Homelessness is reaching epidemic proportions in the United States (American Medical Student Organization [AMSO], 2008, p.1). Problems inherent to homelessness are lack of shelter, food, clothing, and lack of health care. Living conditions of the homeless in and of themselves predispose the homeless population to a plethora of health problems. The problems associated with homelessness and healthcare have far reaching effects for a special subset of the homeless population – the population of homeless youth. Each year, more than 1.35 million children and youth experience life without a home, and one out of seven of all individuals treated by homeless health care projects is a child under age 15 (National Healthcare for the Homeless Council [NHCHC], 2003, p.1).
Homeless children face the same illnesses faced by children in the general population, but their health issues are exacerbated by the circumstances inherent in their homeless status. Homelessness in and of itself is an independent predictor of poor health status among children (Kern Medical Center, 2003, p.3). Some of the health care issues especially prevalent in the homeless youth population are: psychosocial issues, nutrition and issues related to physical development, communicable diseases, dermatological disorders, respiratory disorders, dental health issues, sexual health issues, substance abuse issues, and issues related to medication use and adherence.
Multiple studies have identified the adverse effects of homelessness on children’s psychosocial health including aspects of development, academic success, behavior, and mental health. In comparison to other poor children who have never been homeless, there is increased risk for depression, anxiety, behavioral problems, and academic problems in homeless children (Kern Medical Center, 2003, p. 4). In addition, poor nutrition, environmental toxins, drug exposure, and chronic stress related to homelessness can harm a child’s developing brain (Bostick, 2005, p.3 ). Women who are homeless during pregnancy usually do not have access to adequate prenatal care, often are undernourished, and are substance abusers – all of which leads to low birth weight and neurobehavioral problems, predisposing children to lower academic achievement and behavioral issues at higher rates than children who are not homeless (Little, Shah, Vermeulen, Garman, Dzandoletas, & Ray, 2005, p. 4). Thus, homeless children are set up to experience psychosocial problems from the start of their lives. Historically speaking, studies show that under-stimulation by mothers preoccupied with survival concerns or their own emotional problems frequently results in developmental delays for children under five (HCH Clinicians’ Network, 2000, p.1). Homeless children attend school erratically or not at all due to frequent family moves and obstacles presented to enrolling in school such as legal guardianship requirements and curfew laws (Health Resources and Services Administration [HRSA], 2007, p.1). Chronic ear infections and asthma in homeless children often receive inadequate treatment - ear infections can lead to hearing loss that may delay speech and language development, and eventually affect school performance and the ability to learn; sleep loss and exhaustion, common side effects of asthma, also reduce a child’s capacity to learn (Sherman, 1998, p.1). Past studies document the fact that loss of stability and safety; fractured families; hunger; overcrowded living conditions; exposure to disease, witnessing domestic violence, substance abuse and mental illness are all conditions that elicit and exacerbate emotional problems in homeless children (HCH Clinicians’Network, 2000, p.1). The emotional problems of children may receive low priority as homeless parents expend most of their energy on meeting basic survival needs. Past studies show that unruly behavior and emotional withdrawal is often the earliest response of young children to the crisis of homelessness (HCH Clinicians’Network, 2000, p.1). All of these facts contribute to the development of a large population of children who will grow up developmentally and cognitively impaired, undereducated, mentally ill, with an impaired ability to function in society.
Nutrition and physical development is another area of concern regarding the health of homeless children. Limited or non-existent financial resources can lead to homeless children not being fed at all. When limited finances are available, inexpensive fast-food restaurants and convenience stores are the most common source for food, and, as a result, many homeless children suffer from nutritional deficits including malnutrition, obesity, and anemia (Bostick, 2005, p.2). Malnutrition can affect virtually every organ system, impairing physical and cognitive growth, and the immune response (Kern Medical Center, 2003, p. 3).
Communicable diseases are another concern for homeless youth. As a result of staying in crowded shelters, homeless children are at a higher risk for contracting infectious diseases including upper respiratory tract infections and gastrointestinal infections; close living also makes shelter children more vulnerable to infection resulting from disease outbreaks in the community (Bostick, 2005, p.2). Homeless children also commonly experience immunization delays or are not immunized at all, resulting in an increased vulnerability to communicable diseases such as tuberculosis, chicken pox, meningitis, and influenza (Kern Medical Center, 2003, p. 3).
Dermatological disorders are yet another health issue facing homeless children. The delicate skin of young children without shelter and regular hygiene is highly susceptible to frostbite, infection, and parasites (NHCHC, 2003, p.2). Dermatological disorders commonly faced by homeless children as a result of staying in crowded shelters include scabies, chicken pox, and body and head lice (Kern Medical Center, 2003, p. 4).
Next on the list of health issues facing homeless children are respiratory disorders. The most common serious respiratory problem is asthma. Common triggers for asthma including dust mites, cockroaches, rodents, and indoor molds, are common in homeless shelters. Other common respiratory problems resulting from exposure and contraction as a result of homeless shelter stay are upper respiratory infections and bronchitis (Kern Medical Center, 2003, p.4).
Further health issues commonly experienced by homeless children relate to dental health. Oral health is often neglected by homeless youth. Many factors contribute to poor oral health among homeless youth including: poor nutrition, difficulties in maintaining regular dental hygiene habits related to a lack of access to facilities, and lack of access to routine dental care. Poor oral health contributes to poor overall health of the individual child, and can impair speech, self-esteem, and appearance – all of which affect social interactions and attempts to find employment later in life (HRSA, 2007, p.1).
Sexual health issues, including issues related to sexually transmitted diseases and pregnancy, are also prevalent among the homeless youth population. Many homeless children, especially teenagers, are either victims of rape resulting from dysfunctional familial situations or violent contact with strangers in the shelter setting; many teens barter sex in exchange for a place to sleep, or for a meal or clothing (HRSA,2007, P.2). Regardless of the circumstances, the resulting sexual contact predisposes homeless youth to a risk for sexually transmitted diseases and unwanted pregnancy. Pregnancy in the homeless population, as mentioned previously, is frequently accompanied by poor maternal nutrition and maternal substance abuse, resulting in low birth weight infants who often have neurobehavioral issues, which perpetuates the cycle of homeless youth .
Another issue facing homeless children in general, but teens in particular, is substance abuse. The mental and emotional problems routinely faced by the homeless youth population and the stress of being homeless and struggling for survival predispose homeless youth to substance abuse. As a result, he highest rates of substance abuse among youth in general are seen in street youth, followed by shelter youth and runaways, and finally by housed youth (HRSA, 2007, p.2). An important part of examining the health care issues facing homeless youth includes examining what happens when homeless youth do become ill and seek treatment – examining this issue creates yet another issue regarding the health of the homeless youth population. Without a home, there is no place to recuperate from an illness or to treat an injury. Without finances, there is often no capability for acquiring medication necessary to treat an illness, and if medication is acquired, there is often lack of required food or drink to administer it properly. When frequent relocation is a fact of life, there is no continuity of follow- up care. All of these issues contribute to the fact that, when homeless children do experience illness, problems tend to get far worse before they get better (NHCHC, 2003, p.2).