Homelessness Is a Public Health Issue

Homeless man sits on side of road asking for help

We’re hearing a lot about public health these days. Thanks to COVID-19, we’re in the middle of a public health crisis. But what exactly does that mean?

The Oxford English Dictionary defines public health as “The health of the population as a whole, especially as the subject of government regulation and support.” Things that influence public health include hygiene, disease prevention, and epidemiology. Anything that poses a threat to the health of the public across multiple geographic areas, and is severe enough to threaten many lives, becomes a public health crisis.

There are several notable examples from the last decade. They include:

  • Lead water in Flint, Michigan
  • Opioid epidemic
  • 2010 Haitian earthquake
  • and, of course, the COVID-19 pandemic

Could homelessness be a public health crisis, too?

The answer is yes. It may not be the first thing you think of when the term comes to mind, but it checks all the boxes. Homelessness has elements of poor hygiene, exposure to diseases, and poor standards of living and health outcomes. It has killed many thousands of people worldwide. In L.A. County alone, over 5,620 homeless people died between 2013 and 2019.

Homelessness shaves several decades off the average person’s lifespan. Threats to individuals like assault and lack of food combine with community dangers, like contagious illnesses.

Consider some of the other similarities between homelessness and COVID-19. Both:

  • Disproportionately affect minorities
  • Exist in most parts of the world
  • Threaten economic stability
  • Create community-wide fear, anxiety, and unrest

There are also many factors which make homelessness unique. Homeless people suffer from diseases that are archaic and all but unknown to the modern-day housed population. They include:

  • Typhus
  • Tuberculosis
  • Typhoid fever
  • Shigella
  • Hepatitis A

It isn’t hard to guess why only homeless people, or others in extreme poverty, are the ones who still get these diseases. Factors leading to typhoid fever, tuberculosis, etc. are the ones faced by our ancestors in the Middle Ages: contaminated water, exposure to the elements, and no access to shower or laundry facilities.

It’s unacceptable these diseases exist in the 21st century. Sadly, conditions for homeless people aren’t even staying the same. They’re getting worse. COVID-19 has shown us how much worse things can get. We thought homelessness was an unthinkable human rights crisis before. COVID-19 has illuminated all the cracks in that façade.

Encampments and Resource Agencies Pose Dangers as Well as Protections

Another major reason homelessness is a public health crisis is because of congregation.

Humans are social creatures. We prefer to group together rather than be alone. This is a core survival instinct: being together keeps us safe from predators. It allows us to share food and shelter. We also need to connect with others to avoid loneliness, which comes with its own poor health outcomes. It’s no different on the streets for homeless people. Whether that is a large homeless encampment or a family, homeless people share the same need for closeness and proximity as all of us.

Gathering is also necessary at places like homeless shelters and soup kitchens. It’s not always even a matter of choice. If you want help, you’re going to have to be around other people.

Unfortunately, our need for community can also be our downfall. We’re certainly seeing this now with the COVID-19 pandemic. It’s incredibly tough for us to exist alone. And how many of us, as soon as out-of-state travel restrictions were lifted, rushed to visit distant loved ones?

With congregation comes easier spread of disease. We’ve all become more educated on disease prevention since the COVID-19 pandemic began. We know certain factors spread sickness, such as:

  • Coughing, sneezing, talking, and even breathing in others’ directions
  • Lack of access to hygienic bathrooms. Even the most basic of modern commodities, the flush toilet, is not available to many homeless people
  • No place to shower or wash hands regularly
  • Sharing of items which come into contact with bodily fluids – namely needles, pipes, and other drug paraphernalia

Of course, all these factors exist to some extent among homeless people.

So, How Do We Respond?

There are two main ways of looking at the public health crisis of homelessness.

The first has to do with survival instinct: “Homelessness is dirty and must be eradicated!” While we can all agree homelessness should not exist, we must be careful not to view homelessness as a disease itself. This leads to lack of compassion and even cruelty. Homelessness, instead, should be viewed as a risk factor.

So we come to the second way of viewing homelessness: not as just a crisis but a call to compassion. We fight COVID-19 by testing, social distancing, and working toward treatments and a vaccine. We fight homelessness, and all that occurs as a result of it, by protecting the homeless and those in poverty.

It doesn’t take a group of world-class scientists and doctors to figure out how to keep homeless people from getting sick. The answer is simple: get them housed. If that isn’t immediately possible, get them access to the same amenities we housed folks have.

Consider the tools we already have to fight COVID-19. Homeless people would be far healthier and safer with access to:

  • Modern bathrooms
  • Hand-washing stations
  • Showers
  • Laundry facilities
  • Trash collection

What Can I Do?

First and foremost, continue your work to get people without homes into housing. Pressure your state and local representatives to create affordable housing.

Pressure them also to give homeless people access to basic sanitation necessities. It’s far from the only thing that needs to be done, but it’ll at least reduce the spread of disease. Again, as we’re learning in this pandemic, a few small steps can prevent a lot of death. That alone is worth going out of your way for.

Speaking of going out of your way … something else you can do is donate much-needed sanitation supplies. None of us are taking things like cleaning wipes, masks, hand sanitizer, soap, and toilet paper for granted. Take a moment to think about what it was like to not be able to find these things. Now think about the fact that homeless people generally don’t have these things, ever.

Whether you take a box of supplies to your nearest homeless shelter or hand them out to your homeless neighbors, you’ll be doing a world of good.

We are now more prepared than ever to empathize with homeless people. Fearing for our health, wishing we had more ways to stay clean and healthy – this defines a public health crisis. Ours is temporary. For homeless people, it is their whole life. It may be all they know, and all they expect to know for a long time.

No one’s asking you to find a vaccine for homelessness (if only there was one, though). All it takes is looking – really looking – at your homeless neighbors and doing what you can to help.

Victoria VanTol

Victoria VanTol


Victoria VanTol holds a master's degree in social work. She is a therapist and freelance writer specializing in topics related to social justice and mental health.

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