Why Is the Homeless Mortality Rate Rising?
While many communities across the nation note a decrease in the number of individuals experiencing homelessness, their number of deaths reached record heights in recent years. Last year, for example, advocates for individuals without stable housing in King County, Washington, began monitoring the number of deaths in the homeless population. By September 2017, the death toll surpassed the total count of the previous year, and by November, the number broke the previous highest recorded rate, occurring in 2006. By the end of the year, the total number of deaths was more than double the rate from six years ago.
King County is far from the only jurisdiction recording higher death rates among people experiencing homelessness. A vigil at the end of December in Washington, DC, highlighted the fact that death rates among this community have steadily increased over the course of the past decade. Another similar vigil in Denver recognized that 2017 saw the highest number of deaths in the city’s history. Similar reports have come out of several west coast cities, including Portland and Los Angeles, as well as communities in Canada.
The Issues that Arise When Measuring Homeless Mortality
There are a number of difficulties in counting the number of deaths in the homeless population. For example, the King County medical examiner had to revise its number of deaths after discovering several uncounted deaths of people presumed homeless. Individuals are presumed homeless based on a lack of permanent housing and testimony from next of kin when available. The medical examiner also noted the final number only includes people who did not die of natural causes so the actual number of deaths is likely higher.
A similar issue occurred in Oakland, California, after the body of a man who lived in a truck was discovered long after he died. The body was cremated when no next of kin could be identified, yet his death certificate lists an address: the location of his parked truck where he was found. Oakland and the other incorporated cities of Alameda County do not collect official data on its residents without permanent homes who die each year, including the cause of death. No state actually requires this information to be collected, nor does any federal body track it.
Defining Homelessness in the Context of Mortality Data
Sometimes, official data on residents without permanent homes is available. For example, the California Electronic Death Registration System does include people who have “homeless” or “encampment” listed as place of residence. At the same time, no guidelines exist for when medical examiners or doctors should use this designation, so the information is largely unreliable and likely reflects only a fraction of the true number. Some community agencies do keep track of the people experiencing homelessness who die in their service areas, but the definition of “homeless” may differ: Does someone living in transitional housing count as homeless? Does the man found dead in Oakland count as homeless if he is assigned an address based on the location of his truck?
San Francisco city officials make an effort to count the number of people experiencing homelessness who die each year. At the same time, the record does not always accurately reflect the individual’s status. Those who die in hospitals, for example, are generally not counted among homeless deaths. A report was made about a woman who spent years living on the streets, then died a month after moving into a hotel. For that reason, according to the San Francisco Department of Public Health, she was not counted as a homeless death.
The Usefulness of More Robust Homeless Mortality Research
Despite so much work in recent years to get accurate counts of people experiencing homelessness, there continues to be a lack of systematic data about people who die on the street. Local governments perform methodical counts of individuals experiencing homelessness in the community because these counts are federally mandated and required to receive federal funding. Understanding the mortality rate is important as a basic measure of public health.
Research shows that homelessness may be associated with a 20-year decrease in overall life expectancy. Better mortality data could heighten the urgency for ending homelessness and for creating policy interventions to reduce those rates. Death reframes homelessness as a public health problem rather than a social inconvenience. Learning more about how and why people experiencing homelessness die could help direct the development of more effective programs.
