Tasnime Osama

Tasnime Osama

A place to call home: housing is health

25 February 2022

aerial view of a residential area showing houses along streets and gardens

The scale of the public health crisis of homelessness is difficult to quantify and largely out of sight.

Access to housing or shelter is a fundamental human right. While the trajectory to homelessness is complex and non-linear, it is socially determined by economic, interpersonal and individual factors that are closely interlinked.

In the UK, sleeping rough is the most obvious form of homelessness, with rates doubling over the past ten years. Between March 2020 and April 2021, over 11,000 people slept rough in London – at the time, the UK government advised people to stay at home to limit the spread of COVID-19.

Less visible forms of homelessness include staying in crisis accommodation and shelters. Couch surfing – staying with relatives or friends – is an ever-growing issue in the UK. These efforts to avoid being out on the streets are often missed, constituting a hidden form of homelessness.

Housing, health and human rights

Homelessness is often exacerbated by other social determinants of health, including unemployment, poverty and domestic violence, and is often preceded by social exclusion and adverse life events that occur in childhood. However, the determinants of health that are associated with homelessness are rarely captured in hospital data, limiting our ability to provide effective healthcare for homeless people.

The right to health – through a system that provides equal opportunities and doesn’t discriminate on the grounds of age, gender, ethnicity or any other characteristic – is another fundamental human right. People who are homeless use acute services more often; they are frequent hospital presenters, with high rates of unplanned admissions and readmissions, and prolonged length of stay.

As homeless people are more likely to choose food or shelter over seeing a doctor, they may only seek medical care when a condition becomes life-threatening. More complex and expensive treatment may be needed at this stage, making  the provision of care challenging. Unfortunately, late presentation is often viewed as negligence or carelessness rather than a struggle to survive, despite competing needs being fundamental barriers for people who are homeless .

In England, there is a staggering difference of approximately 30 years between the life expectancy of people who are homeless and the general population.


Significant health inequalities

Socioeconomic disparities impact the health and longevity of different groups in society. In England, there is a staggering difference of approximately 30 years between the life expectancy of people who are homeless and the general population. The average age at death for homeless men and women is reported to be 47 years and 43 years, respectively.

People experiencing homelessness have higher rates of physical and mental health conditions. For example, 41% of homeless people in the UK live with long-term physical health conditions compared with 25% of the general population. Mental health conditions are diagnosed in 45% of homeless people, falling to 25% for the general population. Research has indicated that homelessness is a risk factor for suicide.

Drug and alcohol abuse is another key issue, accounting for over a third of deaths among homeless people. It has been evidenced that 60% of people sleeping rough are dependent on drugs or alcohol.

The hidden impact of COVID-19

The COVID-19 pandemic has highlighted a long-standing issue: deaths – and causes of death – among homeless people remain undercounted and under-reported, preventing us from addressing the toll of homelessness effectively. A major barrier to collecting these data is that housing status is not collected on important documents, including most hospital records and death certificates, concealing the depth of the issue.

The pandemic has accelerated the rate of deaths among people living with comorbidities, which are common among the homeless community. Unlike most of the general population, people who are homeless have not been able to access telehealth services, disrupting another crucial lifeline.

female professional looking through personal records

The COVID-19 pandemic has highlighted a long‑standing issue: deaths – and causes of death – among homeless people remain undercounted and under‑reported.


Meeting the unmet needs of people who are homeless

With the COVID-19 pandemic, two crises have unfolded and collided, disproportionately impacting unsheltered people. In California, US, homelessness increased by 285% in May 2020: Homekey provided beds for 42,000 individuals above the age of 65 at risk of COVID-19. In December 2021, Mayor of London Sadiq Khan invested more than £800,000 in new homeless accommodation at a hotel, which will operate when temperatures are forecast to drop below 0°C, posing a threat to life. The StreetLink app was also recently launched, enabling the public to connect rough sleepers with local outreach services in England and Wales.

Research findings suggest that a holistic policy response is needed, inclusive of all causes that underpin homelessness, such as ill health and social exclusion. As traumatic incidents are common precursors of homelessness, addressing underlying trauma must accompany sheltering of homeless people. Getting everyone inside is just the start.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.