John Elflein
Research expert covering health and health care
When visiting many major cities in the United States homelessness is a visible and unsettling problem. In 2022, it was estimated that around 582,462 people in the United States were homeless. However, estimating the number of people who are experiencing homelessness in the U.S. is extremely difficult and estimates are often criticized for underrepresenting the extent of the problem. The states with the highest rates of homelessness per 10,000 population are California, Vermont, Oregon, Hawaii, and New York. While the states with the largest total number of people experiencing homelessness are California, New York, Florida, Washington, and Texas. The causes of homelessness are diverse and complex but often involve poverty, unaffordable housing, unemployment, mental health issues, physical disability, serious illness, and substance use disorders. Poor physical and mental health can lead to homelessness, but homelessness also contributes to poor health outcomes and can exacerbate existing issues. Unsanitary living conditions, a lack of access to food, drug use, violence, stress, and exposure to the elements all increase the risk of physical illness and mental health conditions among the homeless. In addition, those experiencing homelessness often have difficulty accessing health care and delay treatment. Homelessness is seen as a major issue to many Americans with one survey from 2022 finding that 87 percent of U.S. adults believed homelessness in the country was a very serious or somewhat serious problem.
The health of the homeless in California
California has the largest total number of people experiencing homelessness of any U.S. state, as well as the highest rate of homelessness per 10,000 population. The extent of the problem is well known in cities such as Los Angeles and San Francisco and scenes of homeless people camping in the streets are not uncommon, with Central City East in Los Angeles, also known as Skid Row, perhaps the most well-known congregation of homeless in the United States. As of 2022, it was estimated that around 13 percent of homeless adults in California left their last housing due to their substance use, while nine percent left because they became sick or disabled. Almost half of homeless adults in California report their health as only fair or poor, with some of the most common chronic health conditions reported among this population including high blood pressure, respiratory conditions such as asthma, chronic bronchitis, emphysema, and COPD, and heart problems or stroke. Mental health problems are very common among those experiencing homelessness in California with around 66 percent reporting currently suffering from some form of mental illness as of 2022. Around half of homeless adults in California suffer from anxiety or depression, while 12 percent experience hallucinations. Most homeless adults in California receive health insurance coverage through Medicaid, however, 17 percent were uninsured as of 2022, highlighting the problem of access to care for this vulnerable population.How many homeless people die in New York City every year?
The state of New York has the second largest total number of people experiencing homelessness and the fifth highest rate per 10,000 population. The majority of homeless people in New York are in New York City (NYC), where the problem of homelessness has reached record highs in recent years. From July 1, 2021 to June 30, 2022, the NYC Department of Social Services/Department of Homeless Services (DHS) and the Office of the Chief Medical Examiner (OCME) identified 684 deaths among people experiencing homelessness in NYC, the highest number recorded over the past decade and a seven percent increase compared to the same period one year prior. Of these deaths, around 50 percent occurred in a hospital, while 23 percent were in a shelter, and 11 percent outdoors. The leading causes of death among the homeless population in NYC at that time were drug overdose, heart disease, and accidents (excluding drug overdose). However, drugs were by far the leading cause of death, responsible for almost half of all deaths. Homeless shelters in New York City provide shelter to tens of thousands of people every night, but thousands of homeless people still sleep unsheltered in the streets and other public spaces. Those who are unsheltered are more likely to suffer from mental illness and other severe health problems. Solving the problem of homelessness in the United States is a colossal task that requires above all else, making housing more affordable, expanding accessibility to mental health and substance abuse treatment, and maintaining empathy and understanding for those at risk of becoming homeless and those already experiencing it.
