Homelessness is brutal. Without shelter, food, income, hygiene and physical or behavioral health care it is impossible to be healthy.

Homelessness is defined as living on the streets, in a shelter or transitional housing; living in an abandoned buildings or vehicle, “doubled up” -living with family, neighbors or friends. An individual who is released from a hospital or prison without permanent, stable housing is considered homeless.

Statistics report the average age of a homeless person is 9. The average life expectancy of a homeless person is 47. According to The Daily Telegraph, the life expectancy of a homeless woman is 43. 

The leading causes of homelessness include the lack of affordable housing, unemployment, low wages and poverty.

Some health problems precede, cause or contribute to homelessness. Other health problems are consequences of homelessness. Being homeless complicates the treatment of many illnesses. The homeless are 3-4 times more likely to die prematurely and 2 times more likely to have a heart attack. Between the age of 25-44, the homeless are 3 times more likely to die of heart disease.

Events that may lead to homelessness include major mental illness, especially schizophrenia, AIDS, alcoholism or drug dependence, age related degenerative diseases and job-related accidental injury.

The homeless have the same health problems as the general population but at a much higher rate. Homeless people are usually sicker and at greater risk of death than those with stable housing. Being very sick can lead to homelessness. If you’re sick, homelessness may make you sicker.

According to endhomeless.org, homelessness is often the cause of poor health. The homeless population is more prone to cardiac disease, tuberculosis skin diseases and infectious or communicable diseases. Circulation issues may affect the extremities. Malnutrition, dental and periodontal disease, degenerative joint disease, venereal disease, hepatic cirrhosis related to alcohol and infectious hepatitis related to IV drug use are seen at higher rates among the homeless.

The most basic medical treatment is extremely difficult for the homeless. Bed rest is usually impossible. Shelter rules usually require the homeless leave a shelter in the early morning.

Diabetes is not difficult to treat with daily insulin injections and a controlled diet. For a homeless person, this treatment is unlikely: Some insulins need to be refrigerated; insulin syringes may be stolen because of their high street value. A homeless diabetic may be mistaken for an IV drug abuser. The diet cannot be controlled because soup kitchens serve whatever is available.

On any given night in Baltimore, there may be 3,000 homeless. Reportedly, during the 2012-13 school year, 2,809 Baltimore City School students were identified as homelessness.

Locally, Healthcare for The Homeless serves the homeless population. In 2014, 1,523 children were served by this organization. In 2016, 10,000 individuals received their services including medical, convalescence, dental, psychiatric, behavioral health and addiction treatment.

The Affordable Care Act (ACA or Obama Care) includes provisions that allow the homeless access to health care.  States can choose to expand their Medicaid criteria to increase eligibility. Most states, including Maryland chose to expand their Medicaid eligibility with designated federal funding from the ACA. Children receive expanded Medicaid health care benefits through The CHIP program.

Homeless adults and children needing health care or information can contact Health Care for The Homeless at 410-837-5533.

Marcia Jackson is a retired RN and Baltimore area resident.