Earlier this year, the Maricopa County Office of the Medical Examiner released a grim statistic: 732 people died while homeless in 2022, a 42% increase from 2021.
Valley health care providers who serve the homeless population agree that summer months are especially dangerous for those without shelter. But they add that chronic medical conditions and drug use contribute to the alarming increase in deaths among those experiencing homelessness.
Dr. Mark Bueno, outreach medical director for Circle the City, said he treats a lot of burns and dehydration cases, especially in July.
“We tend to see a lot of exacerbation related to heat if our patients don’t have adequate shoes or they’re just going out shoeless,” Bueno said. “They tend to develop burns, so we offer wound care for our patients.”
He said he also treats severe dehydration that manifests in what he called acute kidney injury.
“We see a lot of that, especially if the patient has underlying heart failure or any other disease that requires diuretics,” Bueno said.
Circle the City operates two outpatient care clinics and two medical respite care clinics in Maricopa County as well as several mobile units that provide free or low-cost health care to people experiencing homelessness.
Street Medicine Phoenix, a volunteer clinic run by health care professionals and students from Arizona’s three public state universities as well as Mayo Clinic, Midwestern University and Creighton University, offers care to individuals experiencing homelessness directly where they are, including shelters, encampments or on the street.
Dr. Robert Fauer, medical director for Street Medicine Phoenix, said while heat-related ailments are common in the summer, underlying health issues as well as emotional and psychological concerns plague more people during the hot months.
He said the heat “makes people more irritable or less apt to accept help. It’s like they’re so irritable they’re in a sense compromised, just trying to manage and acclimate.”
In addition, he said, many homeless people are compromised because of chronic substance abuse, and the heat only makes things worse.
Of the 732 homeless people who died in 2022, 463 deaths, or 63%, were drug related and 170 deaths, or 23%, were heat related, according to the medical examiner’s office.
Catherine Miller, a health education and promotion professional for Street Medicine Phoenix, said their teams measure overall health and underlying medical issues, not just urgent needs.
“We see a lot of people … trying to manage diabetes, high blood pressure or stroke, a whole slew of chronic illnesses,” she said. “They have higher morbidity than the normal population, and they’re less equipped to deal with heat and extreme heat. So it’s compounded effects together.”
Helping homeless individuals manage their chronic illnesses is a big reason why Street Medicine Phoenix seeks out those in need.
“In the encampments specifically, we go up to people living in tents, and the majority of them are unwilling to leave their tents,” Miller said. “Sometimes they live alone, and they don’t want their things stolen. They’re scared of getting assaulted because there’s a lot of violence there. Sometimes they’re disabled, and they can’t leave their tent. The people who do need the care most often are the ones who aren’t getting health care from a clinic.”
Of the 425 heat-associated deaths reported in Maricopa County in 2022, 56% occurred among individuals experiencing homelessness.
Fauer said those numbers don’t show the magnitude of the problem, as they don’t include emergency services provided to homeless individuals for heat-related injuries.
“You can imagine how many people go to the emergency room due to dehydration, burns or other heat-related illnesses, so I’m not sure death is the best end point to look at the volume of injury that this is causing,” he said.
Miller said she would like to see more preventative care for people experiencing homelessness during the summer months.
“The idea is that they don’t have to receive health care necessarily if they’re getting preventative care,” Miller said. “You want to prevent illness and death and not just treat it afterwards.”
Fauer said he would like to see a bigger emphasis on improving health literacy and educating homeless individuals how to use supplies to prevent heat-related illness.
“Last year, we must have distributed 1,000 cooling towels, which would cover the entire encampment downtown, and at least 500 hats,” he said. “You can count the number of people wearing those hats on two hands. They have supplies and don’t use them. It’s similar to someone with high blood pressure not getting their high blood pressure treated, or diabetics not taking their medication. So when they are given tools, there’s something about health literacy, and that keeps them from using it properly.”
Bueno said he believes the way to decrease homeless deaths is through shelter and hydration.
“I would love to see some sort of shaded shelter system for all these people,” he said. “There are people out here in tents, but some of them don’t even have tents, and they’re just sleeping outside. We also have hydration areas that should be utilized. People who are working out here on foot should have a pretty good idea of where to send patients for heat relief.”
That’s why Bueno said clearing up “The Zone” in downtown Phoenix will negatively affect the health care being provided to people experiencing homelessness.
“When people are going to be dispersing from here, you have to question where they’re going to go. They’re going to go further away from here, further away from the services. They tend to be more vulnerable.”
Zephaniah English-MacConville said he has lived in “The Zone” for more than a year and recently had to call 911 because he was struggling with the heat.
“It was so hot that … I called the police on myself,” he said. “I feel like my lung is out of my body right now.”
Bueno said he wants people to realize that there are homeless individuals living in these conditions. Even if you are perfectly stable at home, the heat can have a negative effect, he said.
“It’s just worse when you’re out here,” he said. “I would hope that people try to empathize with these people. If they can offer things like bottled water to community organizations that would be most helpful.”
