Street Medicine Series: Homelessness as a Medical Condition

Diagnostocracy Street Medicine Homelessness

I went into medicine with the full intent of serving the less fortunate. However, I didn’t discover street/homeless medicine until after college, and I quickly fell in love with it. During the last four years, I discovered that most people — especially my peers — don’t know that street medicine is a field. So here I am, armed with a laptop and the effervescent desire to share my passion and educate (or rather, I now have an outlet to rant forever and ever without seeing the glazed look in your eyes).

I’m starting a Street Medicine series on Diagnostocracy in which each article will cover a different aspect of medical care for the homeless, since there is so much to talk about. Through the series, I want to not only open your eyes to a special field of medicine but to also to reverse the stigma that weighs so heavily and unjustly on homeless individuals. Diagnostocracy is about promoting change, whether it be medical, social, intellectual, or spiritual. Ideally, I’ll tap at least the surface on all of those with this series.


Homelessness in Paradise

All right, let’s jump to it.

When we think of Hawaii, we think of paradisiacal beaches against a soft sunset glow, some guy setting your alcoholic drinks on fire at a tiki hut bar, or an intimate honeymoon getaway. (I’ve never been to Hawaii, but this is what the ads tell me.) What’s cast in shadow behind all of this is the fact that Hawaii has the highest rate of homelessness in the country.

One of Hawaii’s representatives, Senator Josh Green, is also a physician, and he recognizes that homelessness isn’t just a social problem; it’s a medical one, too. In January 2017, he co-introduced legislation titled “Declaring Homelessness to be a Medical Condition in the State for Purposes of Medicaid Eligibility and Recognizing that Housing Instability is a Major Health Factor that Negatively Affects Homeless Individuals’ Health and Well-Being.” I’m going to call it by its other name, SCR4, for short.

SCR4 has a couple of lines that encapsulate the aforementioned concept that homelessness is the intersection between an extremely simplified medical vs. social Venn diagram:

“…according to the National Alliance to End Homelessness, ‘[h]omelessness both causes and results from serious health care issues, including addiction, psychological disorders, HIV/AIDS, and a host of order [sic] ailments that require long-term, consistent care’”

“… because housing instability detracts from regular medical attention, homeless individuals’ conditions often get worse, which allows these medical conditions to become more dangerous and costly”

Supporters of the SCR4 measure see homelessness as an illness and housing as a treatment, and it’s easy to see why. Homeless individuals are more susceptible to substance abuse and medical co-morbidities, such as HIV and cardiovascular disease. A study found that the mortality rate in homeless individuals is three to six times higher than that of their housed counterparts.

As future healthcare professionals, there are some things we should think about.

  • Since homelessness is tied to a decrement in health, should we be able to use public insurance, like Medicaid, to fund housing?
  • What are the shortcomings of starting social intervention before medical treatment and vice-versa?
  • How do we approach this issue if housing is just correlated with, not a cause of, a decline in health?
  • With whom can we collaborate outside of medicine to derive a solution?
  • What kinds of biases or other limitations do we have that may be holding us back from tackling this problem effectively and efficiently?

I talked to a homeless patient who tried to stay overweight to appear bigger and therefore intimidating to others on the streets as a defensive measure. What can we do about this battle between health and safety?

How You Can Help

I’d like to ask you to distribute water bottles, food, hand sanitizer, bug spray, hats, and/or sunscreen as you see homeless individuals during your drives or walks. The weather is warming up, so let’s think of ways we can help alleviate the discomfort of our fellow human beings.


I like to keep my articles short and to the point, but sometimes, it’s difficult with a topic that I love talking about. With that being said, please contact me via email, through the Diagnostocracy contact page, or catch me at school if you’d like to know more about homelessness as a medical condition. I have much more to add, some of which I hope to eventually incorporate in this new Street Medicine series, so please stay tuned!

Image: Al Jazeera

How Housing Can Be Tailored to the Autistic Community

Autism_Awareness.jpg

Medical professionals, especially osteopathic physicians, are trained to look at patients holistically. But are clinicians truly assessing an individual’s needs and their goals?

We should challenge the textbook notion that autistic patients require supervision. An apartment complex in Pittsburgh, PA is set to open doors to those diagnosed with autism spectrum disorder (ASD). The project emerged from a shared vision of facilitating independent life for people with autism through affordability and special architectural design. Sweetwater Spectrum, a development of shared homes in California, had a similar idea and was built with acute attention to accommodation, which includes on-site support staff:

It has a community center, farm, greenhouse and pool. The homes have noise-dampening ceilings and quiet heating and air conditioning systems for residents who are hypersensitive to loud sounds.

These apartments parallel the backdrop of a rise in autism rates. According to the CDC, we are at a historic high for the number of people diagnosed with ASD.

Here’s the part that gets – unfortunately – tangled up in a mess called politics. Medicaid is currently the main payer for ASD management, but the Trump administration plans on transitioning Medicaid to a block-based grant system, and then to halt Medicaid expansion altogether. This means that despite the prevalence of autism, we may see a decline in funding for its treatment/management.

Should Medicaid’s possible fadeout worry you, the future health practitioner, and your ASD patients or others who rely on Medicaid? To this, I would say, “Hey, I know of this FANTASTIC blogcast called Diagnostocracy, which will cover the turbulence and impact of the public insurance system in the future, so stay tuned…because it’s a great site.”

Our focus should shift focus to being better at “medicine outside of medicine.” As a society, we have tunnel vision for the next breakthrough in technology or easy pharmaceutical quick-fix, but we should lend ourselves to simple yet effective out-of-the-box thinking (like building a heart pump with supplies from Home Depot). Prescribing personalized housing to facilitate an autistic patient’s well-being goes beyond the clinic room.

With that being said, let us continue to reassess our definition of patients’ needs and goals and what practicing medicine really means.

Image: AOA

(Just wanted to give a quick thanks to Keifer W., Leigh G., and Roy L. for editing this post!)