Marcel Slockers

118 Chapter 8 among homeless people in addition to unnatural death. 5 In our study, cardiovascular diseases were the second cause of death, and we also found a very high excess mortality due to infectious diseases and mental health problems. Studies of patterns of health problems or patterns of healthcare use among homeless people In the street doctor population we studied, the share of psychiatric diagnoses (43%) is the highest - mainly related to the use of alcohol and drugs - followed by the share of cardio- vascular diseases (15%) and endocrine problems (12%). Earlier research has also showed that psychiatric problems (also related to substance abuse and alcohol dependence) and car- diovascular diseases account for a significant share of registered diagnoses. 5,15 The fact that the share of endocrine disorders (especially diabetes) is as large as in the Rotterdam study has not been reported before. However, a recent review did show that chronic diseases such as arthritis, diabetes, HIV and intestinal diseases are common and should have medical attention as they require continuity and good accessibility of care. 16 Studies on the impact of social policy measures on health problems and mortality among homeless people After the implementation of social policy measures in the period 2006-2010, we did not observe significant changes in the overall mortality among homeless people in Rotterdam. However, a significant halving of mortality from intentional injuries (homicide and suicide combined) was shown after the implementation of these measures. Social measures appear to influence the cause of death pattern among homeless people: less mortality from acute unnatural causes and more mortality from chronic conditions. Shifts in the cause of death patterns of homeless people from acute to chronic causes have also been reported in international literature. Among homeless people in Philadelphia who received housing, only 15% died an unnatural death, as compared to 49% of those who remained homeless. 17 The mortality from cardiovascular diseases among housed homeless people increased from 30 to 51%. 1 Improved accessibility of healthcare in Boston led to a decrease in mortality from AIDS, but to an increase in the number of fatal overdoses, combined with an unchanged overall mortality rate. 18