Health of people experiencing homelessness

People experiencing homelessness and those at risk of homelessness (see glossary) are among Australia’s most socially and economically disadvantaged. Experiencing or being at risk of homelessness is associated with a higher risk of adverse health, social, and economic outcomes (Fitzpatrick et al. 2013).

Health problems can arise as a consequence of experiencing homelessness, including malnutrition and dental problems (Goode et al. 2018; Huang et al. 2022). Homelessness can expose people to violence and victimisation, result in long-term unemployment and lead to the development of chronic ill health (Larney et al. 2009). People experiencing homelessness have significantly higher rates of death and chronic illness when compared with the general population (Morrison 2009).

People experiencing health issues while also experiencing homelessness may have difficulties managing their health conditions which can lead to the development and/or exacerbation of a chronic health issue. This in turn can reduce a person’s ability to sustain wellbeing, employment, housing, and personal networks, further impacting their ability to sustain stable housing.

People experiencing homelessness

On Australian Bureau of Statistics (ABS) Census night in 2021, more than 122,000 people were estimated to be experiencing homelessness in Australia, up from 116,000 (an increase of 5.2%) since 2016. Of the people experiencing homelessness in 2021, 56% were male, 58% were younger than 35 and 20% identified as Aboriginal and Torres Strait Islander (First Nations) origin (ABS 2023).

Of people experiencing homelessness in Australia in 2021:

• 47,900 (39%) were living in 'severely' crowded dwellings
• 24,300 (20%) were in supported accommodation for the homeless
• 7,600 (6.2%) were living in improvised dwellings, tents or sleeping out (also termed rough sleeping) (ABS 2023). 

The General Social Survey provides some insights into the health status of people who have experienced homelessness in Australia. In 2019, an estimated 2.2 million Australians aged 15 and over had been without a permanent place to live at some time in their lives (ABS 2019). Around 75% stayed with friends or relatives and 34% experienced rough sleeping. The most common reason for the most recent experience of being without a permanent place to live was a relationship or family breakdown (48%).

Government-funded Specialist Homelessness Services (SHS) across Australia provide services supporting people who are experiencing homelessness or who are at imminent risk of homelessness. In 2022–23, SHS services provided support to around 274,000 clients. Of those, 116,000 (or 47%) clients were experiencing homelessness when they first began support (AIHW 2023).

For further information about the profile of people experiencing homelessness and the support provided by specialist homelessness services, see Homelessness and homelessness services.

The impact of homelessness on health

There is a growing volume of research on the impact of insecure housing on the health of individuals and the associated costs to the health system (Davies and Wood 2018; Zaretzky and Flatau 2013).

Meeting basic physical needs such as food, water and a place to sleep can be the most important day-to-day priority for people experiencing homelessness, especially those rough sleeping. Subsequently health needs are often not considered until an emergency arises (Wise and Phillips 2013). While rough sleeping is the least common form of homelessness in Australia (ABS 2023), the longer-term impacts of rough sleeping on health are profound due to issues such as poor nutrition, living in harsh environments and high rates of injury (Fazel et al. 2014).

Severe overcrowding is the most common form of homelessness in Australia and is associated with different health impacts. For example, severe overcrowding places stress on the infrastructure of the dwelling, such as food preparation areas, bathrooms, laundry facilities and sewerage systems. It may lead to more rapid transmission of infectious disease (including COVID-19) and induce psychological stress (AIHW 2014; Buckle et al. 2020).

Despite the worse health outcomes for people at risk of or experiencing homelessness, there is evidence that this effect can be reversed with appropriate housing. Internationally, some of the health benefits associated with secure housing following a period of insecure housing were:

• decreased rates of hospitalisation
• reduced transmission of infectious diseases
• improved mental health symptoms
• overall improved wellbeing (Carnemolla et al. 2020).

Self-assessed health

In 2014, around 1 in 4 (26%) people in Australia who had ever experienced homelessness assessed their health as fair or poor, compared with 14% of those who had not experienced homelessness (ABS 2015). Note that the data source is limited to people who had experienced homelessness but who were living in private dwellings at the time of the survey.

In general, a higher proportion of people who reported at least one experience of homelessness had a health condition or disability, compared with those who had never had an experience of homelessness (Figure 1). People who had experienced homelessness were more likely to report having a mental health condition or a long-term health condition, with depression, back pain or back problems, anxiety, and asthma the most commonly reported.

Figure 1: Self-assessed health status, by experience of homelessness, 2014

Specialist Homelessness Services clients – health services needs

In 2022–23, around 1 in 4 (27% or 31,600) SHS clients who were homeless when they first presented to a SHS agency for assistance identified health-related reasons for seeking support (AIHW 2023). Clients may require assistance for more than one reason. Of the 31,600 people experiencing homelessness and reporting health‑related reasons (Figure 2):

• 23,700 clients identified mental health issues
• 11,400 clients identified medical issues
• 8,300 clients identified problematic drug or substance use
• 3,900 clients identified problematic alcohol use.

Figure 2: Number of SHS clients who were homeless at first presentation, by sex and health-related reasons for seeking assistance, 2022–23

SHS agencies provide various services to clients, from accommodation to more specialised services such as health or medical services. When a SHS agency is unable to provide specialised services, clients can be referred to another agency, with health-related services among the most commonly referred service types (AIHW 2023).

In 2022–23, SHS clients who were homeless at first presentation needed a range of health-related services:

• around 13,300 clients needed health/medical services
• over 5,000 needed drug/alcohol counselling (Table 1).

Individual clients may have more than one need and SHS data does not describe whether referred clients eventually received the health care needed.

(a) Includes clients who refuse a service.

Source: Specialist Homelessness Services Collection 2022–23, unpublished.

Barriers to accessing health care

Homelessness has a substantial impact on a person’s health and presents challenges for people to access appropriate and effective medical care, including ongoing care (Davies and Wood 2018).

In 2014, 13% of people who experienced homelessness at least once in the previous 10 years were more likely to report experiencing a barrier to accessing health care, compared with 4.4% who had not experienced homelessness (ABS 2015). Among people unable to obtain health care when needed, 2 in 5 (40%) identified the cost of service as the main barrier to access, followed by long waiting times or lack of appointment availability (ABS 2015).

Individual risk factors such as illness and poor health can be a barrier to receiving health care. For example, mental illness can influence both being able to attend appointments and the effectiveness of health care provided (Davies and Wood 2018). The stigma associated with receiving mental health care, feeling stereotyped or judged can also have an impact.

Physical barriers pose further challenges. For example, being able to afford public transport to attend appointments, having no mailing address or phone to receive appointment reminders, and being able to keep medications secure are difficulties faced by people in transient housing such as rough sleeping, couch surfing or short-term accommodation.

Where do I go for more information?

For more information on the health of people experiencing homelessness, see:

• Specialist homelessness services annual report
• Housing data dashboard
• Australian Bureau of Statistics (ABS) Census of Population and Housing: estimating homelessness, 2021
• ABS Information Paper–a statistical definition of homelessness, 2012

For more information on this topic, see Homelessness services.