The most common cause of death among Hawaii's homeless population is methamphetamine-related problems. The second most common cause of death is due to complications and heart disease, including cardiovascular disease, stroke, and heart attacks. Poor health is an unfortunate reality for those without stable housing, and mental illness and substance abuse can often lead to homelessness. Unfortunately, homeless people have woefully inadequate access to healthcare.
Their only source of treatment is often a hospital emergency room, which does not provide continuity or access to preventive services. The H4 seeks to expand access and improve the quality of care for chronic homeless people, while reducing the cost of their care by eliminating the unnecessary use of expensive hospital services. Much of this work is carried out in the nonprofit sector, where there is a higher level of experience in providing services adapted to the city's homeless. Health officials say that, in general, homeless people are difficult to treat because they are part of a transient population.
Hawaiians represent a disproportionate amount of the state's homeless population, nearly 30 percent, and they also tend to die at a younger age than other residents of the Aloha State. After obtaining approval from the Human Subjects Committee of the University of Hawaii (IRB) and conducting a pilot test of the study, a survey was carried out in areas where services were provided or where homeless people were known to congregate. A convenience sample of 205 adults were interviewed at homeless shelters, food distribution events, and other common homeless gathering places on O'ahu using a survey tool developed by the research team. Of the homeless people interviewed, 77% reported having health insurance, 39% reported having dental insurance, and 66% reported having a regular clinic or provider.
Last year, the Queen Emma Clinic treated about 150 homeless patients, even though it has about 600 homeless patients included in its electronic database. The Care-A-Van is basically a doctor's office on wheels that crisscrosses much of Oahu looking for homeless people who may need medical attention. It also has a permanent office in Kaimuki for walk-in patients who are homeless or at risk of homelessness. Homeless people suffer from diseases such as the flu, cancer, HIV and diabetes at much higher rates than those living in homes.
A study published in the Hawaii Medical Journal found that homeless Hawaiians have an even higher prevalence of hypertension and asthma than their peers. This is due to their lack of access to healthcare and other resources that those with stable housing have access to. The H4 seeks to expand access and improve the quality of care for chronic homeless people by eliminating the unnecessary use of expensive hospital services. The Care-A-Van provides medical attention for those who need it most while also providing continuity and access to preventive services.
With more resources dedicated to providing healthcare for Hawaii's homeless population, we can help reduce the prevalence of health issues among this vulnerable population.