Health threats take many forms, and in 2019 Americans experienced the public health consequences of political discord, poverty, and unaddressed social needs. The complexity of these festering problems contributed to widening divisions over how to address them. Below are a few of the most compelling issues.
Crisis at the border. The separation of families and the lack of adequate health care for migrants at the U.S. border have had serious health consequences, including the deaths of seven migrant children in border patrol custody. Illness is prevalent in the detention facilities. Health authorities blame outbreaks of infectious disease on overcrowding and unsanitary conditions. Nurse volunteers from the Registered Nurse Response Network reported that some migrants had essential medications, such as asthma inhalers, confiscated, and that many lacked access to food and clean water. Children were reported to be sleeping in cages on concrete floors in windowless warehouse-like buildings. Many migrant children also turned out to be unvaccinated, leading to outbreaks of mumps, chicken pox, and influenza. Health care professionals have warned of lasting consequences for children traumatized by confinement under such conditions, including chronic medical complications, learning difficulties, and developmental problems. While reports of the housing and health care inadequacies have sparked public outrage and government investigations, political disagreements continue to stymie solution.
Gun violence. Mass shootings in 2019 in the United States continued a three-year trend of record-setting carnage, surpassing anything seen in the last half century. From an average of 5.7 lives lost per year in the 1970s, mass shootings in the current decade claimed an average of 50 lives per year. Overall deaths from firearms, including suicides, also have surged; in 2017, for the first time in U.S. history, these deaths exceeded deaths from motor vehicle accidents.
Firearm injuries are among the costliest nonfatal injuries to treat in hospitals. A study using 2013 data estimated costs at $1.6 billion in ED and inpatient care, and total economic costs, including lost wages and disability, at $16 billion annually. Despite the human and economic toll, funding for research into gun violence, its public health consequences, and prevention strategies has been scant.
Health care professionals frequently encounter patients injured by firearms and are thus well positioned to evaluate the scope of the problem and play a role in prevention. In 2019, 44 medical and public health organizations and the American Bar Association created a firearm injury prevention plan that asks health care providers to counsel patients about gun safety (see the October 2019 Journal of the American College of Surgeons).
Homelessness. The number of people living on the street or in temporary shelters has crept up since 2016, after dropping 15% over the previous decade, according to the U.S. Department of Housing and Urban Development (HUD). Over half a million people in the United States are currently homeless, according to HUD, with 35% living unsheltered on the street. The problem of homelessness is most acute in urban areas, notably New York City and Los Angeles.
Health care and homelessness are inextricably linked. Poor health-especially mental health-often leads to homelessness, and homelessness exacerbates existing health problems while sometimes creating new ones. Healing and recovery are difficult for patients who lack food and safe shelter. According to the National Health Care for the Homeless Council, homeless people suffer higher rates of illness and die on average 12 years sooner than the general U.S. population.
Nearly half of the nation's unsheltered homeless population live in California, prompting the state to pass a law mandating hospitals to provide for the safe discharge of homeless patients. Among requirements of the 2019 law: make sure patients have weather-appropriate clothing and, if possible, transport to a shelter, and provide referrals to health and mental health services as needed. Hospitals in other states are experimenting with a range of remedies. In Colorado, for example, Denver Health has partnered with the Denver Housing Authority to rehabilitate and convert an abandoned building into a shelter for discharged homeless patients. Hospitals nationwide are exploring similar options, which free up beds and cost less than hospitalization.-Lucy Wang Halpern