NEW YORK CITY – January 30, 2006 – Homeless adults died at twice the rate of New York City adults from 2001 through 2003, according to a new report issued jointly today by the City Departments of Health and Mental Hygiene (DOHMH) and Homeless Services (DHS). The report mainly describes the health of those adults who spent at least one night in a DHS shelter during this period. Substance use and HIV/AIDS accounted for nearly one third of all deaths among homeless adults, compared with less than 5% among New York City adults overall. Additionally, substance use, alcohol use, and mental illness accounted for 69% of hospitalizations among homeless adults, compared with 10% among non-homeless adults. Rates of tuberculosis (TB) and new HIV diagnoses were also significantly higher among adults who used the shelters. Much can be done to prevent and treat these illnesses. Today, the City outlined five general recommendations and an immediate action plan within the report, The Health of Homeless Adults in New York City, which is available online at http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-homeless-200512.pdf.
Health Commissioner Dr. Thomas R. Frieden and Acting Homeless Services Commissioner Fran Winter were joined by advocates, community organizations, health and mental hygiene providers, and government officials for today's announcement at Kenton Hall, a shelter for men, operated by Project Renewal.
Between 2001 and 2003, 55,914 single adults and 46,832 adults in families used the DHS shelter system for at least one night. Data collected on over 100,000 adults during this period show that the homeless not only have higher death rates but are also susceptible to poor physical and mental health. The report also tracks hospitalizations as well as deaths due to extreme weather conditions for all homeless adults.
“This report serves as a wake up call to the serious and specific health challenges of this vulnerable population, and underscores the importance of targeting our medical services to meet those needs,” noted Deputy Mayor Linda I. Gibbs. “Focusing in on the leading causes of illness and death can improve the health of a high percentage of men and women who, in addition to suffering from serious illnesses, face the challenge of being homeless. And doing so can help people find and keep a stable home, further improving their health.”
“This study offers a first dramatic look at a hard-to-reach population with serious health needs,” said DOHMH Commissioner Dr. Thomas R. Frieden. “It is a stark reminder of how urgently attention is needed. Progress requires working closely with our partners in community-based organizations and the health care community, particularly those providing direct services to homeless people. Working together, we can improve the health of homeless New Yorkers.”
- The death rate among single homeless adults who used the single shelter system was 2,192 per 100,000 persons (2.19%), twice that of the NYC adult population.
- Among homeless women who used the single adult system, the largest proportion of deaths was due to HIV/AIDS, with a death rate 9 times as high as that among the NYC adult population. Among single adult men, substance abuse caused the largest proportion of deaths, with a rate 16 times higher than that among the NYC adult population.
- Heart disease and cancer were the leading causes of deaths in the homeless adult population, as in the general adult population. The death rate due to lung cancer was twice as high among homeless adults who used the shelters.
- More than 2 out of 3 hospitalizations among homeless adults were due to substance use, alcohol use and mental illness, compared to 10% among non-homeless adults.
- The prevalence of HIV/AIDS among single adults who used the shelters was twice as high as the general adult population.
- The rate of new HIV diagnoses was 16 times higher among homeless adults who used the single adult shelter system and 8 times higher among adults who used the family shelters than among adults in NYC.
- Rates of tuberculosis were 11 times higher among adults who used the single shelter system compared to the general adult population.
- Among single homeless adults, Black adults who used the shelters had the highest proportion of deaths due to HIV/AIDS.
- Among single homeless adults, Hispanic adults had the highest proportion of deaths due to substance use.
“Just because an individual is without a home should not mean their health problems have to go unnoticed or untreated,” said Acting Commissioner of Homeless Services Fran Winter. “We plan to work closely with the Health Department and aggressively broaden our existing collaborations with community-based organizations and healthcare providers to bring these resources to bear in improving the health and well-being of individuals experiencing homelessness.”
DOHMH and DHS has set forth five recommendations along with three immediate action steps to address these issues. Ultimately, safe, affordable housing is the most important resource for improving the lives and health of homeless individuals and families. In brief, these recommendations are:
- Reduce heart disease and cancer by providing additional trainings for medical providers; improving linkages to care for hypertension, high cholesterol, and diabetes; improving access to cancer screenings and trainings; and increasing resources for smoking cessation.
- Prevent and shorten hospitalizations by improving discharge planning and linkages to housing, substance abuse rehabilitation, and mental health services; implementing pilot programs for patients who use hospitals often; and increasing availability of outpatient detoxification services.
- Reduce disability from mental illness and substance abuse by improving access and linkages to rehabilitative services of all types; increasing capacity for case management programs; prioritizing homeless persons with mental illness and/or substance abuse problems for housing; providing trainings for brief interventions for alcohol and drugs for shelter staff; and increasing the availability of information on harm reduction programs, including syringe exchange, among others.
- Decrease infectious diseases like HIV/AIDS and tuberculosis and provide immunizations for flu and other vaccine preventable diseases. This includes such actions as making rapid testing for HIV/AIDS available at shelters, making sure medical personnel at DHS shelters are knowledgeable about tuberculosis, and providing flu shots to all DHS shelter residents and staff.
- Rigorously monitor progress of initiatives by establishing performance indicators to track the extent to which action steps are implemented, and analyze exposure deaths quarterly.
Immediate Action Steps
The DOHMH and DHS also intend to take three immediate action steps, which will be undertaken by December 2006.
- The first action is to enhance medical screenings and treatment options for shelter residents, including increased HIV testing; increased identification and treatment of alcohol/drug abuse; and smoking cessation programs.
- The second set of actions includes increased services for shelter residents, ranging from access to shelter-based ambulatory detoxification services to greater assistance for pregnant women.
- The third is to monitor progress, creating performance indicators to track the extent to which action steps are implemented, as well as regularly analyzing exposure deaths.
The lead author of the report, The Health of Homeless Adults in New York City (PDF), is Dr. Bonnie Kerker, Assistant Commissioner of DOHMH's Bureau of Epidemiology Services. For more information on the health of the homeless, please see the full report at nyc.gov/health.