Pandemic Homelessness Disproportionately Impacts People With Diabetes
On July 28, 2021, the American Diabetes Association (ADA) released a report that found that pandemic homelessness hit people with diabetes 48 times harder than other Americans.
The ADA conducted a national survey that found that 7.6 percent of 3,500 respondents living with diabetes, between June 11, 2021 and June 25, 2021, had become temporarily or permanently homeless since the pandemic’s inception. Roughly 580,000 people were experiencing homelessness in the United States in 2020.
According to Nora Saul, MS, certified diabetes educator and diabetes clinical lead for Silver Fern Healthcare, when homelessness is coupled with managing a chronic condition, like diabetes, it can exacerbate health outcomes.
“Diabetes is expensive for people both with type 1 and type 2 diabetes. Medications are expensive; insulin, oral agents and injectables,” Saul tells Beyond Type 1. “They [people with diabetes] haven’t been able to keep up with rent or mortgage payments, and unfortunately, ended up homeless, which is very sad because it increases their burden of disease.”
Homelessness is a determinant of health status. Long term exposure to weather conditions, drugs, violence and limited access to health care are associated with higher incidence of acute and chronic health problems and premature mortality.
Saul adds that the pandemic amplified economic insecurity with the greatest burden falling on people of color. According to ADA’s national survey, 47 percent of Native American participants and 20 percent of Black respondents were at or near debt compared to 14 percent of white respondents. Latinx respondents were 26 percent more likely than whites to be in or near debt while Asians were 69 percent more likely than whites to become homeless.
It is estimated that 7.7 million Americans lost their jobs in 2020. With job loss often comes a loss in health insurance. For people with diabetes, health insurance is critical to afford insulin and other diabetes management supplies.
The ADA also found that Latinx Americans with diabetes were 54 percent more likely than white people to have missed health care visits. Delayed care can result in increased morbidity and mortality risk.
“If they have lost their jobs, and essentially lost their health insurance, they have stopped going to get health care, and that increases the risk that their diabetes can get worse, which usually means it is more expensive to treat,” Saul says.
Food access was also hit hard by the pandemic. More than 52 percent of Native American respondents reported experiencing difficulty accessing healthy foods since the public health emergency started. 26 percent of Asian respondents as well as 21 percent of Black and Latinx respondents also faced these challenges.
While there is no singular solution to addressing homelessness, Saul highlights the need for accessible health insurance for all. “It would be helpful if health insurance premiums and the cost of medication could be lowered,” Saul says. “For these patients, it would be commensurate with what they could afford instead of the way it is now.”
In addition to accessible health insurance, policy and community level solutions are also needed. For example, the Coalition For The Homeless underscores the importance of the housing first model, a proven solution to put long-term homeless individuals in subsidized housing with support services. This helps keep individuals housed and improve health conditions.
Overall, the data sheds light on how people with diabetes have been impacted by the pandemic. “The current study reveals that, even with a recovery underway, the long-term impacts are considerable and require an ongoing effort to provide much-needed relief to the countless Americans who are struggling to manage their diabetes,” Maria Muccioli, PhD, Thrivable research lead, said in the ADA press release.