The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations

Abstract

In the European Union, more than 400 000 individuals are homeless on any one night and more than 600 000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

“…This is most evident in our team's recent findings whereby increased mortality in persons below the age of 55 was linked with hepatic fibrosis and psychosis, both of which are treatable illnesses (Jones et al, 2015). The evolving interest in this significant public health issue has led to several intervention studies (Smith, Soubhi, Fortin, Hudon, & O'Dowd, 2012) and policy recommendations (Fazel, Geddes, & Kushel, 2014) that aim to challenge the traditional health care model that emphasizes treatment of single disorders, as oppose to comorbid conditions. However, determining the effectiveness of these approaches is precluded by existing gaps in the literature on the nature of multimorbid populations, especially within a socially marginalized context.…”

“…Notably, the rate of reported comorbid substance use and psychiatric illness is upwards of 50% (Fazel et al, 2014;Krausz et al 2013). These individuals also experience greater severity of psychiatric illness when compared to persons of low socioeconomic status with stable housing (Eyrich-Garg et al 2008).…”

Prevalence, risk factors and hepatitis B immunization: helping fill the gap on hepatitis B epidemiology among homeless people, Goiânia, Central Brazil

“…Street population experiences prejudice and discrimination, and has a strong intersection with drug users and sex workers, representing a vulnerable population that mostly has poor access to health services 1 . Globally, the number of people living on the streets is estimated at 100 million.…”

St. Louise Hospital for Marginalized Homeless Population: TB and Other Infectious Diseases are Rare

“…Tomanek (Pavol Tomanek) 1 , M. Hardy (Maria Hardy) 1 , K. Prochazkova (Katerina Prochazkova) 1,2 , G. Mikolasova (Gertruda Mikolasova) 2 , V. Krcmery (Vladimir Krcmery) 1,3 , M. Mikloskova (Monika Mikloskova) 1 , L. Bucko (Ladislav Bucko) 1 …”