Street Medicine: Bringing Healthcare to the People

Medical care for people experiencing homelessness redefined

Women aid a person experiencing homelessness in Brooklyn by Ed Yourdon licensed under CC BY-SA 2.0.

Bringing healthcare to the streets of America seems like a revolutionary idea but in reality, it had been going on for a few decades now. Doctors around the country pile up into vans and drive down to the encampments and parking lots filled with people experiencing homelessness, bringing medical aid directly to vulnerable populations. Since the 1990s, street medicine has been a gamechanger for communities of people experiencing homelessness.

Street medicine providers are often teams of doctors and nurses that set up tents on the streets and under bridges, specifically in places where people experiencing homelessness often frequent. There, they either go from tent to tent in encampments providing checkups and giving aid or set up pop-up booths that people can come up to. They treat wounds, provide medications for disease control, do lab and blood work, and give mental health counseling. In addition to healthcare services, these teams also hand out food and hygiene products and share information about infectious diseases such as COVID-19.

Street Medicine is Able to Connect Hesitant Individuals to Healthcare

Street medicine programs aim to tackle a key byproduct of homelessness, inaccessibility to quality healthcare. People living in homelessness face obstacles to receiving medical care including a lack of access to transportation, fear of theft, and a general distrust of healthcare workers due to the stigmas around homelessness. 

These stigmas are often the biggest reason why many people experiencing homelessness don’t get treatment - they do not want to visit a medical center. The disrespect and judgment that people experiencing homelessness often face deter them from going to the hospital unless there is an emergency, an emergency that would then cost thousands of dollars to treat due to lack of prevention through primary care.

Clinicians in an ICU treating a medical emergency licensed under CC BY-SA 3.0.

Where traditional medical facilities fail to reach people experiencing homelessness, street medicine teams have proved extremely successful. Though only 30% of insured people experiencing homelessness have visited a primary care physician, over 70% of them have been treated by a member of a street medicine team. A big part of street medicine is making connections through the community of people experiencing homelessness and building strong relationships with these individuals that then allow them to trust the medical care and advice being given to them. Many members of street medicine teams don’t even wear lab coats to improve interactions with people experiencing homelessness by appearing as civilians rather than medical professionals in a position of authority over healthcare decisions.

Street medicine teams go beyond giving immediate medical attention and also help increase trust in the medical system and preventative medical care, which can then save a lot of money and lives in the future. They act as an intermediate healthcare team, providing care at the moment but also referring primary care providers to the people experiencing homelessness to ensure long-term care. Through street medicine, primary care access by people experiencing homelessness increases 150% both by referrals and increased trust in the healthcare system.

Heart Failure, Wounds, and COVID-19 are all Treated by Street Medicine Teams

The need for street medicine now is also dire. One of the most common diagnoses of people experiencing homelessness as found by street medicine teams is congestive heart failure, a serious condition in which one’s lungs are filled with fluid that then affects cardiac function. This diagnosis is closely followed in frequency by untreated wounds that can also be exposed to infection in an unsanitary environment and drug-related issues. The biggest causes of death in communities experiencing homelessness include drug overdoses and heart diseases.

During COVID-19, medical problems in communities of people experiencing homelessness have only increased. For people experiencing homelessness that reside outdoors, access to sanitation and hygienic conditions is often a struggle. Without proper sanitation, COVID-19 can spread easily through encampments and other shared spaces even when outdoors. For those who do reside in indoor facilities, a higher risk of transmission through aerosol droplets is present and distancing is often more difficult. 

Communities of people experiencing homelessness are not only some of the most vulnerable communities to COVID-19 but also experience severe side effects of the pandemic as a whole. This includes worsened mental health during lockdown recessions, increased drug use as a result, and delayed access to medical care as unurgent procedures get postponed and hospitals overflow with patients.

Newark Housing Authority FQHC COVID-19 Vaccination Pop-Up

Street medicine teams have helped with the testing process for people experiencing homelessness and are now trying to focus on increasing vaccination rates in these communities. As of late August, only 38% of people experiencing homelessness in California have been vaccinated, much less than the total percentage of Californians vaccinated. Street-based testing and vaccination sites through pop-ups are a successful method of decreasing COVID-19 transmission in communities of people experiencing homelessness as well as sanitization efforts.

Assembly Bill 369 Signifies a Turning Point for Street Medicine

Increasing accessibility to street medicine comes through increased awareness about its importance, growing numbers of medical professionals enthusiastic about providing street medicine services, and of course legislation and monetary commitments to support such programs. Street medicine is often funded by donations and nothing else, existing as nothing more than university programs filled with volunteers or people working on minimal pay. 

But this is all starting to change. Street medicine is finally being acknowledged as real healthcare starting in California, home to one of the largest populations of people experiencing homelessness in the country. Assembly Bill 369, deemed the Street Medicine Act, is the first official acknowledgment of street medicine as an essential part of healthcare and will now allow street medicine doctors to receive payment for the work they do through Medi-Cal government funds. 

Homeless in the Streets of Los Angeles by Robin Kanouse licensed under CC BY-NC 2.0.

The Street Medicine Institute is now providing street medicine services in 85 cities across 15 countries including the United States, India, and many Western European countries. The Institute is pushing for similar laws to also be passed in other parts of the world to support street medicine efforts and communities of people experiencing homelessness.

In California, AB-369 will help support over two dozen programs across the state, the biggest being in LA. Funding for street medicine will increase accessibility to these services and improve the quality of these services as well. In the long run, it will hopefully also increase discussion about improving the healthcare of people experiencing homelessness, especially by ending homelessness itself.