Saturday, December 21, is the winter solstice and the longest night of the year. For this reason, many in New York City and more than 175 communities across the country will observe Homeless Memorial Day. Without such a specific event, many of those who have died without a permanent home might have no memorial at all, passing on as just one more life that fell through our fraying “safety net” and social compact to help our most vulnerable neighbors.
The premature death of each person is regrettable, and the large number of premature, avoidable deaths of people without homes in an affluent society is a public health crisis and a moral and societal tragedy that needs to have attention drawn to it.
Today we also recognize the extraordinary toll homelessness takes on the health and longevity of those experiencing it, on our community and on the public’s health. The most basic measure of health is mortality – whether someone lives or dies. According to the Centers for Disease Control, on average, a person in the U.S. who has reached 40 years of age is expected to live another 40.5 years, to the age of 80; a 50-year-old’s additional life expectancy is 31.4 years.
It is not surprising that the life expectancy of people experiencing chronic homelessness is shorter, but the average number of years life is shortened may shock you. Studies document that the average age of those who die while living on the street are in their 40s or early 50s. That’s an incredible loss of 30 to 40 years of otherwise expected life! Though homeless people living on the streets suffer from higher rates of mental illness and substance abuse, studies have found that, even controlling for those conditions, homelessness is in and of itself a contributing factor in these premature deaths.
The premature deaths are especially lamentable because we have learned how to prevent many of them. Care for the Homeless in New York City is proud to be a health care provider in a consortium that provides effective outreach, mental health care, primary health care and shelter services which over the past eight years has led to a 72% drop in the number of people living on the streets of the Bronx, resulting in fewer people succumbing to the syndrome of ‘death by park bench’
I’ve often heard our physicians and clinicians longing to be able to write the prescription that would most improve their patients’ condition – a script for housing.
Unfortunately, health care practitioners don’t have the ability to write that prescription. But society does. We can choose to fund more affordable housing for very-low income individuals and families, supportive housing for those who need it and a rental subsidy to move people from the more expensive shelter system to these better, cheaper permanent housing solutions.
Recently, Governor Cuomo and the New York State Department of Health adopted a public policy that recognizes that “Housing is Health Care” by using some Medicaid funds to house seriously ill homeless and unstably housed patients. Spending a modest amount of Medicaid funding for housing will result in far better health outcomes and far greater health savings than the cost. The savings come from a great reduction in avoidable emergency room visits, far fewer hospitalizations and re-hospitalizations and shorter hospital stays. This also causes less strain on hospital resources, all of which saves taxpayer dollars and improves the public’s health.
We have seen that providing adequate medical and mental health services, as well as needed human services to people experiencing homelessness pays dramatic dividends in better outcomes and is a good investment. We must commit a greater effort and greater resources to preventing homelessness because we know prevention is better than the cure. It’s better for the individual, better for society and far cheaper for taxpayers.
A recent report by the U.S. Department of Housing and Urban Development indicates that tonight, more than 600,000 men, women, and children will stay in shelters or on the streets in our country, including more than 57,000 New Yorkers. Homelessness has fallen nationwide since 2007 by 9%, but in New York City, we have seen an increase in homelessness of more than 40% over the last three years.
New York’s meteoric increase is believed to largely result from the termination of a state- and city-funded rent subsidy program without anything to replace it. Especially in high-cost housing markets like New York’s, if we are to prevent homelessness and the resulting health problems, we need much more rental support and affordable housing for very low-income families and individuals.
I hope everyone reading this column will consider taking part in a Homeless Memorial Day observance, or at least pause to think about the needless suffering, despair, and premature deaths that we really could prevent. My not-so-silent prayer will be to end homelessness and the need for another Homeless Memorial Day.