Street Population and Health: Challenges of Care Amid Social Vulnerability

Abstract

The homeless population (HP) in Brazil increased by 45% between 2020 and 2023, reaching 221,113 individuals, 25% of whom reside in São Paulo municipality alone¹. This number, however, may be underestimated since many individuals in this condition are not properly registered. Among the main factors leading to homelessness, data from the Ministry of Human Rights and Citizenship indicate that family problems were cited as the primary reason by 44% of these individuals, followed by unemployment (38%) and alcohol and drug use (28%)¹.

These determinants contribute to the susceptibility to diseases and higher mortality within this population, as they exacerbate vulnerabilities due to the absence of family support, precarious living and hygiene conditions, financial insecurity, and the context of trauma and violence²^,³^,⁴. For instance, chronic illnesses such as diabetes mellitus, hypertension, and cardiovascular diseases exhibit higher morbidity and mortality rates among the HP⁵ compared to the general population. Furthermore, there is significant exposure to a wide range of infectious diseases⁶.

An aggravating factor in this scenario is the difficulty in accessing the healthcare system, which deprives this population of preventive measures and adequate primary care. Even in cases where some access exists, public health services are not always effective in providing care and support for the HP. This inefficiency stems from factors such as social discrimination, lack of treatment continuity, challenges in obtaining and storing medications, and issues in understanding their correct usage. Together, these elements directly contribute to higher mortality rates within this population.