Fri May 5

Homelessness today sees workers and families with nowhere stable to live. No wonder their health is suffering

Written by Rachel D Zordan, Research Fellow, St Vincent's Hospital Melbourne and Honorary Research Fellow, Department of Medicine, The University of Melbourne

During the current housing affordability crisis, we’re seeing people who work ^[1] and families with children ^[2] becoming homeless or living in unstable housing.

They may be living in a motel room, vehicle, tent or caravan park. They may be on a friend’s couch or on the street.

They may be exposed to health hazards, including excessive heat or cold, poor ventilation or mould, injury, overcrowding, vermin, violence, or a combination of these – all while trying to hold down a job or getting their kids to school.

The lack of affordable housing ^[3] and its impact on homelessness ^[4] is a talking point ahead of next week’s federal budget.

Here are some of the unique physical and mental health challenges of being homeless today.

Housing is too expensive

Unaffordable housing is a leading cause ^[6] of homelessness in Australia. And having a job no longer guarantees secure housing.

A recent report ^[7] from Anglicare Australia described just how hard it is to afford a private rental in 2023, even if working full time on the minimum wage.

Women tend to earn less than men ^[8] and are among the fastest growing ^[9] groups of people who experience homelessness in Australia.

Families with children are homeless and living in insecure housing, too. Figures from the last census show around 19,400 children ^[10] aged up to 14 years were homeless that night, either with their families or alone.

Impacts on health

For decades, we’ve known people’s health suffers if they experience homelessness. This has included our own research ^[12] into homelessness among people who attend emergency departments, which shows the long-term consequences of unstable housing.

We found that even being marginally housed (at risk of homelessness) was enough to increase mortality rates. These people died, on average, six years earlier than people who were housed.

Steep housing costs, poor dwelling conditions, overcrowding, and evictions leave people vulnerable to illness, injury, and victimisation.

For example, people who live in housing ^[13] that’s too hot or too cold ^[14] are more likely to have breathing problems, including asthma ^[15], or heart problems.

We know overcrowding directly contributes to poor physical health ^[16], such as infectious diseases and injuries.

Unstable housing contributes to unhealthy behaviours, such as ^[17] substance use and poor diet ^[18], which can compound over time. Unstable housing may also disrupt access to health care ^[19], including to prescription medications, causing people to delay seeking care ^[20].

Being homeless increases the likelihood of being the victim of violent crime ^[21], which threatens physical and psychological health in the short and long term.

Understandably, the psychological wellbeing of adults experiencing homelessness is worse ^[23] than the general population.

Lack of routine and loss of a sense of home and community can lead to social isolation and onset or recurrence of mental illness. Indeed, post-traumatic stress disorder ^[24], substance use disorders ^[25], and suicidality ^[26] (thinking about or attempting suicide) are more common in people who experience homelessness.

Impacts on children

Children and young people may be particularly vulnerable to the health consequences of poor housing. For instance, cold, damp conditions ^[28] lead to higher rates ^[29] of breathing problems.

When crammed into undersized spaces or places not meant for people to live, a lack of space for cooking, playing, or schoolwork can have their effects, particularly on children ^[30].

For instance, children who live in overcrowded homes are more likely to have ^[31] poorer mental health and do less-well at school.

Children’s long-term health may also be affected if preventative health care ^[32], such as immunisations or dental visits, are missed.

Working while homeless has extra challenges

Working while homeless is uniquely challenging.

People who work and are homeless may hide their homelessness ^[33] out of shame, fear of judgement, and worry about losing their job.

The stress of being homeless can affect work performance ^[34] and the ability to hold down a job. Taking time off from work to seek stable accommodation may further jeopardise employment ^[35].

Workers who are rough sleeping report particular struggles ^[36]. Getting adequate sleep is difficult and even risky. Maintaining good hygiene and clean clothing is tough. Transport to and from work may become difficult to afford.

It’s a human rights issue

Health and housing are basic human rights. And stable housing is a critical determinant of health.

But as recent evidence shows, even renting is unaffordable ^[38] for some, despite working full time.

It’s time we acknowledged the impact of structural issues on homelessness, including housing affordability and the job market, rather than blaming individual risk factors ^[39], such as substance use or mental health difficulties.

We also need to tailor support services for homeless people so they are suitable and affordable, as well as being close to ^[40] family, friends and children’s schools.