New Report Outlines the Health Toll of Homelessness

New Report Outlines the Health Toll of Homelessness

UIC study shows those experiencing homelessness face shorter life expectancy, greater risk of being victim of violent assault or homicide

SPRINGFIELD - People experiencing homelessness are likely to have a significantly reduced life expectancy and are more likely to be the victim of a violent assault or homicide, according to a report prepared for the Illinois Department of Public Health (IDPH) by the University of Illinois Chicago (UIC) School of Public Health.

The "Illinois Homelessness Morbidity and Mortality Report 2017-2022" is only the second report on the mortality of people experiencing homelessness undertaken by a state government, after the 2023 Minnesota Homeless Mortality Report. The report, which draws on statewide hospital records and death certificates, was developed as part of an ongoing multi-agency effort by Illinois state government to promote housing access and stability across the state. This effort is led by the Office to Prevent and End Homelessness (OPEH), which works with IDPH and other state agencies through the Illinois Interagency Task Force on Homelessness to deepen strategies to prevent and end homelessness. The report highlights the scope of health issues disproportionately faced by people experiencing homelessness and the need to increase health-promoting interventions. An executive summary can be found here.

"Housing is an important social and structural determinant of health," said IDPH Director Dr. Sameer Vohra. "Only the second report of its kind in the United States, the information presented draws into sharp focus the enormous toll that homelessness takes on unhoused Illinois residents, and the health system that works to care for them. The report diagnoses the problem, but it is only the first step. With partners across government, community, academia, and the private sector, the State of Illinois will move forward to design new and improve our current programs and policies to address disparities and achieve optimal health for our residents."

"The health inequities highlighted by this report are stark. The findings validate what we have long understood: all people need safe, affordable housing to live healthy lives," Illinois Chief Homelessness Officer Christine Haley said. "Homelessness is the product of generations of inequitable public policies. We must choose to collectively chart a new path- one that strengthens communities by prioritizing access to housing, particularly for our most marginalized neighbors."

"The health concerns of people experiencing homelessness are not limited to psychiatric conditions and substance use disorders," said UIC Professor Lee Friedman, an author of the report along with Dana Madigan, PhD and Hannah Matzke, PhD. "People experiencing homelessness with chronic health conditions have a very high level of hospital utilization, and among those that died, the majority were suffering from chronic conditions at their time of death."

UIC Research Assistant Professor Dana Madigan noted, "The focus for many jurisdictions has been on mortality data, which provides clear insights on the health impacts of those experiencing homelessness, but this report's additional analysis of hospitalization data can inform interventions at earlier stages that can have a larger impact. This is especially relevant for addressing the chronic health needs of this population and drivers of increased hospital use when someone is identified as experiencing homelessness compared to times when they are not."

IDPH intends this report to be a tool to help partners communicate and understand the health inequities facing this population and to shape policies and programs to address these inequities. One such community partner, Dr. Yvonne Collins MD, FACOG, Chief Medical Officer at CountyCare, said, "This report reflects the reality that our CountyCare members experience daily- people experiencing homelessness are at an increased risk of a myriad of health conditions, face barriers when accessing appropriate care and die prematurely and unnecessarily. Through investments in programs like the Flexible Housing Pool, an innovative program which seeks to permanently house the most vulnerable while providing them the support they need for success, CountyCare and Cook County Health are taking the opportunity to care for patients experiencing homelessness and support access to housing."

Findings in the report include:

• For the time period covered in the report, the average age at time of death was nearly 20 years younger for people experiencing homelessness (PEH) than for the population at large, 56.3 versus 74.2 years old.
• There has been an overall increase of 36.6% in deaths of people experiencing homelessness since the start of the COVID pandemic, while there has been only a 6.1% increase in deaths in the general population over the same time period, after accounting for the three COVID waves in both groups.
  
• The increase in deaths since the start of the COVID pandemic appears to be driven in part by an increase in fatal drug-related overdoses (proportion of deaths pre- vs post-COVID; 27.1% vs 33.2%).
  
• PEH were at heightened risk of being assaulted and were nearly three times as likely to die from homicide than the overall population, 2.9% compared to 1%.

The report also emphasizes the importance of increasing access to stable housing for people experiencing homelessness, and of improving their access to health care, including primary care, substance use disorder treatment, and behavioral health care. As part of Illinois' cross-agency effort to prevent and end homelessness, the state has made historic investments in homelessness interventions in recent years, including a $290 million investment in the fiscal year 2025 budget. This data will be used to inform plans for how to utilize that funding most effectively.

As part of the ongoing effort to share this data and make it actionable to partners including community services providers, policymakers, health care providers, and advocates, IDPH and the UIC School of Public Health recently hosted a webinar on the report. This online discussion presented findings from the document and gave participants an opportunity to present input on possible future policy initiatives. A recording of the webinar can be found here.