Disorders and Health Problems: Overview

The relationship of social disparities and health is a long-standing area of concern in public health policy and practice. Early interest in social disparities in health occurred in the late 1960s, when the war on poverty and the civil rights movement heightened public awareness of broad disparities. Poor populations were reported to suffer disproportionately from higher mortality rates, a higher incidence of major diseases, and a lower availability and utilization of medical services. More than three decades later, major disparities persist in “the burden of death and illness experienced by low-income groups as compared with the nation as a whole” (National Center for Health Statistics 1998, 23).

The individual risk of illness cannot be considered in isolation from the disease risk of the population to which a person belongs. It has long been recognized that social and environmental forces and a strong governmental health infrastructure capable of influencing these forces are critical in ensuring a community's health. Lower socioeconomic (SES) groups have lagged in health largely because the gains in social and environmental conditions enjoyed by higher SES groups have not been widely distributed. Areas populated by low-income groups tend to be [Page 116]fraught with air, water, and soil pollutants, poor access to supermarkets and healthy food choices, poor working conditions, crowded and substandard housing, unsafe settings that do not support physical activity, and other similar deficits. Indeed, lower SES groups are at “risk of risks” (Link and Phelan 1995, 80–94). The greatest impacts in improving population health and reducing health disparities will not be made by modifying one or a few risk factors, but will be the consequences of gradual developmental changes in areas populated by lower SES groups.

Homeless persons, as a group, are exposed to the highest levels of virtually all social and environmental risk factors for health, and as a result pose serious public health concern. Even relatively short bouts of homelessness expose individuals to severe deprivations (for example, hunger and a lack of adequate hygiene) and victimization (for example, physical assault, robbery, or rape). Homeless children, growing up in shelters and without a stable home, often have unmet emotional, social, and educational needs. Many health problems, such as the high rates of infection that result from overcrowded living arrangements in shelters, hypothermia from exposure to cold, and poor nutrition due to limited access to food and cooking facilities, are a direct result of the homeless experience.

Further, in the context of the pressing demands for day-to-day survival, the use of health care may become a lower priority, which commonly exacerbates even minor illnesses and makes treatment more difficult. While there are many commonalities among subgroups of the homeless population in terms of their health, mental health, and use of services, there are unique features that characterize homeless adult individuals, adult family members, children, and youth. The following provides an overview of the health issues that face each homeless subgroup.