Tuesday, October 22, 2013

Let's Treat Housing as a Health Care Issue



Jeff Foreman, Director of Policy
 
Governor Andrew Cuomo and New York State did something Care for the Homeless has long advocated. He adopted the public policy that housing is health care.

CFH’s health care professionals, who treat people experiencing homelessness every day, advocate for it. They know it’s not just easier to access treatment when you’re stably housed, but ongoing treatment is always more effective for those who have stable housing.

Studies show age adjusted life expectancy for chronically homeless people is in the 40s and 50s, compared to a national life expectancy of over 80 years. A 2012 study published in the International Journal of Epidemiology concluded “homelessness is an independent risk factor for death from specific causes.”

Homelessness itself is a contributing cause of ill health and premature deaths.

Managing treatment on the streets, or even in shelters, is difficult.  Fighting infections with an already compromised or weak immune system in close living conditions or with constant exposure to the elements can be disastrous. Homelessness is an added impediment to properly taking medications, following treatment regimens or keeping medical appointments. Managing diabetes is nearly impossible if you rely on soup kitchens for food. 

For children (there are 22,000+ children sleeping in New York City homeless shelters tonight) the health consequences are often irreversible. In very young children it often manifests as a negative impact on developmental and physical growth. Children who are homeless often exhibit significant delays in developing gross and fine motor skills as well as social skills.  

In older children there’s a negative impact on school performance. They experience a higher drop-out rate.  One study documented a 75% drop-out rate for chronically homeless kids. One-third of homeless children in one study had to repeat at least one grade. Homeless children suffer chronic illness at a much greater rate than peers.

Homeless kids have an 83% chance of having experienced an incident of violence by the age of 12. They are 15% more likely to need mental health care as a result of a trauma than other children exposed to violence.   

Now New York State has adopted a public policy, albeit a tentative one, to do something about it. 

As part of New York’s Medicaid reform (CFH Executive Director Bobby Watts was on the Medicaid Reform Team taskforce that looked at some of these issues) the Cuomo administration set aside a very modest $75 million of health care funds for supportive housing for people experiencing or at risk of homelessness. That’s already translated into financing for a 12-story affordable and supportive housing project under construction on Boston Road in the Morrisania section of the Bronx. 

“The thing we figured out,” according to U.S. HUD Secretary Shaun Donovan, “is that it’s actually cheaper, not just better for people, but cheaper to solve homelessness than it is to put a band-aid on it. Because at the end of the day it costs, between shelters and emergency rooms and jails, it costs $40,000 a year for a homeless person to be on the streets.”

New York City is known for its high intensity public health campaigns, from anti-smoking to nutrition labeling and the attempt to outlaw large sugary drinks. Last December the Mayor rightly hailed the achievement when New York’s average life expectancy jumped above the national average to 80.9 years. Maybe the next big thing, the biggest potential public health bang for our tax bucks, might be housing the homeless.