On the longest night of the year (known as the winter solstice), hundreds of communities in the United States honor people who died while affected by homelessness over the past year. And although the winter solstice is often cold, deaths from exposure happen year-round — in the heat, and particularly when temperatures fluctuate from warm to cold in the course of a day or a few days. To put it simply: experiencing homelessness can be deadly.
Studying trends in death is important in order to improve public health. Over the past several years, I’ve researched these trends among people affected by homelessness in Albuquerque, N.M. Along the way, I became aware of the vital need to document housing instability and homelessness more systematically. The data makes it clear that we need to prioritize affordable housing initiatives, at both the state and federal levels. For our most vulnerable neighbors and communities, it can literally mean the difference between life or death.
Homelessness is a recurring problem. Yes, people affected by homelessness can and do exit homelessness, but new people continue to become homeless everyday. Some experience it briefly, others chronically. Some are youth, some veterans, some are adults with children. Regardless of how people are grouped, each year, and in each community, new people have died.
Honoring the lives of people who died must mean learning from what has happened and preventing the same things from happening again.
Research has shown that people affected by homelessness have higher rates of early mortality compared to the general population. This has been a consistent finding since the early 1990s. Interestingly, during this time, the leading cause of death among people affected by homelessness has shifted from HIV/AIDS to crack to opioids. Current trends show greater numbers of deaths due to fentanyl. However, many deaths are also attributed to violence and victimization, untreated infections, cardiovascular disease and simply exposure to the elements.
Importantly, consistent and increasing numbers of deaths each year suggests that while we memorialize people who died this year, new people are currently living in the same situations as those who have died. To this end, honoring the lives of people who died must mean learning from what has happened and preventing the same things from happening again. For example, research and interventions to reduce risky health behaviors has led to legislation and campaigns warning against texting while driving. We need to make similar strides with housing and homelessness. This could include funding state level mortality review committees and networks to connect these datasets to better inform new policies and interventions.
In my research, I’ve found that not having enough data (which is often the case) is constraining, and results in many tensions that lead to additional judgment calls and ambiguities. These include a person having an ID with an address that’s not for the place that they were staying at, being doubled up, or living in a hotel, RV or camper. There’s much nuance to each situation. Continuing to develop and test guidelines for medical examiners on documenting recent and current housing status and experiences of homelessness will be key.
What is clear is that housing stability matters, and that housing instability is a bigger problem than our current systems are set up to address.
This column was produced by Progressive Perspectives, which is run by The Progressive magazine and distributed by Tribune News Service.