Health care beyond clinic walls — sustaining and scaling up street medicine

Roughly 650,000 people experience homelessness at any given time in the United States, of whom approximately 40% are unsheltered, according to a point-in-time count conducted by the Department of Housing and Urban Development during January 2023. The unsheltered homeless population has reached its largest size since national reporting began in 2007. People who are unsheltered lack safe and stable housing, and many of them reside in locations that are unsuitable for human habitation, such as on sidewalks and in vehicles. Emerging evidence highlights the poor health outcomes in this marginalized population. For example, a prospective cohort study conducted in Boston between 2000 and 2009 found that all-cause mortality among unsheltered homeless adults was nearly 10 times as high as all-cause mortality in the nonhomeless Massachusetts population and nearly three times as high as that among sheltered homeless adults. Unsheltered homeless adults have largely been overlooked by the health care sector and have limited access to primary care and other essential services.