by Ariana Schneider, MSW, LCSWA, CTP
Imagine yourself 27 years from now. What have you accomplished? How many experiences have you gained? 27 years seems like a long time, right? Now with this perspective, think about the fact that homeless individuals live 27 years less than housed individuals (Centers for Disease Control, 2019; Stasha, 2022). This large difference in life expectancy for the homeless community can be attributed to a combination of poverty, discrimination, exposure to violence, and increased risk for chronic and infectious diseases (National Coalition for the Homeless, 2018). Further factors which may impact life expectancy include poor mental health and increased rates of substance use within the homeless community (National Coalition, 2018); these issues affect the larger healthcare system and those in the behavioral health arena, such as health departments and mental health clinicians.
It is important to understand how the healthcare system tries or fails to address the disproportionate risks and challenges facing the US homeless population. Even though physical and emotional challenges play a role in reducing a person’s life expectancy, the issue is more complex. One of the key challenges of providing healthcare to individuals facing homelessness is lack of insurance coverage; one study found that around 60 percent of homeless Americans lacked insurance coverage (Sherman, 2018). This means that for many homeless individuals, the emergency department is their primary way of getting help—it is estimated that 1/3 of emergency department visits are made by those experiencing homelessness (Sherman, 2018). It is important to note that while care is provided in emergency departments, this type of care focuses on the most visible concern and rarely addresses the root issues causing the health concerns. Currently, the health care system rarely addresses the needs of the homeless in a comprehensive and preventative way and only takes care of the outcomes of poor healthcare rather than focusing on the heart of the issue—the widespread lack of preventative care and chronic care management for homeless populations.
It is important to note that homelessness disproportionately impacts ethnic and racial minorities (National Alliance to End Homelessness, 2020). An article by National Alliance to End Homelessness indicated that while black Americans only make up around 13 percent of the population, they account for up to 40 percent of the US homeless population (2020). Hawaiian and Pacific Islander peoples face the highest rate of homelessness of any ethnic or racial group, followed by those of American Indian descent (National Alliance, 2020). Due to the disproportionate representation of minorities in the homeless population, lack of quality healthcare is a public health issue that is worsened by structural and institutional racism: the top-down discrimination of a group of people through laws, policies, or actions that lead to inequity.
I urge you to return to thinking about 27 years. What if you had 27 years less of life compared to someone else? I’d bet that you’d want to change that if you could. So, what can we do to change this reality for those experiencing homelessness? I can suggest some solutions—Medicaid and Medicare expansion, universal healthcare, and developing healthcare policy through an antiracist lens—but I know this is just the start of combatting the issue. We have to work together as a society and leverage our collective knowledge and resources to solve the problem, because we all deserve to live healthy, fulfilling, and long lives.
Centers for Disease Control and Prevention. (2019). Life expectancy data for the United States.
Jain, S.H. (17 April, 2021). Homelessness is a healthcare issue. Forbes.
National Alliance to End Homelessness (2021, June). Racial inequities in homelessness, by the
National Coalition for the Homeless. (21 December, 2018). Remembering those lost to
National Healthcare for the Homeless. (2006). The hard, cold facts about the deaths of homeless
Stasha, S. (5 March, 2022). The state of homelessness in the US.