Home > "Illegality" and Vulnerability, Difficulty researching unauthorized populations, Homelessness > Potential Health Outcomes of Being Undocumented and Homeless – Maggie Sullivan

Potential Health Outcomes of Being Undocumented and Homeless – Maggie Sullivan

Maggie Sullivan

Homeless persons who are also unauthorized immigrants face a reality of extreme marginalization which puts them at significant physical and mental health risk. As a family nurse practitioner working in shelter-based clinics, I care for many of these patients regularly. And though resiliency is certainly not uncommon, the burden of disease for those who are both homeless and unauthorized is high.

Not having a home and being undocumented confers considerable health risks. It is known that homelessness, in and of itself, confers significant risk of illness and premature death[i]. The majority of homeless individuals in the United States are U.S. citizens, and many of our foreign-born homeless patients are authorized immigrants. The minority who are both homeless and unauthorized immigrants face unique challenges and risks to their health. It is an aspect of health disparity not often addressed.

Research on homeless individuals is scant and painstakingly difficult. Research on undocumented homeless individuals is, to my knowledge, non-existent. But I see these very individuals regularly in clinic, and their state of health and risks of illness and injury, not to mention their personal stories, are remarkable.

I am usually first struck by individual stories of border-crossing, as there are often subsequent health implications. And next I am struck by how these individuals became homeless, as this undoubtedly reveals many more links to health. For example, one patient from Guatemala, whom I will call Sara, was sexually assaulted by men she paid to get her across the border. She escaped these men, who had become her captors, and found her way to Boston to join her estranged husband and earn money to send back to their children. Sara was later diagnosed with syphilis and active tuberculosis. During the course of her hospitalization and treatment, she confided in a clinician that her husband was physically abusive. She was discharged to a domestic violence shelter, at which point she came into my care and presented with significant depression and anxiety.

Another patient, whom I will call Marco, came to the U.S. alone in the late 1980s when he was 23 years old. Marco states that he was sent to the U.S. by his mother, who feared he would be killed if he remained in Guatemala because of his father’s association with the government. When he arrived in Boston he was young, alone, spoke no English and had a 6th-grade education. He worked in construction and began to drink heavily. When he came to the U.S., he had already been smoking since early childhood, but along with an increase in drinking came an increase in tobacco use. Because of his drinking, Marco was unable to maintain steady work or an apartment. He became homeless many years ago and stays outside or in a shelter. He came into my care shortly after being assaulted while drinking, and the injuries he sustained have now evolved into chronic pain. His significant smoking history has resulted in interstitial lung disease. While Marco now has 6 months of sobriety and is 20 days into his first attempt at smoking cessation, he is again looking for work in construction which remains elusive and difficult to find.

A brief and generalized snapshot of the demographics from my own clinical practice, show these patients to be overwhelmingly male, grade-school educated and currently or recently employed in a low-skilled service industry. Their average age is 45, and their average age at arrival to the U.S. was 22. The vast majority arrived from Mexico, Central America and the Caribbean. Strikingly, compared with other Latinos in the U.S., homeless unauthorized immigrants appear to have an estimated incidence of diabetes around 3 times the national average[ii], their rate of asthma is about two-fold[iii], their rate of smoking is about three-fold[iv], and their rate of mental illness is about four-fold5[v]. Combined with a life expectancy shortened by 30 years due to homelessness alonei, this is the grim and difficult reality for many of my patients. Essentially each of them came to the U.S. to work, to improve the quality of life for their family, and to overcome the odds of poverty and the lack of opportunity in their own countries. But for whatever reasons, the undocumented immigrants who find themselves homeless, and whom I see in shelter-based clinics, continue a struggle beyond anything I can imagine.

[i] Premature Mortality in Homeless Populations: A Review of the Literature, December 2005, James J. O’Connell.

[ii] In 2007, 7.9% of Hispanics in the US reported a diagnosis of diabetes (versus an estimated 23% of homeless undocumented patients observed in clinic). http://www.cdc.gov/diabetes/statistics/prev/national/figbyhispanic.htm

[iii] In 2008, 6.3% of adult Hispanics in the US reported a diagnosis of asthma (versus an estimated 13% of homeless undocumented patients observed in clinic). http://www.cdc.gov/asthma/brfss/08/current/tableC5.htm

[iv] In 2008, 14.5% of adult Hispanics in the US reported being current smokers (versus an estimated 45% of homeless undocumented patients observed in clinic). http://www.cdc.gov/nchs/data/nhis/earlyrelease/200812_08.pdf

[v] In 2008, 11.1% of Hispanics reported “frequent mental distress” in the past 30 days (versus an estimated 45% of homeless undocumented patients with a mental health diagnosis observed in clinic). http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Measure=7&Category=4&submit1=Go



Cite this:

Sulivan, Maggie. 2010. Potential Health Outcomes of Being Undocumented and Homeless. AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed (date) at https://accessdeniedblog.wordpress.com/2010/07/19/potential-health-outcomes-of-being-undocumented-and-homeless/


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