Author: Sara Habibipour
Hypertension is one of the leading health issues among all socioeconomic classes in the United States. Hypertension has risen by 30% in the last decade and at least 73 million American adults are considered as living with high blood pressure. Still, hypertension is a “silent killer,” as 20-30% of people living with hypertension are unaware that they have the condition. This can lead to serious, oftentimes fatal, issues including heart attacks, strokes, kidney failure, and eye damage.
Second to alcohol abuse, hypertension is the most common chronic health condition affecting the homeless population. Personally, I had the recent experience of joining a street medicine team within my local Los Angeles community. Last weekend, we set up a street clinic on Skid Row and we took the blood pressures of all those who wanted to know their health status. Of all the patients I personally screened (which was about 6 or 7), only one had a normal blood pressure; the rest were concerningly high. Although this is just my anecdotal experience, I feel that it still accurately reflects the crisis at hand.
Compared to their housed counterparts, unhoused people are two-to-four times more likely to have hypertension and cardiac disease which can be attributed to poor diet, excessive alcohol and drug use, stress, etc. There was one lady that I met on Skid Row who had a very high blood pressure; we talked about her diet and she said she “had never been taught, not even as a child, what a healthy diet was.” Homelessness and financial instability can obviously make access to healthy foods impossible to reach and store in the first place (you won’t find a refrigerator on Skid Row), but that is a quote that will definitely stick with me. There is a lot of work to be done within unhoused and low income populations alike from an educational perspective regarding healthy diets but, of course, the larger systemic issue at hand is ensuring that nutritious foods are accessible to a greater population.
Management of hypertension within the unhoused population is also particularly challenging. Access to primary health care and insurance is a huge issue, particularly on Skid Row, which is why street medicine teams exist in order to provide free basic health screenings, wound care, etc. within the communities themselves. But, it can also be
challenging for unhoused people to follow a medication regimen; for those on drugs or under the influence of alcohol, they may not be in a conscious state of mind to remember to take their blood pressure medications. It’s also hard to get them refilled when you don’t have ready access to a healthcare provider; there were many patients I saw who had been prescribed blood pressure medication in the past, but were not currently taking them because they ran out a long time ago and didn’t know where to refill them, couldn’t afford to, didn’t understand the importance of continually taking them, etc. It’s important that in any type of community health work, you don’t just give a vulnerable patient the medication and leave; you have to stay connected, follow up regularly to ensure they still have their medication, that they’re taking it regularly, that they’re not experiencing side effects, etc. In other words, community health work must be done responsibly and in the best long-term interest of patients.
There’s also a large issue on Skid Row, and within any homeless population in general, related to stealing. When people leave their tents even for a few minutes, their belongings can be stolen, including medications. But, also, this issue deters many unhoused people from traveling to a free clinic or primary care provider in the first place, as time away from their tent risks the only shelter they have and their safety.
There are a plethora of issues related to homelessness, access to primary care, and chronic diseases such as hypertension. Likewise, the factors playing into these issues are complex; food insecurity, the American healthcare system, the political and historical origins of Skid Row itself, are all deeply woven together to produce the issues we see today. This is why long-term community health work is so important: it’s one of the only ways we can ensure that the most vulnerable people in our population receive the care that they deserve, especially when it comes to managing chronic disease.
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Sources:
https://happy.sites.yale.edu/barriers-care
Image Sources:
https://history.howstuffworks.com/american-history/skid-row.htm
https://today.usc.edu/usc-street-medicine-team-homeless-health-care/