12.22.2021-digital

Q&A: Rachel Biggs

Cities across the country look to improve data around homeless mortality

BY HANNAH HERNER

Something that is assumed with all data around homelessness is that people are undercounted. The population is fluid and hard to track, but it’s also because cities often don’t have a system to get accurate data. This is especially true for homeless mortality. A spinoff of the National Health Care for the Homeless Council, headquartered in Nashville, Homeless Mortality Data Workgroup put together a toolkit that was released in 2020. The toolkit confirms that it’s rarely the local government, and definitely not the national government, that collects this data on how many people who’ve experienced homelessness we lose each year. This data by and large relies on homeless service providers, community advocates and religious organizations. Only two percent of counties keep a count at all, it says. In Nashville, the list is an informal amalgamation. Getting reports for each person from the medical examiner’s office to make the data more complete costs money and time, and the cause of death remains largely incomplete. Still, homeless service providers collaborate on a shared google sheet each year. Rachel Biggs, chair of the Homeless Mortality Data Workgroup, explains how this data can improve.

Can you tell me about why the mortality work group got started?

Homeless mortality was a topic that just kept coming up — talking about if we had better data to talk about how many people die while experiencing homelessness. We have some really good reports out of Boston and out California that have been doing homeless mortality recording for decades.

But what we were talking about in the [NHCHC] policy committee was that we wanted to have more local data for our own localities to talk about homeless mortality and use that data in our policy and advocacy works. Because we knew that if we were able to really bring to light the huge disparity in terms of life expectancy for someone experiencing homelessness versus someone that is housed, we could use that to advocate for the things that we know end homelessness, like affordable housing, living wage and access to health care.

What’s the purpose of the group?

The purpose of the group was really to bring together the expertise of localities that were doing the work to help other localities that hadn't really started doing homeless mortality counts and are wanting to get started. And so it's a great place to learn from some of the technical experts — from epidemiologists or folks that have really good relationships with their medical examiner's office or coroner's office, and then help the localities that were just getting started to figure out a way to start this work because it is a pretty big undertaking.

Do we know at this point how COVID affected the homeless population?

In all of this work, when we're talking about documenting homeless mortality, or documenting how many people experience homelessness, we acknowledge that it's always going to be an undercount of the issue. And so right now trying to find the data to understand the impact of COVID on experiencing homelessness has been challenging, because we do have such a different way of documenting homeless mortality across the country. One of the things that we have been speculating on, and perhaps seen in early reports is more looking at the impact of COVID on lack of ability to access services and what that means for homeless mortality. So not necessarily COVID-related deaths, but the impact of COVID and accessing essential services and what that meant for people who are more vulnerable out on the street and having early mortality due to the lack of access. Things were closed down or transportation was limited or people were fearful to go into congregate settings or into health care facilities because of concern with contracting COVID, and what that meant for impacting homeless mortality. So we're still looking at that and the impact of COVID more broadly than just COVID deaths among the homeless population.

So if we know how the mortality is happening in this community, what could help something like life expectancy for this group to go up overall?

Across the board, housing is the number one thing that we can do to improve life expectancy consistently. Other recommendations after housing improvements, like expanding the ratio of street medicine teams, and looking at ways to better reinforce street medicine and treatment in non-clinical settings… Doing more of that would go a long way in reaching people, connecting them most importantly to housing but other health services. I think expanding and improving substance disorder services for people experiencing homelessness is a big finding, making sure we really invest in syringe exchange services [and] naloxone distribution to prevent overdoses [are] big findings as well.

Having put out that toolkit, are there other goals or big projects that you're working on with this group?

Standardization is a big one. We are looking at updating the toolkit. We want this to be something that's continually updated. And hopefully we'll have another version of it released in the coming months. We're still working to come up with some really big national level policy priorities out of the national homeless mortality data workgroup, so that'll be a next step for us.