On any given night, more than 700,000 people are homeless in the United States, and up to 2 million experience homelessness during the year. Although most are men, women and children are the fastest growing segment of the homeless population. Homeless individuals have higher rates of hypertension, arthritis, mental illness, TB, substance abuse and victimization than people with homes.
Two recent studies supported by the Agency for Healthcare Research and Quality examined victimization and healthcare use among the homeless. The first study concluded that sexual and physical assault are common experiences for homeless and marginally housed people.1 The second study demonstrated significant unmet need for medical care among homeless women.2
Of 2,577 homeless adults interviewed in San Francisco, 32% of women, 27% of men and 38% who identified themselves as transgendered reported being either sexually or physically assaulted within the past year. Being homeless was associated with more than triple the likelihood of sexual assault for women but not for men.
More than one-third (37%) of the 974 homeless women, ages 15–44, had needed medical care in the two months before the interview, but had not received it. The odds of unmet needs were about twice as high among those who did not know where to go for care, opposed long office waiting times, or were too sick to seek care. Additional factors for having unmet medical needs included lack of education, history of drug abuse, living in a car or abandoned building vs. a shelter, having children, and having serious physical health symptoms.
More than 65% of the homeless women surveyed felt the factors that were helpful in obtaining healthcare included: receiving treatment for all health problems in the same place, weekend or evening clinic hours, free transportation to healthcare and help finding healthcare. The last two are areas where EMS personnel could be of help to the growing homeless population.
1. Kushel MB, Evans JL, Perry S, et al. Victimization among homeless and marginally housed persons. Arch Intern Med 163:2492–2499, Nov 2003.
2. Lewis JH, Andersen RM, Gelberg L. Health care for homeless women: Unmet needs and barriers to care. J Gen Intern Med 18:921–928, Nov 2003.