Health and Safety - Health Of Homeless Children

The Urban Institute suggests that as many as 2% of American children are homeless in the course of one year. Doctor Catherine Karr, in Homeless Children: What Every Health Care Provider Should Know (National Health Care for the Homeless Council, December 29, 2003, http://www.nhchc.org/Children/index.htm [accessed July 28, 2004]), argues that these children suffer from frequent health problems. They are seen in emergency rooms and hospitalized more often than other poor children. The often crowded and unsanitary conditions they live in lead to a higher rate of infectious diseases, like upper respiratory infections, diarrhea, and scabies. Homeless children live in

TABLE 5.9

*Estimates are considered unreliable.
— Data not available.
1This table presents a summary measure of ambulatory and home health care visits during a 12-month period.
2Includes all other races not shown separately, unknown poverty status, and unknown health insurance status.
3Estimates are age adjusted to the year 2000 standard population using six age groups: Under 18 years, 18–44 years, 45–54 years, 55–64 years, 65–74 years, and 75 years and over.
4The race groups, white, black, American Indian and Alaska Native (AI/AN), Asian, Native Hawaiian and Other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 Standards. The 1999 race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards with four racial groups and the category "Asian only" included Native Hawaiian and Other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999 estimates can be seen by comparing 1999 data tabulated according to the two Standards: Age-adjusted estimates based on the 1977 Standard of the percent of persons with a specified number of health care contacts are: (no visits) identical for white and black persons; 0.1 percentage points higher for AI/AN persons; 0.4 percentage points lower for Asian and Pacific Islander persons; (1–3 visits) identical for white persons; 0.1 percentage points lower for black persons; 1.3 percentage points higher for AI/AN persons; 0.1 percentage points lower for Asian and Pacific Islander persons; (4–9 visits) identical for white persons; 0.2 percentage points higher for black persons; 2.2 percentage points lower for AI/AN persons; 0.4 percentage points higher for Asian and Pacific Islander persons; (10 or more visits) identical for white and black persons; 0.9 percentage points higher for AI/AN persons; and 0.1 percentage points higher for Asian and Pacific Islander persons than estimates based on the 1997 Standards.
5Poor persons are defined as below the poverty threshold. Near poor persons have incomes of 100 per cent to less than 200 percent of poverty threshold. Nonpoor persons have incomes of 200 percent or greater than the poverty threshold. Poverty status was unknown for 20 percent of persons in the sample in 1997, 25 percent in 1998, 28 percent in 1999, 27 percent in 2000, and 28 percent in 2001.
6Estimates for persons under 65 years of age are age adjusted to the year 2000 standard using four age groups: Under 18 years, 18–44 years, years, and 55–64 years of age. Estimates for persons 65 years of age and over are age adjusted to the year 2000 standard using two age groups: 65–74 years and 75 years and over.
7Health insurance categories are mutually exclusive. Persons who reported both Medical and private coverage are classified as having private coverage. Persons 65 years of age and over who reported Medicare HMO (health maintenance organization) and some other type of health insurance coverage are classified as having Medicare HMO. Starting in 1997 Medical includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP). The category "insured" also includes military, other State, and Medicare coverage.
8MSA is a metropolitan statistical area.
Notes: Some numbers is this table for health insurance estimates were revised and differ from previous editions of Health, United States. In 1997 the National Health Interview Survey questionnaire was redesigned. Data for additional years are available.
SOURCE: "Table 70. Health Care Visits to Doctors' Offices, Emergency Departments, and Home Visits within the Past 12 Months, according to Selected Characteristics, Selected Years 1997–2001," in Health: United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003, http://www.cdc.gov/nchs/data/hus/tables/2003/03hus070.pdf (accessed September 3, 2004)
Health insurance status6,7
Under 65 years of age:
Insured	14.3	15.4	14.1	49.0	48.6	49.1	23.6	23.2	24.2	13.1	12.7	12.6
Private	14.7	15.9	14.4	50.6	49.9	50.6	23.1	22.9	24.0	11.6	11.3	11.0
Medicaid	9.8	10.7	10.4	35.5	35.6	35.4	26.5	26.0	26.3	28.2	27.6	27.8
Uninsured	33.7	37.3	37.5	42.8	41.6	41.4	15.3	13.2	14.6	8.2	7.9	6.5
65 years of age and over:
Medicare HMO	8.9	5.7	5.0	35.8	34.2	30.0	33.1	34.6	41.1	22.3	25.5	23.9
Private	7.3	6.7	5.5	35.9	34.9	34.6	34.0	34.9	35.2	22.7	23.5	24.8
Medicaid	9.3	*7.3	6.1	19.2	21.4	18.7	27.9	34.8	31.6	43.7	36.5	43.5
Medicare fee-for-service only	15.5	14.0	14.1	34.0	35.8	30.5	28.1	31.0	34.2	22.4	19.2	21.2
Poverty status and health insurance status5,6,7
Under 65 years of age:
Poor:
Insured	13.7	14.6	14.0	38.8	41.4	41.1	24.5	23.2	24.9	22.9	20.7	20.0
Uninsured	36.7	39.8	43.2	38.8	39.3	34.6	14.9	12.6	15.3	9.5	8.3	6.9
Near poor:
Insured	15.6	17.0	15.8	45.5	44.9	44.7	22.3	22.6	22.7	16.6	15.5	16.8
Uninsured	34.5	38.0	35.3	41.8	40.2	40.9	15.6	13.4	16.6	8.1	8.4	7.2
Nonpoor:
Insured	13.4	14.7	13.6	50.3	49.1	49.8	24.2	24.2	25.0	12.1	12.0	11.6
Uninsured	29.1	32.9	31.9	45.4	43.7	46.0	17.0	14.6	15.5	8.4	8.8	6.6
Geographic region3
Northeast	13.2	12.8	11.8	45.9	46.4	47.2	26.0	25.6	26.6	14.9	15.2	14.3
Midwest	15.9	16.2	14.9	47.7	46.7	47.2	22.8	23.8	24.0	13.6	13.3	13.9
South	17.2	18.9	17.7	46.1	45.5	45.2	23.3	22.5	24.4	13.5	13.2	12.8
West	19.1	20.9	20.5	44.8	44.8	44.1	22.8	21.9	22.8	13.3	12.4	12.7
Location of residence3
Within MSA8	16.2	17.4	16.4	46.4	45.9	45.7	23.7	23.4	24.6	13.7	13.2	13.2
Outside MSA8	17.3	17.7	16.7	45.4	45.1	46.1	23.3	22.9	23.6	13.9	14.4	13.6

