HOMESLESS DEATHS WORLDWIDE LINKED TO BARRIERS TO HEALTH CARE

I did what I normally do when I am looking for medical information. I searched for research done in countries which have socialized medicine. I like my medical information to not be filtered through the US dollar. I found some interesting conclusions. It is most likely due to the lack of social and health services being fitted to their needs. Homeless people are struggling to just get basic needs met such as a place to sleep, food, safety, and for the ones addicted a supply of alcohol or drugs for that day. Even in countries which have universal health care which the homeless could access for free they have high death rates of the homeless, often due to not seeking help for health problems because of the struggles they have just to survive.
Among the population of homeless are people who had health problems before they became homeless. This is often one of the reasons for homelessness. Not quite sick enough for social security according to the government, but yet too sick to hold down a job. This includes the mentally ill. Once someone is homeless it is impossible to maintain the routine one needs to take care of a health problem or even maintain normal healthy practices if you are healthy to begin with. A diabetic for instance may not be able to take their medications routinely as they may not be able to plan when they can eat. There may not be an appropriate place to store the medications either. They can’t do routine exercise or eat a healthy diet. Taking insulin syringes with them could lead the police to suspect them of drug use.

Mortality rates of homeless adults in the United States and Canada have been shown to be 3 to 5 times higher than those of the general population. Heart disease is a leading cause of death in older homeless people 45 to 64 years old, and despite other common causes of death in younger homeless people 25 to 44 years old, heart disease is 3 times more common in this group than in the age-matched general population. Most striking are the high prevalence of heavy smoking and the high rates of poorly controlled diabetes and undiagnosed and under treated hypertension and hypercholesterolemia. The risk of CV disease in homeless people may not be entirely the result of traditional major risk factors. Recent cocaine and alcohol use are highly prevalent in the homeless cohort. The use of these substances is a known risk factor for CV disease. Psychosocial issues, including stress, anger, and depression, are other possible novel CV risk factors not considered in the Framingham equations. The risk of CV outcomes in the homeless cohort may well be underestimated. Research is needed to establish CV risk estimation equations that include variables that are more common in homeless people, such as heavy smoking, cocaine abuse, alcohol abuse, and stress. http://circ.ahajournals.org/cgi/content/full/111/20/2555

Most of the homeless are not chemically dependent, but those who have died this year in Anchorage are. Hypertension, hyperlipidemia, respiratory diseases, cellulitis, infectious diseases such as endocarditis from Bartonella Quintana, and AIDS are among some of the health problems of the homeless. The homeless often live in shelters packed close together where influenza or other highly communicable viruses are easily spread. Injuries from a hard life and trauma can be part of the picture. There is no running water in the woods to clean your hands or a wound to prevent infection. Add alcoholism, drug addiction, liver disease and renal disease to the mix and it is a lethal situation. There are only ten detox beds in all of Anchorage. The only reason they have those is the Salvation Army has opened them. Why are there no beds from the state of Alaska?
Not having a home when ill creates huge difficulties for recovery. Bed rest, taking medication on time, dressing changes, checking blood sugar levels, relaxation, are impossibilities to most homeless people. The health care for inmates in the prison system in this state is so poor that the surprising thing is the death count is not higher. Large numbers of people released from prison end up on the streets because they have no place else to go. They had basically no health care while incarcerated and then end up homeless. That includes the mentally ill which make up a big portion of the homeless population. The prison system provides very little chemical dependency treatment then sends people into a bad situation. It is easy to see how this is a set up which causes continued use of drink and drugs.
The housing situation is bad for those who have been incarcerated. Low income housing in this state is often substandard with some health problems of it’s own, such as mold and problems are not taken care of by landlords. There are not any health inspectors for housing. Those with criminal records will have a difficult time finding someone willing to rent to them even if they have the finances to pay. They are barred from the section 8 program. The department of probation provides very little help. When asked about services to help the homeless on probation recently released from prison a probation officer in Anchorage told me it “is not our responsibility to help people find housing”. There is apparently a half-way house which this officer said was “just like being in jail”. Most of the homeless people who have recently died have been incarcerated at some time. The prison system in this state destroys people. The psychological abuse, the lack of treatment of psychological problems and physical illness by the prison system essentially sets inmates up for failure. Housing a chronic alcoholic without treatment in prison and then releasing him to the streets with no resources says plain and simple the powers that be not only do not care about the inmates they also don’t care about society.
Effective health care for homeless people is only effective if delivered where the homeless are. Care for the homeless needs to be delivered on the streets and in shelters to be successful. Clinics set up in the middle of the areas where the highest population of homeless are located help. Several cities have programs for the homeless who are ill and need a period of time to recover. Decent housing for those who have barriers to housing is needed. A team of health care professionals in a van or motor home could park anywhere they were needed. The shelters do a fabulous job. I don’t know much about The Mission, but at Brother Francis they do their best to accommodate those who have health problems. They are very skilled at dealing with mentally ill guests. They have case managers who help people look for work, housing and social services. Chronic inebriates may have a hard time participating in this program. For one thing just remembering to keep an appointment could be difficult. There is a program called Caring Clinic which is run by Sr. Jackie Stoll, a nurse practitioner. This program is at Brother Francis Shelter which is wonderful. The clients would be mostly those staying at the shelter. People living in camps would be less likely to go to the clinics.
Could there be another factor in the deaths? Yes, there has been so many so close together that it is possible. They claim it would be obvious if poison was being used, but there are poisons which would look like intoxication and have some of the same side effects as ethanol such as ethylene glyclol. It tastes pretty good also. They admit they are not even testing for poisons. I find that strange. Is there some kind of infectious disease that is contributing to the deaths? Is it because we have had good weather and people are living in camps with less exposure to the services in the shelters? Is it related to the added stress of the homeless being criminalized? I can only hope we will find these answers soon before more die.