Homeless projects funded through this program participated in a major research effort directed by the University of Massachusetts' Social and Demographic Research Institute. In addition, a number of surveys and special studies have focused on the relationship between homelessness and mental illness (Blackwell et al., 1990) and homelessness and alcohol and substance abuse (Institute of Medicine, 1988).

Reviews of these studies reveal that the homeless suffer from many of the same acute and chronic illnesses that afflict people in the general population but at much higher rates (Brickner et al., 1990). Because the homeless have little or no access to adequate bathing and hygienic facilities, survive on the streets or in unsafe and generally unsanitary shelters, smoke and drink to excess, and suffer from inadequate diets, their physical health is compromised. Among the findings from the Health Care for the Homeless Demonstration Projects were that the most commonly reported acute conditions were upper respiratory infections, trauma, and skin ailments. Nutritional deficiencies were found in 2 percent of those seen. Of patients seen more than once, 37 percent had at least one chronic condition including hypertension, arthritis and other musculoskeletal disorders, dental problems, gastrointestinal and neurological disorders, peripheral vascular disease, genitourinary problems, and chronic obstructive pulmonary disease. The use of estimation techniques based on recorded diagnoses led to estimates that 38 percent of the homeless seen in the demonstration projects abused alcohol, 13 percent abused drugs other than alcohol, and 33 percent were mentally ill. During the demonstration period, the rates of tuberculosis (968 cases/100,000 population) and AIDS (230 cases/100,000) were significantly higher than those of the general population (e.g., 9 cases/100,000 for TB) (Wright and Weber, 1987). While these findings reflect the homeless population that sought care from the demonstration projects, which may inflate the burden of illness, the demographic characteristics of the patients seen in the demonstration projects did not differ significantly from those described in many ethnographic studies of the homeless (Wright and Weber, 1987).

As with the migrant and seasonal farmworker population, it is difficult to calculate vital statistic rates for the homeless. Not only is the denominator in dispute, but neither birth nor death statistics record homelessness. A study conducted in New York City compared infants born to women living in welfare hotels with infants born to women living in low-income housing projects. The babies born to homeless women living in the hotels were more likely to be of low birthweight (18 percent vs. 8.5 percent) and had a higher infant mortality rate (Chavkin et al., 1987). At the other end of the age spectrum, many who work with the homeless report that very few are over the age of 55, which suggests that the homeless die young. In support of this contention, the median age of those seen in the Health Care for the



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