Not here. Many homeless people worldwide will hear that sooner or later. In Hungary, sleeping on the street is a criminal offence, but in many countries forced relocation is a by-product of other policies; maintaining public order, or rotation policy in the reception. What that does to people’s health is difficult to measure.
With a model you can take a good shot at that, thought a group of researchers in the United States. They published the result in the authoritative paper JAMA, of the American Medical Association. They focused specifically on homeless people who use intravenous hard drugs, such as heroin. These people often depend on a network of formal and informal health care: for clean syringes, for less harmful substitutes such as methadone, or for help with an overdose.
They based their model on available data on homelessness, drug use and health risks from 23 US cities. Subsequently, these city models were populated with artificial residents, each with their own – randomly assigned by the computer – drug past. That model could run for ten years, from 2018 to 2028, leaving residents alone. Then the researchers did a second experiment. Now every ‘individual’ ran the risk of being forced to move every week, with care being interrupted and having to be rebuilt elsewhere.
Ten years of rest, or keep moving
After ten years, the differences in outcomes turned out to be large. With disruptions to the health care network, users were nearly twice as likely to die from an overdose, they spent nearly 50 percent more time in a hospital and were at a greatly increased risk of infectious diseases, sometimes resulting in death. The only two indicators that went down were drug recovery programs and life expectancy. The latter, still not high, fell by almost a year, from about 7.1 to 6.3 years.
Modeling studies have significant limitations. No model is able to imitate the complex and ever-changing reality. Moreover, the research is emphatically in an American context, in other countries the circumstances of both homelessness and drug problems are very different.
But to consistently find so many worse outcomes when people are forced to move makes one think. That is the conclusion of Margot Kushel of the University of California San Francisco in an accompanying editorial JAMA. Involuntary displacements can damage health in many ways, and their consequences are not limited to people who inject drugs. “We can assume that all people experiencing unprotected homelessness and involuntary displacement are at increased risk of harm. And that on top of the increased risk that homeless people already run.”
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