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.
