Homeless Persons’ Memorial Day & One Roof’s Vulnerability Survey

This Saturday, December 21 is National Homeless Persons’ Memorial Day. Two weeks ago, the body of Christopher Kelley Winstead, a man experiencing homelessness in our community, was found in Southside. Mr. Winstead appeared to have been dead for several weeks. The cause of his death is unknown and it’s unclear whether or not his death was preventable, but we at One Roof do know this: if Mr. Winstead had been stably housed, he would’ve been able to pass with dignity. We believe that all people deserve safety and stability, and this includes passing with dignity. No one deserves to die in the street.

This fall, One Roof partnered with students from UAB’s Inter-professional Global Health Service Learning program to pilot a vulnerability survey in three of our member agencies that provide emergency shelter: Firehouse, First Light, and Salvation Army. On a single night in early November, we surveyed around 150 persons staying in shelter to measure their vulnerability to death. We chose to pilot this survey in our emergency shelter population because, aside from our population staying on the streets, this population is perhaps the most vulnerable, the most unstable, and the most likely to have a serious, yet treatable or manageable health condition cause irreparable damage or death.

We found that nearly 1 out of every 4 persons surveyed is living with heart disease. These statistics are not necessarily surprising because we know that heart disease is a leading cause of death in the United States. However, a person experiencing homelessness is much more vulnerable to dying from heart disease than a housed person. Unlike a housed person living with heart disease, a person experiencing homelessness and living with heart disease may not have access to appropriate treatment and care, nutritious well-balanced meals (though they may have access to food), or routine cardio exercise. According to the Centers for Disease Control and Prevention (CDC), about half of Americans have one of the following three risk factors for heart disease: smoking, high blood pressure, and high LDL cholesterol. Additional risk factors for heart disease include diabetes, poor diet, physical inactivity, obesity, and excessive alcohol use. According to the National Health Care for the Homeless Council, one study shows that men aged 45-64 and experiencing homelessness are 40-50% more likely to die from heart disease than men aged 45-64 and stably housed. The authors of this study (full-text here) identified the following risk factors for persons experiencing homelessness:

  • extreme blood sugar fluctuations among those with diabetes due to poor diet and lack of exercise (even when taking medication)
  • inadequately treated or undiagnosed high blood pressure
  • inadequately treated or undiagnosed high triglyceride levels, possibly due to diabetes, alcohol usage, kidney failure or kidney disease
  • other health conditions caused by high rates of smoking, excessive alcohol use, and inadequate nutrition

As you can see, risk factors for heart disease are much higher for persons experiencing homelessness.  These risk factors, along with a gap in treatment and care, directly increase the vulnerability to death of persons experiencing homelessness and living with heart disease.

We also found that around 10% of people surveyed have experienced cold weather related conditions, including hypothermia, frostbite, and trench foot, and around 15% of people surveyed have experienced heat stroke/exhaustion. Persons experiencing homelessness are much more vulnerable to developing weather and exposure related conditions than stably housed persons (National Coalition for the Homeless). Think about it: a person living on the streets or in shelter doesn’t have unlimited access to warm, dry shelter in the winter or cool, dry shelter in the summer. A person experiencing homelessness doesn’t always have access to clean, dry clothing. This lack of resources, along with various risk factors and health conditions, directly increases the vulnerability of persons experiencing homelessness.

According to an article by Dean Carpenter (On the Front Lines: A Case of Trench Foot in a Homeless Woman), the following are risk factors for weather related injuries in persons experiencing homelessness:

  • alcohol use, which decreases the awareness of symptoms of cold-related injuries
  • nicotine use, which restricts blood flow and causes extremities to get colder faster
  • nerve damage due to diabetes or alcoholism
  • poor nutrition and dehydration
  • ill-fitting shoes, stockings, or socks, all of which restrict circulation to the feet
  • no access to clean, dry socks and warm shelter

We assessed our homeless population’s history of weather related conditions because this is a key part of understanding the vulnerability of persons experiencing homelessness in our area. As noted in a study by Dr. Jim O’Connell of Boston Health Care for the Homeless Program, persons experiencing homelessness with a history of hypothermia, frostbite, or trench foot are eight times more vulnerable to death than persons experiencing homelessness without these conditions.

In our community, we also had to consider injuries and conditions due to hot weather. Hydration is incredibly important for persons exposed to hot weather conditions. Joseph Rampulla notes that persons living with alcoholism or poorly treated diabetes are often chronically dehydrated, a condition worsened by exposure to extreme heat. Many persons experiencing homelessness may limit how much liquid they drink due to a lack of available public bathrooms in their community. For a stably housed person, having a place to use the bathroom is a given. For a person experiencing homelessness, drinking lots of water to stay hydrated means having to search for a bathroom and, often, being turned away. Without regular access to cool, dry shelter and public bathrooms, a person experiencing homelessness is much more vulnerable to hyperthermia and heat stroke.

One Roof believes that all people deserve safety, stability, appropriate treatment and care, and affordable housing, and it is our mission to prevent and end homelessness in our community. We believe that all people deserve to live healthily and die with dignity. As a community of service providers, concerned citizens, and advocates for some of the most vulnerable persons in our community, it is our responsibility to make sure that no person experiencing homelessness in our community dies on the street.

Please donate here to support our efforts to educate, advocate, and coordinate services in our community.


Josh Helms is an AmeriCorps member serving at One Roof as the Capacity Building Assistant.



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