We need a health-care system that recognizes homelessness first and foremost as a medical issue.
Mr. Morris sits in the exam room. He’s losing control of his diabetes. Insulin management is not on his mind. He wants to talk about a new wound that has developed. After a breakup, he has found himself homeless. His cheeks redden as he shares that he has not taken his insulin for three weeks — his medications stolen while he slept outside.
Mr. Morris’ story is not a unique tale of misfortune. While that is not his real name, such stories are all too commonplace among Seattle health-care providers. Across the state, more than 21,000 peoplestruggle with homelessness, and the crisis is growing.
Doctors try to manage chronic diseases, but more than anything, patients like Mr. Morris need stable housing.
We need a health-care system that recognizes homelessness first and foremost as a medical issue. People experiencing homelessness are hospitalized at rates four times that of the general population. Yet, the medical community has often sat on the sideline, with homelessness siloed as an issue for the housing authority to address. It is time for the housing crisis to be treated as a public-health crisis and for our health-care dollars to be invested in housing.
Homelessness is not only a symptom of morbidity and mortality, it is a root cause. And it is a condition that we know how to effectively treat. Multiple studies have demonstrated how stable housing improves the health of the chronically homeless. Providing housing is not only morally just, it is also cost-effective. In Seattle, “Housing First” approaches demonstrated savings of nearly $2,500 per person per month. Similar findings have been repeated across the country. Yet, our health-care system has rarely invested in housing.
Nevertheless, there is momentum in the right direction. Washington state has prioritized supportive housing with the Medicaid Transformation Demonstration. These new programs provide important services to help patients obtain and keep housing. However, they do not go far enough. Due to federal limitations, Medicaid funds cannot be used directly toward housing expenses — and this is a crucial step to reversing the housing crisis.
The medical community has recently rallied around this idea. Last month, the Washington State Medical Association passed a historic resolution urging the state to expand upon this work, resolving to “work with the Health Care Authority and Accountable Communities of Health on policies to mitigate chronic homelessness, up to and including the use of state and/or private funding for housing.” This is an important step for the medical community, but how do we ensure that WSMA’s commitment is manifested in more than words?
We in the medical community need to advocate for health reform that encourages insurers, managed-care providers, and other stakeholders to invest in programs addressing the housing crises. We need to elect strong local leadership committed to expanding affordable housing options and housing support services, and forge alliances between the health and housing sectors. Multiple communities have discovered innovative ways to improve the health of people experiencing homelessness while controlling health-care spending, and these strategies could be replicated locally. Until we start to address these “upstream” issues, our hospitals and clinics will be overwhelmed by the “downstream” effects of homelessness — the acute and chronic diseases that result in avoidable suffering.
Fighting the health inequities inherent to homelessness must be seen as our obligation as health-care providers. Chronic homelessness is associated with a life expectancy 30 years less than the general population. If we could give a pill that would extend our patients’ lives by 30 years, we would rush to do so! We must feel that same urgency when it comes to the care of our homeless patients.