About Homelessness

What is homelessness?

Homelessness can be defined in several ways. Commonly, people are considered to be experiencing homelessness if they stay in a shelter, live in transitional housing, or sleep in a place not meant for human habitation, such as a car or outdoors. Sometimes people are considered to be experiencing homelessness if they are living in a motel or are doubled up with family or friends because they do not have anywhere else to stay.

Who experiences homelessness?

Each year, the U.S. Department of Housing and Urban Development (HUD) conducts a Point-in-Time Count (PIT) to estimate the number of people experiencing homelessness in the United States.

According to the data from these counts, most people experiencing homelessness stay in homeless shelters. Around 40% of people experiencing homelessness live in unsheltered locations (such as in a car or outside). Almost one third of people experience homelessness as a family. People who are Black or African American and those who are American Indian or Alaska Native have higher rates of homelessness.

About Homelessness & Health

People experiencing homelessness are at increased risk for infectious and non-infectious diseases. Homelessness is known to increase the risk for infectious diseases such as Viral Hepatitis (especially Hepatitis C), Tuberculosis (TB), Human Immunodeficiency Virus (HIV), and Coronavirus Disease 2019 (COVID-19). People experiencing homelessness also commonly face mental illness, alcohol and substance use disorder, diabetes, and heart and lung disease.

Risk Factors for People Experiencing Homelessness:

• Congregate setting of homeless shelters increases risk for TB and COVID-19
• People experiencing homelessness who use drugs are at an increased risk for Viral Hepatitis, HIV, and other bloodborne pathogens
• People experiencing homelessness are at risk of developing mental illnesses, such as anxiety, depression, and post-traumatic stress disorder (PTSD)
• Delayed care seeking and lapses in care can lead to worse health outcomes, such as severe illness or death

Each night, hundreds of thousands of people experience homelessness in the United States. Some of these people experience chronic homelessness, while others have temporarily lost their shelter. The reasons why they are homelessness are complex. They can include a combination of factors such as:

• Poverty
• Unemployment
• Lack of affordable housing
• Mental and substance use disorders
• Trauma and violence
• Intimate partner violence
• Justice-system involvement
• Sudden serious illness
• Divorce
• Death of a partner or parent
• Disabilities

Poor health can contribute to homelessness. And being homeless can contribute to poor health. Many of the problems that people experiencing homelessness face can make their health worse, including:

• Limited access to health care
• Problems getting enough food
• Trouble staying safe
• Violence
• Stress
• Unsanitary living conditions
• Exposure to severe weather

Some of the common health problems that people experiencing homelessness may have include:

• HIV
• Lung diseases, including bronchitis, tuberculosis, and pneumonia
• Malnutrition
• Mental health problems
• Substance use problems
• Wounds and skin infections

Many people experiencing homelessness are dealing with trauma. They may have been abused or assaulted. This includes children, who are at risk for emotional and behavioral problems.

Contact your local homelessness assistance agency to get the help you need, such as access to shelters, health centers, and free meals.

People experiencing homelessness are at an increased risk of becoming infected with TB germs compared to the general population. The increased risk of infection with TB germs is due to several factors, including substance use, HIV infection, and the homeless shelter environment such as crowding and the state of the ventilation system. This combination of factors is favorable for spreading TB. In addition, people experiencing homelessness often lack ready access to the medical care required to make an early diagnosis of TB disease.

Among persons aged 15 years of age or older with TB in 2021, 341 (4.5%) reported experiencing homelessness within the 12 months preceding TB diagnosis. This compares with 290 (4.3%) of TB cases in 2020 among persons aged 15 years of age or older with reported homelessness in the United States.

To address TB among people experiencing homelessness, CDC is:

• Collaborating with other national and public health organizations to improve screening, diagnosis, and treatment for people experiencing homelessness;
• Working to improve TB control activities in partnership with healthcare agencies addressing the needs of people experiencing homelessness.

People experiencing homelessness are an important group at increased risk of TB. To achieve TB elimination, ongoing efforts are needed to address the disproportionate number of TB cases among this population.