[Health status and medical care accessibility of single, homeless persons].

The homeless population in Germany is continually increasing. Featuring prominently among those on the increase are women, young persons and homeless people from East Germany. Studies of the health of homeless individuals in recent years show that indices of illness are far higher for many disorders than for comparable groups who are housed. One result from a recent study by the University of Mainz (1994) was that more than 90% of homeless people urgently need medical treatment. According this research, the main health problems of the homeless are: cardiac disease (hypertension, CAD) (52.5%), skin disease (scabies, lice, leg ulcers, abscesses, pyodermias) and acute infections (50%), lower respiratory tract (COAD) (47.5%) and trauma victims (50%), followed by liver (30%), kidney (25%) and gastrointestinal diseases (GU) (20%). The problems of alcoholism and mental disorders of various sorts are added to this picture. Violence to homeless people is increasing. A lot of homeless people are multi-morbid. The relationship between the time of homelessness and the state of illness was not linear. It was found that in the beginning of homelessness most of the homeless people were in a poor physical condition. The poor physical condition of homeless people does not stem from only one cause, but results from a combination of different factors: individual social conditions (social class; social relations; sedentary lifestyle), personal or family life crisis (life events and coping behaviour), the individual risk behaviour (for instance the bizarre sleeping accommodations, alcohol and cigarette consumption unemployment in a depressed economy, structure of the society (cutbacks in government welfare and social service programmes). As a result of bad experiences with existing medical institutions, homeless persons do not consult the doctor or too late. Many are afraid of large institutions; most are not members of a health insurance scheme (uninsured); and many are perceived in some sense to be "undesirable" as patients. Medical care offers for homeless people must be re-examined and changed appropriately in accordance with the requirements of the patients and the acceptability of the measures. Health care for the homeless is sorely needed. It is an urgent necessity to create special low-level acceptance medical care institutions. This health care service should be made available to homeless persons at the places where they gather (to set up a mobile medical service, medical streetwork, medical care ambulances). The interdisciplinary theme approach, which integrates the skills of physicians, nurses and social workers, is an invaluable strategy for establishing though and continuous care. Without good health, homeless people cannot resolve their other basic problems; and people simply cannot be healthy if they do not have a stable place to live.