Homeless mortality: Are 1 in a 100 San Franciscans dead at 50?

San Francisco and the Bay Area is, in many ways, a microcosm of much of America. As a metaphor for the extremes of environmental wealth and poverty in America today, you can walk 10 short San Francisco blocks from 6th and Market to 1001 Taylor Street. In that short distance, your walk spans the divide between an area where homeless men lie in igloos of wool blankets as urine trickles down a crack in the sidewalk, up to where Grace Cathedral's soaring Ghiberti Doors, known as the gates of paradise, open over Nob Hill. Similarly, each neighborhood in San Francisco has its own arc, its own character, and, often, its own social and ethnic concentration.

My project is a look at homelessness by neighborhood in San Francisco. With roughly 8,000 homeless living in a city of 800,000 residents (one in a hundred), San Francisco has one of the highest concentrations of homelessness in an urban area. Life expectancy and death rates for the homeless in America are worse than many Third World countries, ranging from 40-50 years, with women dying at the same early ages as men. Recent research notes an independent effect on mortality from being unstably housed, even when people are compared to equally impoverished neighbors. Surprisingly, studies also consistently show (across numerous different cities and countries) that a history of substance abuse or psychiatric illness does not increase your risk of death – but that recent hospitalization for any number of diagnoses does increase it. Additionally, most securely-housed people are unaware of the health impacts of homelessness on their own neighborhood and health – ranging from decreased longevity (an effect that has been described as "the bottom quartile dragging down life-expectancy of the top quartile"), to more immediate concerns such as outbreaks of scabies, lice, trench foot, tuberculosis and even H1N1.

Housing people, combined with supportive services, has been shown effective in reducing the health disparities of homelessness, particularly among the long-term homeless. But short of getting housed, are there other steps that can be taken? As a California Health Journalism fellow, my project is a series of articles looking at the face of homeless mortality by neighborhood and population in San Francisco, as well as the impact on the "temporarily houseless" experiencing foreclosure. I will analyze data on death rates by population and neighborhood, and geomap known contributors to adverse health outcomes (fast-food stores, overdose deaths, laundry/shower/shelter facilities' locations, incidence rates of reported violence, etc.). The project will also include information on effective interventions, and their success rates, as well as information about emerging markers for early mortality. I hope to raise awareness about the one in a hundred who may be dying among us.