HEALTH
In general, SMD is associated with much higher levels of long-term limiting illness/disability.
For Current SMD(3D), much (four times) higher rates of long-term conditions/disability are associated with the homelessness and offending domains, as well as rising steeply with combinations involving two or three relevant disadvantages, but apparently rather less with the substance-only category (see Figure 18). The Ever SMD(5D) analysis is more robust in terms of overall numbers and the range of datasets drawn upon, and also shows subjectively reported poor (“bad” or “very bad”) health (Figure 19). It shows that the level of ill-health or long- term conditions is rather less for those who have experienced homelessness or offending, or DVA, but is much higher for those with MH conditions, or combinations involving MH (five to six times that of people without any disadvantages). In general, the incidence of these health indicators rises with number of SMD domains, but what is critical is which disadvantage domains apply, with MH by far the most significant, followed by homelessness. There are some signs that the incidence plateaus above SMD2 (5D).
The strong association between poor health and homelessness was emphatically underlined by the findings of the administrative data linkage HHiS study (Waugh et al, 2018). This found that people accepted as homeless in Scotland between 2001- 2014 had a roughly five times higher chance of dying than people of the same age and gender living in the least deprived fifth of areas in Scotland, with death rates amongst the homeless cohort also double that of their non-homeless peers living in the most deprived fifth of areas. In the age range 25-45, the death rate was 10-20 times higher than the comparator group living in the least deprived areas, equating to 11,520 excess deaths in the homeless cohort over the period. Acute hospital admissions for adults in these middle age ranges were two-and-a-half times higher than average for those ages, and four-to-five times higher than for people living in the least deprived areas. A&E cases showed a similar pattern.
94
That adults with SMD have poor physical as well as mental health has also been shown from wider systematic reviews of research evidence (Aldridge et al, 2018). While acknowledging that they may well not receive an adequate level of response to some of their mental health problems (see below), it is nonetheless clear that their level of utilisation and associated cost to the NHS is significantly above that of the general population. This partly reflects the strong element of co-morbidity between physical and mental ill-health. PSE data shows that in general for working age groups the number of long-term health conditions (excluding MH) rises with SMD level, so that adults with SMD3 have substantially more long-term conditions than those with no SMD disadvantages; in the age group 45- 54 the progression is from 1.8 conditions to 4.3 conditions per adult.
We have attempted an approximate analysis of the excess healthcare costs associated with the homeless cohort in the Waugh et al (2018) HHiS study. The largest extra costs are in mental health prescriptions (£311m per annum) and acute in-patient and day cases (£306m), followed by prescriptions for substance dependency at £150m. The smallest items are actually drug treatment and out-patient appointments. The total excess financial cost of healthcare for people who have ever been homeless is £900m, which seems a big figure, compared with the annual Scottish Health budget of c. £13bn, although it should be recalled that ‘Ever Homeless’ in Scotland are about 10% of the whole adult population25
. This analysis
also suggests that the excess costs for poverty and deprivation affecting people in the general population who have not been homeless amounts to £2.3bn. The total (2.3+0.9=£3.2bn) is roughly in line with Bramley et al (2016) estimates of the excess health costs in Scotland associated with poverty broadly defined (i.e. about a quarter of the health budget).
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140 |
Page 141 |
Page 142 |
Page 143 |
Page 144 |
Page 145 |
Page 146 |
Page 147 |
Page 148 |
Page 149 |
Page 150 |
Page 151 |
Page 152 |
Page 153 |
Page 154 |
Page 155 |
Page 156 |
Page 157 |
Page 158 |
Page 159 |
Page 160 |
Page 161 |
Page 162 |
Page 163 |
Page 164 |
Page 165 |
Page 166 |
Page 167 |
Page 168 |
Page 169 |
Page 170 |
Page 171 |
Page 172 |
Page 173 |
Page 174 |
Page 175 |
Page 176 |
Page 177 |
Page 178 |
Page 179 |
Page 180 |
Page 181 |
Page 182 |
Page 183 |
Page 184 |
Page 185 |
Page 186 |
Page 187 |
Page 188 |
Page 189 |
Page 190 |
Page 191 |
Page 192 |
Page 193 |
Page 194 |
Page 195 |
Page 196 |
Page 197 |
Page 198 |
Page 199 |
Page 200 |
Page 201 |
Page 202 |
Page 203 |
Page 204 |
Page 205 |
Page 206 |
Page 207 |
Page 208 |
Page 209 |
Page 210 |
Page 211 |
Page 212 |
Page 213 |
Page 214 |
Page 215 |
Page 216 |
Page 217 |
Page 218 |
Page 219 |
Page 220 |
Page 221 |
Page 222 |
Page 223 |
Page 224 |
Page 225 |
Page 226 |
Page 227 |
Page 228 |
Page 229 |
Page 230 |
Page 231 |
Page 232 |
Page 233 |
Page 234 |
Page 235 |
Page 236 |
Page 237 |
Page 238 |
Page 239 |
Page 240 |
Page 241 |
Page 242 |
Page 243 |
Page 244 |
Page 245 |
Page 246 |
Page 247 |
Page 248 |
Page 249 |
Page 250
