Chapter Summary

Homelessness occurs when an individual lacks a regular, fixed nighttime residence. Poverty, lack of affordable housing and health care, domestic violence, and mental illness contribute to homelessness. Groups experiencing homelessness are twice as likely to experience many chronic diseases and disorders and are often exposed to communicable diseases, violence, malnutrition, and weather-related exposures. Overall, the health outcomes of individuals experiencing homelessness are far worse than their housed counterparts.

Veterans living in the United States have unique health needs and are more likely to experience trauma-related injuries, substance misuse, and mental health disorders than those who have not served in the military. Musculoskeletal injuries, chronic pain, and disability are common among veterans, along with depression, PTSD, and SUD, placing them at increased risk for suicide. Every veteran should be screened for depression and assessed for suicide risk. MST is associated with PTSD, eating disorders, dissociative disorders, and personality disorders. MST increases the risk for suicide and self-harm.

LGBTQIA+ individuals experience many health disparities and challenges. LGBTQIA+ adolescents are at high risk of experiencing bullying, dying from suicide, and using illegal substances. Sexual and gender minority groups, including individuals who identify as transgender, experience harassment, discrimination, and violence. LGBTQIA+ individuals have poorer overall physical and mental health, with higher rates of anxiety and depression, substance use, and suicide than their cis-heterosexual counterparts.

Migrant populations frequently experience poor continuity of care. Environmental and work stressors cause frequent bouts of illness and long-term debilitating health effects. Migrant families often face limited access to health care, language barriers, low education levels, and few economic or political resources. Communities of migrant farmworkers have high levels of poverty; very few have employment benefits. Migrant farmworkers have higher morbidity and mortality rates than the majority of the American population due to poverty, limited health care access, hazardous working conditions, and a lack of regulations.

Institutional discrimination, ableism, lack of disability cultural competency in health professional curricula, and systemic barriers in the health care system result in significant health disparities between individuals experiencing disabilities and those who are not. Individuals with disabilities face frequent barriers to care, such as an inaccessible physical environment, a lack of assistive communication technology, and negative attitudes. This population reports much higher rates of stress and depression than nondisabled individuals.

ACEs refer to traumatic childhood events, such as experiencing violence or neglect, that can have a lifelong negative impact on health. ACEs create toxic stress that disrupts the development of brain architecture and increases the risk for stress-related disease and cognitive impairment. The more ACEs an individual experiences, the higher their ACE score, and the more at risk they become for a variety of poor health outcomes.