Homeless people are at relatively high risk for a broad range of acute and chronic illnesses. Exact data of specific illnesses among homeless people compared with those among non homeless people are difficult to obtain, but there is a body of information indicating that homelessness is associated with a number of physical and mental problems.
In one study, more than 85% experiencing homelessness reported having a chronic health condition. The most common health risks include mortality and unintentional injuries, musculoskeletal disorders and chronic pain, hunger and nutrition, skin & foot problems, dental problems, and more.
People experiencing homelessness have a significantly higher risk of death. From our section on mortality: “Unintentional injuries are a leading cause of morbidity and mortality, especially among homeless men. Injuries are often the result of falls or being struck by a motor vehicle. Deaths due to an unintentional overdose of drugs or alcohol, or both, are also common. Exposure to the elements is a major hazard. In cold weather, the risk of frostbite and hypothermia is substantial, and deaths due to freezing are not uncommon. In hot weather, severe sunburn and heatstroke can occur.” Suicides among homeless people are also common.
The harsh conditions of being homeless often lead to serious injury or death.
Musculoskeletal disorders and chronic pain
Disorders that affect joints, ligaments and tendons (like arthritis) are common among people experiencing homelessness. One study on managing chronic pain among homeless persons found that treatment is a challenge due to stressful living on streets or in shelters, inability to afford prescription medications, and poor sleeping conditions. Some refuse to see doctors for their pain because of how they have been treated in the past, and some use drugs or alcohol to cope with their pain because their history of missed appointments or drug use prevents doctors from prescribing over-the-counter pain medication. As a result, much chronic pain in this population goes untreated.
Hunger and nutrition
Poor nutrition can contribute to a number of chronic conditions over time, and issues like fatigue and weakness in the short term.
Skin & foot problems
People experiencing homelessness are often out and about for long periods of time, sometimes in ill-fitting shoes and worn-out socks. Foot disorders such as onychomycosis, tinea pedis, corns and callouses, and immersion foot are usually the result of inadequate footwear, prolonged exposure to moisture, long periods of walking and standing, and repetitive minor trauma.
People living on the street are particularly prone to develop skin diseases such as cellulitis, impetigo, venous stasis disease, scabies and body lice. The inability to shower often and maintain good hygiene often adds to existing health issues.
Infectious diseases
People who are homeless are often at risk of infectious diseases—like hepatitis A, B, and C, tuberculosis, and HIV/AIDS—due to compromised immune systems, poor nutrition and hygiene, and frequent overcrowding at shelters.
Furthermore, some activities that some homeless people engage in, such as survival sex or intravenous drug use, also increases the risk of the spread of disease. This, combined with barriers many homeless people face in getting treatment, make avoiding infectious diseases difficult.
Dental problems
Periods of prolonged homelessness are often detrimental to people’s oral health. The inability to access preventative and restorative care, combined with poor hygiene, often results in tooth decay and other oral health issues.
Respiratory illness
Chronic obstructive pulmonary disease, emphysema, bronchitis and other forms of respiratory disease are also common among people experiencing homelessness.
Chronic diseases and disorders
Many chronic diseases and disorders, like hypertension and diabetes, are common in homeless populations. Homelessness has also been associated with seizures. In one 2006 study, 49.3% of people in the sample group were diagnosed with epilepsy and 40.7% with alcohol-related seizures. In the latter group, other factors like sleep deprivation, anxiety, and stress also contributed to the seizures.
Sexual & reproductive care
This is an area of health with a growing research base, especially among young people who are most at risk. Youth who are homeless tend to have more sexual partners and at younger ages, making them more at risk of sexually transmitted diseases. Being homeless makes reproductive conditions like pregnancy even more stressful, due to already having compromised health and lacking support systems.
Mental health issues
A large part of the homeless population has serious mental health issues. 30-35 percent of the homeless, in general, and up to 75 percent of homeless women specifically, have been diagnosed with a mental illness. 20-25 percent of homeless people suffer from concurrent disorders (severe mental illness and addictions). People who have a severe mental illness are over-represented in the homeless population, as they are often released from hospitals and jails without proper community supports.” Depression rates are also higher amongst the homeless population, with "22-46 percent having attempted suicide and up to 61 percent having had suicidal thoughts".