less structured and often unsafe environments, leaving them more vulnerable to accidents and injury. They tend not to have access to nutritious food, and are often malnourished or obese. Homeless children tend to lag behind their housed peers developmentally, and school-age homeless children often have academic problems. The greater likelihood that

TABLE 5.10

Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 1987–200 2
Characteristic	1987	1988	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999b	2000b	2001b	2002
aChildren are considered to be covered by health insurance if they had government or private coverage at any time during the year. Some children are covered by both types of insurance; hence, the sum of government and private is greater than the total.
bEstimates beginning in 1999 include follow-up questions to verify health insurance status and use the Census 2000–based weights. Estimates for 1999 through 2001 are not directly comparable with earlier years, before the verification questions were added.
cPersons of Hispanic origin may be of any race.
dGovernment health insurance for children consists mostly of Medicaid, but also includes Medicare, the State Children's Health Insurance Programs (SCHIP), and Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
SOURCE: "Access to Health Care: Percentage of Children under Age 18 Covered by Health Insurance by Type of Insurance, Age, Race, and Hispanic Origin, 1987–2002," in America's Children in Brief: Key National Indicators of Well-Being, 2004, Federal Interagency Forum on Child and Family Statistics, 2004, http://www.childstats.gov/ac2003/tbl.asp?iid=118&id=3&indcode=ECON5A (accessed August 24, 2004)
All health insurance
Total	87	87	87	87	87	87	86	86	86	85	85	85	87	88	88	88
Age
Ages 0–5	88	87	87	89	89	89	88	86	87	86	86	84	87	89	89	89
Ages 6–11	87	87	87	87	88	88	87	87	87	85	86	85	88	88	89	89
Ages 12–17	86	86	86	85	85	85	83	85	86	84	83	84	87	87	87	87
Race and Hispanic origin
White, non-Hispanic	90	90	90	90	90	90	89	89	90	89	89	89	92	93	93	92
Black	83	84	84	85	85	86	84	83	85	81	81	80	84	86	86	86
Hispanicc	72	71	70	72	73	75	74	72	73	71	71	70	74	75	76	77
Private health insuranced
Total	74	74	74	71	70	69	67	66	66	66	67	68	70	70	68	67
Age
Ages 0–5	72	71	71	68	66	65	63	60	60	62	63	64	66	66	64	63
Ages 6–11	74	74	75	73	71	71	70	67	67	67	68	68	70	70	69	68
Ages 12–17	75	76	76	73	72	71	69	70	71	70	69	70	73	73	72	71
Race and Hispanic origin
White, non-Hispanic	83	83	83	81	80	80	78	77	78	78	78	79	81	81	80	79
Black	49	50	52	49	45	46	46	43	44	45	48	47	52	53	52	50
Hispanicc	48	48	48	45	43	42	42	38	38	40	42	43	46	45	44	43
Government health insuranced
Total	19	19	19	22	24	25	27	26	26	25	23	23	23	24	26	27
Age
Ages 0–5	22	23	24	28	30	33	35	33	33	31	29	27	27	29	31	32
Ages 6–11	19	18	18	20	22	23	25	25	26	25	23	23	23	25	26	27
Ages 12–17	16	16	15	18	19	19	20	20	21	19	19	19	19	20	20	22
Race and Hispanic origin
White, non-Hispanic	12	13	13	15	16	17	19	18	18	18	17	16	16	17	17	18
Black	42	42	41	45	48	49	50	48	49	45	40	42	40	42	42	44
Hispanicc	28	27	27	32	37	38	41	38	39	35	34	31	33	35	37	40

FIGURE 5.2

homeless children come from families plagued by mental illness, drug use, and domestic violence negatively impacts their own mental health. Homelessness results in serious negative consequences for children's health.