma (Fajardo-Bullón et al., 2019).

Addressing social determinants of health is the preferred approach to tackling health inequities according to both Healthy People 2020 and the World Health Organization. The WHO released a report titled Health Equity through Action on the Social Determinants of Health, and several U.S. health programs — including the National Prevention and Health Promotion Strategy and the National Partnership for Action to End Health Disparities — also emphasize addressing health inequities through their social determinants. Social determinants of health constitute a collection of social issues that affect health outcomes. Focusing on them challenges conventional clinical boundaries, as these factors are often regarded as non-medical concerns even though they play a critical role in determining the health status of homeless individuals. Understanding the underlying determinants of health is therefore important for the promotion of overall well-being, since addressing them will lead to improved health outcomes (Fajardo-Bullón et al., 2019).

In the city of Philadelphia, the age-adjusted death rate of the homeless is nearly four times higher than that of the city's general population. In New York City, it is approximately two to three times higher. However, a study of Toronto's homeless population found that although its mortality rate was higher than that of the city's general population, it was substantially lower than those of the homeless populations in Philadelphia, Boston, and New York. The significant difference between the mortality rates of Canadian and American homeless populations is explained by Canada's universal health insurance program, lower barriers to accessing healthcare, and lower homicide rates. Moreover, homelessness in Canada tends to be more short-term, making it less likely to be associated with premature death. Although Canada performs better than the United States on these measures, the death rates of its homeless populations relative to its general population remain quite high (Andaya, 2016).

Barriers to Healthcare Access

In addition to poor social determinants of health, homeless individuals also face several external and internal barriers to healthcare. Internal barriers include the tendency to downplay health problems and the intense pressure to meet competing survival needs — such as food, water, clothing, and shelter — rather than seeking medical care. External barriers include the unavailability of primary care services, as well as prejudices and misconceptions held by some healthcare professionals. With poverty, multiple barriers to care, and complex comorbidities, it is unsurprising that homeless individuals experience very high death rates (Fajardo-Bullón et al., 2019).

A significant barrier that has traditionally been cited as a contributor to health inequity is the lack of compassionate treatment and care for the homeless. Many healthcare professionals hold prejudices and misconceptions about homeless individuals, which leads to treatment that lacks empathy or compassion. This often results in homeless individuals not seeking care unless it is absolutely necessary. Ensuring that medical professionals understand and practice compassion in the care of homeless patients could substantially improve health outcomes for this population (Andaya, 2016).

Another major barrier is mental illness and the comorbidity of drug abuse. Both mental illness and substance abuse among the homeless can prevent individuals from utilizing care services that could improve quality of life and overall health status (Andaya, 2016).

Conclusion

Homelessness is both a social crisis and a public health emergency. The evidence reviewed in this paper demonstrates that homeless individuals face dramatically higher rates of morbidity and premature mortality than the general population, driven by a combination of adverse social determinants, inadequate access to care, provider bias, mental illness, and substance abuse. Meaningful reduction of health disparities requires tackling the root causes of homelessness itself through permanent housing solutions, community investment, homeless prevention programs, and compassionate, culturally informed healthcare. Both the comparative success of Canada's universal coverage model and the promising outcomes of housing-first programs in European cities suggest that structural policy responses — rather than clinical interventions alone — are essential to achieving health equity for homeless populations.

References

Andaya, A. (2016). Understanding the causes of health disparities among the homeless. UC Merced Undergraduate Research Journal, 9(1).

Fajardo-Bullón, F., Esnaola, I., Anderson, I., & Benjaminsen, L. (2019). Homelessness and self-rated health: Evidence from a national survey of homeless people in Spain. BMC Public Health, 19(1), 1081.

Koh, H. K., & O'Connell, J. J. (2016). Improving health care for homeless people. JAMA, 316(24), 2586–2587.

Plumb, J. D. (2000). Homelessness: Reducing health disparities. CMAJ: Canadian Medical Association Journal, 163(2), 172–173.