In 2022, over 500,000 people in the United States found themselves homeless, without a permanent shelter to offer a sense of stability in their lives. This poses a far-reaching problem for the individuals who find themselves in this situation, but also for our society as a whole.

Homelessness can be caused by a combination of factors, such as poverty, unemployment, lack of affordable housing, mental and substance disorders, trauma,, and violence, just to identify a few.

Poor health can be a contributing factor to homelessness (the inability due to poor health to consistently hold down a job to cover living costs). Simultaneously, being homeless may lead an individual on a path where their exposure to various health risks increases, such as HIV, lung diseases (bronchitis, tuberculosis, pneumonia), malnutrition, and substance use problems.

A person who is homeless and suffers from chronic health conditions such as high blood pressure, diabetes, or asthma faces an uphill battle in finding access to services where they can secure healthcare to keep these diseases consistently under control. Behavioral health issues such as drug use, alcoholism, and depression can also develop or intensify, especially if one sees no way out of the struggle they are in and loses any hope for a more secure future.

Even if medical services are coordinated for a homeless individual, they will generally prove ineffective if this same individual has their health continually at risk due to living in a dirty back alley of a city or, if they are lucky, in a homeless shelter. Continuity of healthcare is nonexistent.

Let us take a close look at someone who finds themselves without permanent shelter, without a place to call home, who is living in the shadows of life.

Deep furrowed lines, entrenched in sorrow and despair, encircle the forehead. Sadness fills their dark eyes, searching for glimmers of hope. Scruffy hair, shades of gray and white, protrudes from under a tattered knit cap. An overgrown beard covers the face, camouflaging sunken cheekbones, evidence of too many missed meals. Tattered jeans and an old pair of Jack Purcell’s, courtesy of Goodwill.

Treasures kept in a garbage bag are slung over the shoulder as they move about the dirty city streets, searching for a safe place for the night.

“Must keep moving. Keep moving. Where can I get the next meal? Where can I hide so the cops don’t get me? Existence is day-to-day, moment-to-moment.”

Each day blends into the next … survive … survive. No tears are shed; they must stay strong … survive … survive.

Scared but not showing it. Haunting memories of a life that once was but no longer is … push them away … stay strong.

They shelter under a bridge to fitfully sleep until the sun shakes the sleep from their body. Homeless. Alone. Invisible. Surviving in the shadows of life.

How do we react when we see a homeless person? Do we look the other way? Do we cross the street to avoid interaction? But for the grace of God, we might find ourselves one day in this situation. How would we want to be treated … as underlings of society? Homelessness is a problem within America and many other so-called civilized countries around the world. It impacts the quality of life and certainly the health of the unfortunate individuals who find themselves in this situation. We must do better as a society to find more viable solutions to the problem of homelessness … for the survivability of our society as a whole depends on it. I recall the words of Mother Teresa, “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” Positive change can begin with you and me casting that stone across the waters. Godspeed, everyone.

Michele Luckenbaugh is a patient advocate.