Zip Code Matters More Than Genetic Code: The Devastating Health Effects of Homelessness

In the field of public health there is a central motto: "The postal code is more important than the 'genetic code'". Numerous scientific studies reveal that our socioeconomic characteristics, which decisively determine where we live, decisively influence our health and longevity, much more than our genetics. In Madrid, for example, a recent mortality analysis found that there was a difference of up to seven years in life expectancy between the inhabitants of the richest neighborhoods and those of the poorest.

What happens, though, when someone doesn't even have a zip code because they don't have a home to live in? In Spain, a country where there are around 3.4 million empty houses, it is estimated that there are between 25,000 and 33,000 homeless people. Their lives show dramatic realities that rarely have visibility in the media and in society. In this group, the most unfavorable socioeconomic conditions weigh heavily on health. People without a roof over their heads have a mortality rate between three and four times higher than that of the general population and a life expectancy of between 42 and 52 years, 30 years younger than the rest of the people. Premature deaths occur throughout the year, not just from the cold in winter, and these deaths are primarily associated with chronic medical conditions rather than mental illness or substance abuse.

In addition, the chances that individuals in this group will die prematurely increase the more they are continuously exposed in public spaces or if they are young or have AIDS. Young homeless women are especially vulnerable, as their premature mortality is more than four times higher than the rest of the population. On the other hand, 30% of homeless people suffer from serious illnesses and 25% have attempted suicide.

Homeless people are extremely vulnerable for a multitude of reasons. To begin with, individuals in this group live an average of between seven and eight chained traumatic events (The general population suffers an average of three or four events throughout their lives). These events can be the loss of a job, an eviction, a war, a sentimental separation, the death of a loved one... All of this, together with a lack of family and social support, can lead to homelessness.

The delicate health situation of homeless people is also shown when they try to access medical treatment (something that does not always happen) and are discharged from hospital. The recovery process is affected by not having the necessary resources and living on the streets. According to the Spanish organization that fights against homelessness "Home Yes"among the health problems they face are "amputations, uncompensated diabetes, cancer, transplants, surgeries" or the need for oxygen.

To alleviate this serious health and social problem, initiatives such as those of Hogar Sí seek to support people who live on the street so that they can face the recovery from their illness or ensure adequate treatment of a chronic disease, access the health system, reintegrate later in society and have a permanent home. The help process It is multidisciplinary and it combines social, economic (manage aid such as minimum vital income) and health (guarantee access to medical services) interventions. People in terminal phase and in palliative care who do not have a roof over their heads also receive support from these programs.

The team involved in providing comprehensive care is interdisciplinary and is made up of professionals from social work, nursing, psychology, occupational therapy and social and socio-health assistants. Homeless people can access the service from Social Services Centers, hospital social work units, the public care network for homeless people and certain authorized non-profit entities.

Another similar initiative that has stood out for increasing the quality of life of the homeless it was the one from finland. This country has managed to reduce by 35% the number of individuals living on the street thanks to the delivery of permanent housing, without conditions. Unlike temporary shelters and refuges, homes provide better conditions for these people as a starting point to rebuild their lives: their physical and psychological health improves, and their reintegration into society is favored. Considering the high costs of health care for homeless people, this type of project can be considered an investment in public health.

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