Based on the capacity of homeless shelters, it is estimated that in the nine largest metropolitan areas of Canada there are about 8,000 people sleeping in these shelters every night, representing 5/10,000 of the population. The number of individuals using these shelters at least once a year is five times greater. This estimate does not include individuals who sleep on the street, more numerous than those who sleep in shelters, and who, in Vancouver alone, are estimated to account for 3/10, 000 of the population.
These figures indicate that the total number of homeless people in Canada is in the tens of thousands. The demographic characteristics of the homeless population vary from city to city. Single men are the largest group in most Canadian cities: about 70% in Vancouver, Edmonton and Calgary, and about 50% in Ottawa. They are usually young, most between 25 and 44 years of age.
Homeless people suffer a variety of medical problems
Single women account for about a quarter of the homeless population in Vancouver, Edmonton and Toronto, but only 10% in Calgary and Ottawa. Studies in the United States of America (USA) indicate that, compared to homeless and child-bearing women, single women tend to be older and have a history of mental illness or drug abuse. Homelessness also affects many families with children.
Homeless young people under the age of 20 to 25 often come from families where they have suffered physical or sexual abuse. This segment is underestimated because most of them do not sleep in shelters. In Canada, homelessness particularly affects Aboriginal people.
For example, in Edmonton they account for 35% of the homeless population, but only 3.8% of the total population. Aboriginal people are generally among those who sleep in the street, not in shelters. Homeless people are at greater risk of dying than the rest of the population. Compared to the youth population of Quebec, the mortality rate of homeless youth is 9 times higher for males and 31 times higher for females.
In the U.S. the mortality rate of homeless men doubles that of Canada, a difference due to various factors, such as lower rates of homicide and Human Immunodeficiency Virus (HIV) infection, and possibly the universality of health insurance in Canada. Homeless people suffer a variety of medical problems and their illnesses can be much more serious due to factors such as extreme poverty, delay in seeking medical care, failure to comply with treatment, cognitive impairment and adverse health effects of homelessness itself.
Those living on the street tend to be in worse health than those living in shelters.Among the most common medical problems in the adult homeless population are seizures, chronic obstructive pulmonary disease, arthritis and other musculoskeletal diseases. Diseases such as hypertension, diabetes and anemia are often poorly controlled. Respiratory infections are common and oral hygiene is often poor. Skin and Podiatric problems are also common.
More than half of the cases are primary infections
Those living on the street are particularly prone to cellulite, impetigo, venous stasis, scabies and pediculosis. Inappropriate footwear, prolonged exposure to moisture, long walking and standing periods, and minor repetitive trauma often lead to onychomycosis, tinea pedis, calluses, and dipping foot.There is also an increased risk of tuberculosis, a diagnosis that should be considered in every homeless individual with fever and persistent Productive Cough. More than half of the cases are primary infections. Among the homeless in Toronto, the incidence of active tuberculosis (71/10, 000) is about 10 times the average in the province of Ontario.
Treatment of active tuberculosis may be hampered by non-compliance, prolonged infectivity and drug resistance. Directly Observed Treatment provides higher cure rates and fewer relapses. Homeless people with positive tuberculin and no active tuberculosis are candidates for directly observed prophylaxis.The most common risk factors for HIV infection among homeless Canadian youth are prostitution, multiple sexual partners, lack of condom use and injecting drug use. Infection rates vary widely between cities, and even within cities (between 2.2% and 11.3% in Vancouver in 1988). The pattern of Risk Factors in adults is different, with drug use predominating over sexual behaviors. Sexual and reproductive health is a major problem for homeless youth.
In Montreal, 25% of them have been prostitutes.
Sexually transmitted diseases are very common, even among non-prostitutes; the most prevalent are gonorrhea and sexually transmitted infections. Chlamydia.La violence is a constant threat to the homeless. A survey conducted in Toronto revealed that, in the previous year, 40 per cent of homeless individuals had been assaulted and 21 per cent of women had been raped. Homeless men are nine times more likely to be killed than men in general.
Death from involuntary drug or alcohol overdose
Involuntary injuries are one of the leading causes of morbidity and mortality, especially among males; they are often caused by falls or run over. Death from involuntary drug or alcohol overdose is also common.Another major hazard is exposure to weather elements. In winter there is a high risk of frostbite and hypothermia, while in summer severe sunburn can occur. insolación.Al contrary to popular belief, only a small proportion of homeless individuals are schizophrenic (6-13%). Affective disorders are much more common (20-40%).
Alcohol use disorders are extremely common, with a prevalence of 60 per cent in males, six to seven times higher than in the general population. In the US, the average prevalence of drug use disorders has been estimated at 30%.
Cocaine (especially crack) and marijuana are the illicit drugs most commonly used by homeless people in Canada.Homeless adults have high consumption of health care and often receive such care in emergency services. Their admission to the hospital is up to five times more frequent than in the general population and the stays are longer than those of other low-income patients. They are often transferred to shelters, although this is not the best way to deal with their problems.
Homeless people face many barriers in their access to health care. In the U.S. one of its main problems is the lack of health insurance. Although health insurance coverage in Canada is universal, many homeless people cannot prove to be covered, due to loss or theft of their identification documents. On the other hand, many of these individuals do not take prescribed medications because they cannot afford them. In addition, there are other barriers not related to insurance. The daily struggle for subsistence can make them perceive health problems as secondary and many recommendations on rest and diet changes may be impossible to comply with.