Tag Archives: #life expectancy

Commemoration Events And Causes of Death

The Stone and Glass Art Installation launch was beautifully done.  Artist Rebecca Houston had a vision along with the Myseum Intersections project. How can we tell stories that reflect the culture of Toronto while including historical dimensions?

Rebecca chose to highlight the numerous homeless deaths that have occurred over the past few decades. Names, initials, Jane and John Doe’s were projected onto the Church of the Holy Trinity’s front façade. This is where the Toronto Homeless Memorial happens every second Tuesday of the month at noon, to remember those who have passed away.

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To open the night, a few remarks were made by Rebecca, Britt Welter-Nolan, street nurse Cathy Crowe, and Reverend Sherman. Andrew Wesley began smudging and recited a prayer and then the Smoke Trail Singers began drumming to initiate the projection of the names.

Visitors were then encouraged to stand vigil as the names scrolled across the church wall. Otherwise, people could go inside and experience other interactive pieces. There was an audio installation where you could hear stories about people’s lives and the intersections of homelessness, as well as a reading of the names.

Cups were placed on a table next to the list of people who have died and you could write one of the names on the cup in memoriam to that person, which was placed on the carpet to act as a “headstone.”  Art pieces and a reflections board were displayed where people could write down any thoughts about the night or about homeless deaths in general.

 

What are the causes?

I have written previously on how death is widespread within the homeless community. However, I want to bring to light the causes of death.  Before I get into some of the research, I will say right up front:

People who die when they are homeless, die because they were homeless.

You may be thinking, “what do you mean? They die from stabbings, and alcohol and other things!” Well, those “other things” are actually just symptomatic. Other researchers have also suggested that homelessness itself is the main risk factor for death that needs to be addressed (Hibbs et al., 1994:308, Barrow et al., 1999:533, Condon & McDermid, 2014:3). Let’s explore further.

We know that both individual AND structural factors are involved with why people become homeless in the first place (Fazel et al 2015:1). We also know several times over that people who are homeless die younger than the general population (Hibbs et al., 1994:307; Cheung & Hwang 2004:1243; Barrow et al., 1999:529; O’Connell 2005:13). In British Columbia, “[t]he median age of death for a homeless person…is between 40 and 49. The average life expectancy for the general population in British Columbia is 82.65 years” (Condon & McDermid, 2014:4). In Copenhagen “[h]omeless people staying in hostels, particularly young women, are more likely to die early than the general population” (Nordentoft & Wandall-Holm 2003:81).

When homeless people are at almost half the life expectancy as the general population, then we have a major crisis that needs addressing.

For people who are homeless, many die from violence and trauma from being on the streets (Wright et al., 1999:244). “In the USA…younger people die disproportionately from external causes of death (suicide, accidental overdoses, and homicide) and infectious diseases, and there is also a spike in older homeless people” (Fazel et al. 2015:5). Some researchers suggest that “[d]rug overdose has replaced HIV as the emerging epidemic” (Baggett et al., 2013:2). The St.Michael’s Hospital Centre for Research on Inner City Health recently released this quick read guide that highlights health problems and mortality rates. Mental illness is a major factor in homelessness, but I will be writing about that in more detail in a future post.

Numbers, numbers and more numbers

The 2015 Annual Review of Statistics on Deaths of Shelter Residents was recently released. This report provides rough estimates of deaths since 2007 specifically of shelter residents, which does not include many others who choose not to go to shelters. People have suggested that we need a count of the number of people who are homeless at a particular point in time. Researchers say that, “…without sufficient provincial data it is difficult to determine the necessary steps to minimize homeless deaths across the country” (Condon & McDermid, 2014:18). I understand how policy makers like to use evidence based decisions to tackle social issues. As a graduate student, I also understand the need for research and providing evidence in order to strengthen arguments.

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However, in this case, do we really need a count? We know people are dying. The government needs a number? How high must the number be in order for these deaths to be seen as a significant issue? For me, one death would be enough. Apparently there needs to be many, but we don’t know what that number is since the government is not making this a priority, nor are its citizens. A child gets shot, we fight for gun laws. A child is hit by a car, we fight for road laws. A child dies on the streets and apparently we don’t give a shit.

Prevention

Researchers have not only mentioned that homelessness itself is a risk factor for death but also that homeless deaths are largely preventable (Hibbs et al., 1994:304,Condon & McDermid, 2014:3). Hwang et al. maintain that “[a] large part of the premature mortality in people living in shelters, rooming houses, and hotels was potentially avoidable” (2009:6).

For individual circumstances, we need to “… include behavioural health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness” (Baggett et al., 2013:2).  For young people it is suggested that they receive “…psychiatric treatment, detoxification treatment, medical treatment, social advice, and accommodation. The prevention of social exclusion should start early in life” (Nordentoft & Wandall-Holm 2003:81). For older homeless people “the management of chronic diseases, geriatric conditions, frailty, and end-of-life issues is more prominent” (Fazel et al. 2015:5).

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In order to prevent people from dying way earlier then they should, we need a national housing program and social supports that include counseling, better access to health care, decriminalization, employment help and training programs. These must be used together. If you only have housing first programs or only have employment training, then they will fail.

Tackling stigma is another factor in preventing homeless deaths from happening in the first place. Some common stigmas include racism, sexism, AIDS, autism, homophobia, and ageism, among others. Attitudes and beliefs can make the difference between someone being housed or homeless.

The fight will be a tough one and we need more people that can speak out against the crisis of homeless deaths. People are needlessly dying. We need to notice and we need to care. Ending homelessness in our towns is not some esoteric unattainable concept, others have done it. So why don’t we?

 

Featured Image artwork by Jim Houston

 

References

Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., Singer, D.E., & Rigotti, N. A. (2013). Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA internal medicine, 173(3), 189-195.

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.

Condon, S., & McDermid, J., (2014). Dying on the Streets: Homeless Deaths in British Columbia. Street Corner Media Foundation. https://d3n8a8pro7vhmx.cloudfront.net/megaphone/pages/7/attachments/original/1415231881/Dying_on_the_Streets_Homeless_Deaths_in_British_Columbia.pdf?1415231881, accessed Mar.10, 2016.

Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384(9953), 1529-1540.

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.

Nordentoft, M., & Wandall-Holm, N. (2003). 10 year follow up study of mortality among users of hostels for homeless people in Copenhagen. Bmj, 327(7406), 81.

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.

Wright, R. D., Wright, S. E., & Jones, A. (1999). Dying homeless but not alone: Social support roles of staff members in homeless shelters. Illness, Crisis & Loss, 7(3), 233-251.

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Signatures Needed – Please Sign

Cathy Crowe, street nurse and local homelessness advocate, has started a petition to bring attention to Mayor John Tory to address the homeless deaths in our city.

She is hoping that there will be more funding for shelters and warming centres in the 2016 budget. Let’s all pitch in and do what we can, and hope that council will approve the funding

Sign here!

Death Is Everywhere

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).

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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.

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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.

 

References

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.