The burden of illness and disease is extremely high among homeless people (Levy and O'Connell, 2004). However, any consideration of the common health problems of homeless people must first recognize the large degree of heterogeneity among people who are homeless. Among street youth, single men, single women, and mothers with children, the patterns of illness differ notably. Adolescents suffer from high rates of suicide attempts, sexually transmitted diseases, and pregnancy (Greene and Ringwalt, 1996; Greene and Ringwalt, 1998; Greene, et al., 1999; Feldmann and Middleman, 2003). Female heads of homeless families tend to have far fewer health problems than single homeless women, although their health is poorer than their counterparts in the housed general population (Robertson and Winkleby, 1996). Homeless single men have a higher prevalence of alcohol abuse and drug abuse, whereas single women have a higher prevalence of serious mental illness (Fischer and Breakey, 1991).
Health status also tends to be correlated with a person's history of homelessness. Individuals with severe mental illness, substance abuse, and medical conditions are overrepresented among the chronically homeless, whereas those who are homeless for a transient period lasting only a few weeks or months are more likely to be relatively healthy (Kuhn and Culhane, 1998). Although chronically homeless people make up only about 10% of all individuals who experience homelessness in a given year, they account for a disproportionately large share of the demand for shelter beds and health care services for homeless people (Burt, 2001). In addition, the public's perception of homeless people often reflects a stereotyped image of this highly visible subgroup.
Cross-national comparisons of disease patterns among homeless people reveal the strong effect of social factors within each country. Among homeless men in Tokyo, Japan, morbidity due to alcohol dependence (but not drug use) is common, as are musculoskeletal injuries incurred doing construction work (Takano, et al., 1999b). In contrast, 60% of homeless people in Amsterdam, the Netherlands, suffer from drug abuse or dependence (primarily heroin), and most are chronically homeless (Sleegers, 2000c).
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