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The health effects of homelessness include higher rates of infectious diseases, mental health problems, physical disorders, disability, and premature death. A United Kingdom report noted that those sleeping on the street on average lived only to their mid-to-late forties. Higher rates of infectious disease result from overcrowding, damp and cold living conditions, poor nutrition, lack of immunization, and inadequate access to health care services. There has been a particular concern with increased rates of tuberculosis (TB), particularly multiple drug-resistant TB. It has been reported, for example, that 48 percent of the homeless in Toronto test positive for TB. Another factor leading to increases in TB and other infectious diseases is the higher prevalence of AIDS (acquired immunodeficiency syndrome) in those segments of the homeless population involved in drug abuse and prostitution.
The conditions in which homeless people live also make them more prone to trauma. A study of street people in Toronto found that 40 percent had been the victims of assault in the previous year, while 43 percent of the women reported sexual harassment and 21 percent reported they had been raped in the previous year. These street people were also more than five times more likely to have been involved (as pedestrians) in a motor vehicle accident than the general population, and one in twelve of them had suffered frostbite in the previous year.
Homeless people are also more likely to suffer from cardiovascular, respiratory, arthritic, gastrointestinal, and skin disorders. The Toronto study found that arthritis and rheumatism were twice as frequent, emphysema and bronchitis five times as frequent, asthma two and one-half times as frequent, gastrointestinal problems twice as frequent, and epilepsy six times as frequent as in the general population.
Mental health problems contribute to and result from homelessness. The United Kingdom report noted that 9 to 26 percent of those living on the street have serious mental health problems (compared to 0.5 to 2% in the general population), while Canadian estimates are that 20 to 40 percent of those using shelters have substance abuse or psychiatric problems. Alcohol abuse and dependency is also very common in this population. But while such substance abuse and mental health problems contribute to homelessness, homelessness also contributes to these problems. The Toronto study, for example, found that one-third of the street people interviewed had feelings of worthlessness, that more than one in four (and almost two-thirds of the women) had contemplated suicide in the past year, and that one in twelve (and almost one in three of the women) had attempted suicide in that same period.
The increase in homelessness among families in recent years has focused increasing attention on the serious health problems faced by children living in hostels and temporary accommodation. These problems include disturbed sleep, mood swings, depression, and developmental delays, as well as increased rates of obesity, anemia, infections, injuries, and other health problems.