‘No fixed abode’ recipe for an early death finds study
LONDON: A majority of homeless men and women died on their own, in streets, parks and doorways from preventable causes and 30 years earlier than those with a home, a study has found.
Waikato University researchers studied the coronial findings for 171 people of “no fixed abode” at the time of their death from 2009 to 2018.
The mean age of death for those in the study was 45. New Zealand’s average life expectancy is 82.
Lead author Sabrine Charvin-Fabre said the study was limited to a smaller group of homeless people without any address at the time of death as this provided the most complete data set.
The wider definition of homelessness included people living in temporary or overcrowded accommodation who would have an address recorded at the time of death, even if it was a night shelter, Charvin-Fabre said.
But difficulty accessing health care was experienced by all homeless people, she said.
Just over three quarters (118) of those in the study died “from conditions amenable to timely and effective healthcare interventions, mostly from natural causes and suicide”.
“Most … were alone at the time of death and were found deceased by witnesses, sometimes several months after that death occurred,” the study found.
People over 75 where the cause of death was not able to be established or of a criminal nature were excluded.
The study highlighted the need for health care services to be provided in ways that met the social and healthcare needs of homeless people, Charvin-Fabre said.
“I think within society and within the health sector there is obviously some marginalisation and stigmatisation in regard to homelessness, so homeless people feel guilty for their situation.”
Estimates from the 2018 census found about 41,600 Kiwis were homeless according to the accepted definition – as “unable to access a home to rent or own with all basic amenities”.
The figure was likely to be an underestimate as homeless people were unlikely to take part in the country’s first digital census, University of Otago public health researcher Kate Amore said.
Māori were close to four times more likely to be homeless than Europeans, while Pacific people were six times more likely.
The most prevalent natural causes of death were cardiovascular diseases, including heart disease and heart failure..
Other preventable conditions that led to death included pneumonia, alcohol-related disease, diabetes, “transport-related injuries” and hypothermia.
A vast majority had experienced “significant and multiple stressful and traumatic life events”.
Suicide accounted for nearly one third (28.6 per cent) of all deaths, and in those aged 44 and under, it was the cause of two-thirds of deaths (67.3 per cent).
Of those who committed suicide, most were found in public spaces, or private vehicles, temporary accommodation and private garages.
The report noted suicide was prevalent among homeless youth and young adults.
Just under three quarters of those who committed suicide were diagnosed with a mental health condition, mainly from alcohol or drug misuse and depressive disorders.
Less than half of homeless people were treated for a psychiatric disorder and there was evidence of recent contact with a health professional for only about a quarter of cases, the study found.
A majority of homeless people had their last contact with a health professional one year or more prior to death. One in five had no contact at all with a health professional.
“The magnitude of social isolation and disconnection from the health system, combined with chronic psychological distress and unstable life conditions, negatively affects the health-seeking behaviours of homeless people,” the study said.
Homeless people were often unable to enrol with a GP without a permanent address, and would not be able to pay an appointment fee.
Carvin-Fabre, who is a qualified GP in her home country of France, said she noticed how hard it was for homeless people to get health care in her voluntary work with Tauranga not-for-profit Street Kai.
She wanted to see more awareness of homelessness and training for health providers.
It was also an issue that transcended the health sector, Carvin-Fabre said.
“As citizens we can give a hand, give a smile – something simple, it’s free … just to say you are not invisible, I see you.”
