If you are reading this in Australia, your odds of living to the ripe old age of 81 are good, as that is now the average age of death in the country. Australia now has the third highest life expectancy globally. But this average masks a sobering three-decade gap in life expectancy for people who have experienced homelessness.
This is a disturbing but largely invisible national crisis, with Guardian Australia’s investigation revealing an average age of death of a mere 44 years after examining 10 years’ worth of coronial death notifications where homelessness was documented. These deaths are the tip of an iceberg as they only include those notified to a coroner and where homelessness or itinerant living was mentioned. From our tracking of deaths among people who have experienced homelessness in Perth, we know the true death toll is much higher. Since 2017 our research team based at the University of Notre Dame has recorded and verified more than 600 deaths in Perth alone, with an average age of 49 years.
While similar life expectancy gaps have been observed among homeless populations in the UK and the US, this provides no absolution of shame for Australia. It is not just the number and average age of deaths that is shocking. It is also that many of these premature deaths occurred in circumstances created by systemic failures across the housing, health and justice systems. Australia is a developed and comparatively affluent country but we have left those experiencing homelessness behind. This is a growing cohort living in the shadows, trying to avoid judgment by day and find safe places to sleep by night; often deeply scarred by childhood and adult trauma; and too often falling through the cracks of health and welfare systems.
There are some who will counter that homelessness itself does not appear on death certificates as the direct cause of death. But this is a moot point. The national commitment to close the gap in Indigenous life expectancy is premised on recognising a population left behind, and this has brought renewed focus to the underlying drivers of this disparity. Australia has also witnessed a growing response to deaths associated with family and domestic violence, and custody, and to suicides among veterans.
Why has there not been an outcry about the three-decade gap in life expectancy for people who have experienced homelessness? The dearth of visible data on their deaths is one reason. You can’t change what you can’t measure and, in most population health and mortality data, there is no “homelessness” flag.
In Australia and other developed countries, dying and death typically conjure images of interventionist healthcare, the bedside gathering of family and friends, and collective mourning for a life well lived. But this is often not the case if you are without a home and your life has been indelibly scarred by trauma. In death as in life, the invisibility of homelessness in our country is palpable – among the many Perth deaths we have verified in our research, newspaper deaths notices are rare.
These uncomfortable truths can lead to a paralysis around what can be done but there are cogent calls to action that the Australian government and its citizens can take up.
First, Australia is urged to follow the lead of England and Wales, where the Office for National Statistics reports annually on deaths among homeless people. This response was in fact taken after journalists shone a spotlight on homeless deaths.
Second, just counting and reporting on premature deaths among people who have experienced homelessness is not enough. We have to address “the causes of the causes” of health inequality. Safe, secure housing is a fundamental precursor to optimal health. Picture yourself living on the streets, seeking to stay safe, find food and somewhere to sleep each night. It is not hard to imagine how a healthy lifestyle and attending medical appointments become a lesser priority. We need to get serious about housing as a critical health and life-saving intervention. Although the crisis in affordable and social housing supply is receiving increasing attention, the public housing waitlists around the country remain enormous. Surely those with chronic health conditions and at risk of premature death warrant prioritisation?
Third, there is a complex web of systemic factors implicated in these premature deaths. In our WA research we see first-hand the barriers to preventive health screening and earlier health intervention for people who are homeless. Right now, for example, I am aware of several people with bowel cancer that was not detected early enough, either because of no address at which to receive the national screening kit or deep trauma that has prevented the next step of a colonoscopy.
The importance of bringing visibility to homeless deaths nationally cannot be understated. But even more important is that we individually and collectively act to change this.
Australia could lead the world in reversing the life expectancy gap for people experiencing homelessness but it takes bipartisan political will, inter-sectoral action and a groundswell of citizens who want the long life expectancy of Australians to be equally shared.
• In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
• Lisa Wood is a professor at the Institute for Health Research, University of Notre Dame, Western Australia
