Bobby Watts, the author, right (photo via Care for the Homeless)
Many New Yorkers have become aware of the cost of homelessness on our social fabric and on municipal budgets. One of the greatest costs is often overlooked: homelessness is hazardous to one's health and leads to premature death. Tonight, December 21st, the winter solstice, is the longest night of the year, and the day Homeless Memorial Day is observed in over 175 communities in America including New York City. It's a day to remember our neighbors who died while experiencing homelessness and to recognize the extraordinary toll homelessness takes on the health and longevity of people and also on the public health of our community and nation.
The most basic measure of health is mortality – whether someone lives or dies. According to the federal Centers for Disease Control and Prevention (CDC), the average lifespan for a New Yorker is over 80 years. For those experiencing chronic homelessness, it is not surprising that their life expectancy is shorter – but the amount it is shortened is shocking.
Overall, the age-adjusted mortality rate of homeless people is three to four times higher than their peers living in homes, and much higher for some age groups. Studies consistently document the average age of those experiencing chronic homelessness who die while living on the streets to be in their forties or fifties, which represents an incredible loss of 30 to 40 years of life. Epidemiological studies have determined homelessness is in and of itself a cause of these premature deaths, even after controlling for factors such as mental illness, substance use, and chronic and acute illnesses. Simply put, homelessness kills.
Let me say it again: homelessness kills.
For the millions of Americans suffering homelessness and unstable housing, and the 58,000 people sleeping in homeless shelters in New York City this long night, the lack of housing may be a premature death sentence.
As a public health professional, and director of a health care program serving homeless people, I've often heard physicians and clinicians longing to be able to write the prescriptions that would most improve their patients' conditions - a script for housing. Unfortunately, health care practitioners don't have the ability to write that prescription. But society does.
Governor Cuomo and the New York State Department of Health have adopted a "Housing is Health Care" public policy by using state Medicaid funds to house chronically homeless or marginally-housed patients. These policies deliver better health outcomes for homeless people, improve communities and promise tax savings through fewer emergency room visits, hospitalizations, and re-admissions, and through shorter hospital stays.
We understand how to end modern-day homelessness because we've seen programs that work. We know providing adequate medical and mental health services as well as needed human services to people experiencing homelessness yields dramatic dividends in better health and housing outcomes and pays for itself. This year, New York City increased funding to prevent homelessness by 50 percent after having previously doubled it, and we've had some success – we just need more investment in these proven programs. For example, we join with advocates that call on the Cuomo administration to join Mayor de Blasio's and contribute to the construction of the 35,000 units of supportive housing needed to meet demand.
I hope everyone reading this column will take part in a Homeless Memorial Day observance too, or at least pause to think about the avoidable deaths, suffering, and despair that we could prevent through better public policies. My not-so-silent prayer today will be to end homelessness and negate the need for many more Homeless Persons' Memorial Days.
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Bobby Watts is Executive Director of Care for the Homeless, one of New York City's oldest and largest providers of health care and other services to people experiencing homelessness, and past President of the National Health Care for the Homeless Council. On Twitter @CFHNYC.
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