Your environment is one of the key factors shaping your health, and being homeless is one of the harshest and most challenging environments.

Unfortunately, homelessness and housing insecurity in the UK is on the rise: the official ‘street count’ for England has risen 164% since 2010[1].

Shelter recently estimated that 320,000 people in the UK are currently homeless[2]. This includes people sleeping rough, those residing in homeless hostels, and those in temporary and bed and breakfast accommodation. Additionally, the Big Issue has suggested that at least a further 300,000 are ‘hidden’ from statistics[3].

There is widespread evidence from across the world of the negative impact of homelessness on health. A recent Lancet paper suggests that inclusion health groups in developed world countries (including people experiencing homelessness) have excess mortality ratios of 7·9 in males and 11·9 in females in these groups, for all causes of death[4].

Across England and Wales specifically, the Office of National Statistics recently reported 726 deaths of people who were homeless in 2018, an increase in deaths of 22% on the previous year. Shockingly, the average age at death was 45 years for males and 43 years for females[5].

One of the key reasons for these poor health outcomes is ‘tri-morbidity’. This means that people are more likely to experience having a physical health, mental health and addiction problem at the same time.

They are also more likely to have certain health conditions. For example, when comparing people who are homeless with the rest of the population, they are approximately:

  • 50 times more likely to have Hepatitis C [6]
  • 34 times more likely to have Tuberculosis [6]
  • 12 times more likely to have epilepsy [7]
  • 6 times more likely to have heart disease [7]
  • 9 times more likely to commit suicide [8]

Despite these health inequalities, there is variable health provision across the country to support people who are homeless, and people often experience practical and discrimination barriers when trying to access mainstream primary care services [9]. Other inclusion health groups e.g. refugees and asylum seekers, Gypsies and Travellers, people leaving prison, and sex workers often face the same challenges.

Nurses in the QNI’s network help to break down these barriers for all inclusion health groups, and deliver specialist outreach care to people facing some of the highest risks of poor health. However, despite these challenges there is no formal standard for the education nurses need to have about homelessness and health inequalities.

The QNI’s Homeless and Inclusion Health Programme is here to help nurses and any other practitioners so that together they can learn, share practice and use their experiences on the frontline to influence policy, education and practice, and ultimately to improve care for those most in need.



[1]  Rough Sleeping Statistics Autumn 2018

[2]   Shelter (2018) 320,000 people in Britain are now homeless, as numbers keep rising

[3]  Geraghty, L (8 Jan 2018) Hidden Homelessness: The Cold Hard Facts

[4]  Aldridge RW, Story A, Hwang SW, et al. (2017) Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2017; 6736:1–10

[5]  Office of National Statistics (2018) Deaths of homeless people in England and Wales

[6]  Beijer, U et al (2012) Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. The Lancet Infectious Diseases; 12:11, 859–870

[7]  Story A (2013) Slopes and cliffs in health inequalities: comparative morbidity of housed and homeless people. The Lancet. 382, S93

[8]  University College DublinCrisis (2011) Homelessness: a silent killer

[9]  University of Birmingham (2019) Homeless people are denied basic health care, research finds

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