People experiencing homelessness and those at risk of homelessness are among Australia’s most socially and economically disadvantaged (see Glossary). Homelessness can result from many factors, such as whether a person is working, experience of family and domestic violence, ill health (including mental health) and disability, trauma, and substance misuse (Fitzpatrick et al. 2013).
Homelessness can expose people to violence and victimisation, result in long-term unemployment and lead to the development of chronic ill health. Some health problems can cause a person to become homeless. For example, poor physical or mental health can reduce a person’s ability to find employment or earn an adequate income. Alternatively, some health problems are a consequence of homelessness, including depression, poor nutrition, poor dental health, substance abuse and mental health problems. Recent studies have also found that people experiencing homelessness also experience significantly higher rates of death, disability and chronic illness than the general population (Australian Human Rights Commission 2008).
On Census night in 2016, more than 116,000 people enumerated in the Census were homeless, up from 102,000 in 2011. Of these, 58% were male, 58% were aged under 35, and 20% identified as Aboriginal and Torres Strait Islander Australians (ABS 2018). Almost half (44%, or 51,100) were living in severely crowded dwellings, more than 21,200 (18%) were living in supported accommodation for the homeless, and 8,200 (7.0%) were sleeping rough. The rate of homelessness has fluctuated over time—from 51 per 10,000 population in 2001 to a low of 45 in 2006, increasing to 48 in 2011 and 50 in 2016 (ABS 2018).
The General Social Survey provides additional information on people experiencing homelessness in Australia. In 2014, an estimated 2.5 million people aged 15 and over had experienced homelessness at some point in their lives; 1.4 million of these had experienced at least 1 episode of homelessness in the previous 10 years, and 351,000 had experienced homelessness in the previous 12 months (ABS 2015).
Of those who had experienced homelessness in the previous 10 years:
- 1 in 7 (14% or an estimated 198,000 people) reported the tight housing market/rental market as the reason for their most recent experience of homelessness
- 13% (an estimated 190,000 people) reported financial problems as their reason for experiencing homelessness.
Information is also available from government-funded specialist homelessness services (SHS) across Australia that provide services supporting people who are experiencing homelessness or who are at imminent risk of homelessness. In 2020–21, around 278,300 clients received assistance from SHS, with around 111,100 clients homeless when they first began support (AIHW 2021).
For further information about the profile of people experiencing homelessness and the support provided by specialist homelessness services, see Homelessness and homelessness services.
While the causes of homelessness vary, there is a growing amount of research on the impact of insecure housing on health, and the associated costs to the health system (Davies & Wood 2018; Zaretzky & Flatau 2013). There are various forms of homelessness, including rough sleeping (the most visible form of homelessness), couch surfing, short-term or temporary accommodation, and severe overcrowding.
Meeting basic physical needs such as food, water and a place to sleep can be the most important day-to-day priority for people experiencing homelessness, especially those rough sleeping, and subsequently health needs are often not considered until an emergency arises (Wise & Phillips 2013). While rough sleeping is the least common form of homelessness in Australia (ABS 2018), the longer-term impacts of rough sleeping on health are typically more profound due to issues such as poor nutrition, living in harsh environments and high rates of injury (Fazel et al. 2014).
Severe overcrowding is a less obvious, but most common, form of homelessness in Australia, and is associated with different health impacts. For example, severe overcrowding places stress on the infrastructure of the dwelling, such as food preparation areas, bathrooms, laundry facilities and sewerage systems. It may lead to more rapid transmission of infectious disease and induce psychological stress (AIHW 2014).
Regardless of the form of homelessness, international research on the gap in life expectancy consistently reveals large differences among those who are experiencing homelessness compared to those who aren't—more than 30 years in the United Kingdom and the United States (Maness & Khan 2014; Perry & Craig 2015), and more than 10 years for people in marginal housing in Canada (Hwang et al. 2009).
More recent research has shown that much of this gap is due to conditions which could be effectively treated with appropriate health care (Aldridge et al. 2019). A study from Scotland found that interactions with health services increased in the years prior to becoming homeless, with a peak in interactions around the time of the first assessment as homeless—particularly for services related to mental health or drug and alcohol misuse (Waugh et al. 2018). The authors submit that the pattern of health service use suggests that health services could play a role in preventing homelessness by identifying risk factors, and early intervention.
Self-assessed health
In 2014, an estimated 1 in 4 (26%) people in Australia who had ever experienced homelessness assessed their health as fair or poor, compared with 14% of those who had not experienced homelessness (ABS 2015). (Note that the data source is limited to people who had experienced homelessness but who were living in private dwellings at the time of the survey.)
In general, a higher proportion of people who reported at least 1 experience of homelessness had a health condition or disability compared with those who had never had an experience of homelessness (Figure 1). People who had experienced homelessness were more likely to report having a mental health condition or a long-term health condition, with depression, back pain or back problems, anxiety and asthma the most commonly reported long-term conditions.
