Death was always there, as if it were another parent raising me as a child. By the age of 12, I had experienced three deaths in my family, including my father. Death was quite salient for me throughout the rest of my life as well, heading into adulthood there were more deaths of friends and loved ones.
Death is not the only way to be introduced to the idea of mortality, as other experiences can cause people to reflect on their mortality, such as illness, injury or disability. Over 30 years of psychological research has been conducted on how becoming aware of our inevitable deaths can affect our behaviours. Those of us who have had to deal with mortality reflecting hardships understand that time is limited and precious. People in different vocations have to live with the salience of death in their lives, such as doctors. However, when it comes to the homeless population, the story becomes even more complex.
Many homeless people that die are without the resources of loved ones, proper health care and a home (Song et al 2007a:435). Death is hard for us all, but just try to imagine what it would be like to lose people without having support systems in place. No one to call when you are grieving, no shoulder to cry on and add to that mental exhaustion and the inability to cope. For homeless people, “[n]umerous experiences with death and dying causes homeless people to believe that death is ubiquitous, and should be expected at any moment” (Song et al. 2007b:431). Homeless youth in particular “…are experiencing serious distress as indicated by the high prevalence of suicide attempts, thoughts of death and suicide, and psychiatric disorders” (Yoder et al., 2008:97).
Life Expectancy: The Evidence is Clear
According to the report on homeless deaths in Los Angeles county, the average death for homeless people was 48.1 years old, while the average American life expectancy was 77.2 (Stoops, 2007:4). Homeless people die younger than the general population (Hibbs et al., 1994:307; Cheung & Hwang 2004:1243; Barrow et al., 1999:529; O’Connell 2005:13).
James O’Connell reviewed the literature for premature mortality in homeless populations and suggests that mortality rates may be higher than we predict since most studies focus on those homeless people who have utilized shelters and does not include the so called “rough sleepers” who are vulnerable to extreme weather and violence” (2005:12). These studies also do not include those who have moved away and who may have died without the researcher’s knowledge.
Why is death so common on the streets?
If we examine why homeless people face death regularly, then we notice that there are some common themes that arise. We know from research that “[h]omeless persons face many barriers to health care, have few resources, and experience high death rates. They live lives of disenfranchisement and neglect” (Song et al. 2007b:427). We tend to take for granted the little things in life that allow us certain privileges. When you are homeless, it’s not that simple just to walk into your doctor’s office and get treated, especially without any identification or a permanent address. Jonathan R. Hibbs and colleagues explain that “[h]omeless people are likely to die from a variety of preventable causes” (Hibbs et al., 1994:304). Preventable? And yet, they still lose years off of their lives. As a society, we tend to ignore the health aspect to homelessness and dismiss any problems that they encounter by victim blaming. Our individualist culture suggests that when homeless people become sick and die, it’s their fault.
Researchers suggest otherwise. “Homelessness itself, rather than identifiable medical conditions, appears to be the risk factor that most needs to be eliminated in order to reduce preventable mortality” (Hibbs et al., 1994:308). Barrow et al maintain that interventions must be broadly based outside of specific health risks by focusing on “the general phenomenon of homelessness itself and the societal problems of poverty and discrimination that have given rise to it” (1999:533). Much work needs to be done. But in the meantime, maybe by recognizing that homelessness and death are heavily related we can be a little more compassionate when it comes to understand the lives of the homeless.
Barrow, S. M., Herman, D. B., Cordova, P., & Struening, E. L. (1999). Mortality among homeless shelter residents in New York City. American Journal of Public Health, 89(4), 529-534.
Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: a cohort study and review of the literature. Canadian Medical Association Journal, 170(8), 1243-1247.
Hibbs, J. R., Benner, L., Klugman, L., Spencer, R., Macchia, I., Mellinger, A. K., & Fife, D. (1994). Mortality in a cohort of homeless adults in Philadelphia. New England Journal of Medicine, 331(5), 304-309.
O’Connell, J. J. (2005). Premature mortality in homeless populations: A review of the literature. Nashville, TN: National Health Care for the Homeless Council, 1-16.
Pyszczynski, T., Solomon, S., & Greenberg, J. (2015). Thirty Years of Terror Management Theory: From Genesis to Revelation. Advances in Experimental Social Psychology.
Shapcott, M. (2005). Dying for a place to call home: Women and homelessness in Toronto and Canada. National Housing and Homelessness Network: Toronto Disaster Relief Committee, 1-10.
Song, J., Bartels, D. M., Ratner, E. R., Alderton, L., Hudson, B., & Ahluwalia, J. S. (2007a). Dying on the streets: Homeless persons’ concerns and desires about end of life care. Journal of general internal medicine, 22(4), 435-441.
Song, J., Ratner, E. R., Bartels, D. M., Alderton, L., Hudson, B., & Ahluwalia, J. S. (2007b). Experiences with and attitudes toward death and dying among homeless persons. Journal of general internal medicine, 22(4), 427-434.
Stoops, M. (2007). Dying without dignity: homeless deaths in Los Angeles County, 2000-2007. Los Angeles Coalition to End Hunger & Homelessness.