If a pharmaceutical representative walked into your office with a new drug that would reduce mortality by 15% and saved society $20,000 per year, would you start to use it in your practice? Probably yes! In the world of medical advances, a 15% gain in life and dollars is a remarkable achievement, and would be covered by the payers, both public and private.
Evidence from the work of Dr. Joshua Bamberger in the San Francisco Department of Public Health suggests another intervention with even greater benefits – housing. Poverty combined with homelessness, mental illness, substance use, and chronic illness is a lethal disease. People – our patients- with this cocktail of conditions are 25 times more likely to die prematurely than the general population.
Data from Dr. Bamberger’s work in San Francisco suggests that providing housing to the homeless increased survival rates by 80%. Yes, that is correct, 80%. Moreover, he has found that cost savings per patient per year averaged $20,000 – $30,000.
He has found that it is not just housing, but the quality of housing that contributes to this mortality and cost benefit. Quality is defined by five factors:
- Quality of the building
- Quality of the neighborhood
- Severity of illness of the tenants.
- Homogeneity of the residents
- Quality of the services available onsite
So, as you consider how best to care for your homeless, chronically ill patients, look for opportunities in your community to partner with housing agencies and others who are investing in housing options for the homeless. Look beyond the medical causes of disease and suffering to the social determinants of the health of your patients. Remember housing is health care.