In both medicine and the societal disgrace of homelessness, one maxim is true: Preventive care is always less expensive than end-stage care. This is why smart cities go with the Housing First philosophy — because supportive housing is less expensive in the long run than a decades-long succession of stays in shelters, hospitals and jails.
It goes without saying, that Housing First also greatly reduces the toll of human suffering, but that is not the argument that holds the most sway when presented to the government and other entities responsible for doling out dollars. In the medical arena, everyone agrees that preventing or aggressively treating diabetes is much preferable to letting it run its course — better for the patient, and infinitely better for the budget.
Thirty million Americans have diabetes. 17% of people experiencing homelessness, according to the House the Homeless Health Survey, are either diabetic or pre-diabetic. Adding to this unsolicited, self reporting statistic, it was coupled with solicited, self-reporting with 40% declaring high blood pressure,thus exacerbating the problem in that these negative health conditions often go hand in hand. House the Homeless President Richard R. Troxell says,
A large number of these people can positively affect their situation through dietary response; however, no one has thus far devised a methodology for consistently providing a good diet.
Diabetes is disordered insulin. Insulin helps glucose (sugar) to get into the body’s cells so they can use it for fuel. If the pancreas doesn’t make any insulin, a person has Type 1 diabetes. Usually, they’re born this way. They need multiple injections per day, and may even wear a high-tech (and very costly) computerized pump that analyzes the blood and automatically delivers the right amount of insulin.
Type 2 diabetes is probably preventable, but a lot of people get it anyway, from less than optimal eating habits or other precipitating causes. Sometimes it can be handled with oral medication, but if it’s serious enough to require insulin, there are no pills, only shots.
It isn’t always easy to keep thing in balance. Either too much blood sugar (hyperglycemia) or not enough of it (hypoglycemia) can put a person into a coma. When insulin is called for, the need is urgent. Diabetes can spawn other expensive and medical problems, including the amputation of a foot or leg.
The grim reality
Managing this disease is difficult enough for a housed, insured person. Imagine being on the street, confined to a wheelchair, with no choice but to eat food you know will make you sicker. An amputee who still has one foot is supposed to take very good care of it, and inspect it carefully every day for signs of trouble. Not so easy to do when you live under a bridge in an artificial cave. Picture being non-ambulatory, in constant need of injections, having to prick your finger and then stick a needle into yourself in filthy conditions.
Picture needing to get back and forth to a pharmacy with tedious frequency. Or to and from a medical facility for dialysis. The plight of a wheelchair-bound person experiencing homelessness is dire. Where and how do you wash your clothes and yourself? Even in cities with some sense of decency, how many handicap-accessible porta-potties have been set up?
Diabetes can also affect the eyes. Imagine being blind, with or without the amputation. To look at this situation is to see a lot of human suffering, and premature death, and unnecessary expense to the taxpayer. Creative innovation could make a big difference.
This has been the introduction to a difficult and complicated topic. Next week, we shine a light on some of the potential pathways toward getting this diabetes thing handled.