Marcel Slockers

12 Chapter 1 almost a third (32%) aged 18 to 30 and almost a fifth (19%) older than fifty. More than half (57%) had a migration background and more than a third (37%) were staying in one of the four large cities in the Netherlands: Amsterdam, Rotterdam, The Hague or Utrecht. 1 Between 2009 and 2012, the estimated number of homeless people in the Netherlands between 18 and 65 increased by almost ten thousand people. In the subsequent years, homeless people increased by twelve thousand people. As a result, there was a large increase in the number of homeless people aged 18 to 65 from almost 18,000 in 2009 to around 39,000 in 2018. Also relatively seen, the years from 2009 to 2018 showed more than a double in the number of homeless people, with an increase of 17 to 37 per 10,000 inhabitants aged 18 to 65. The biggest rise in homelessness, a threefold increase, was found in people younger than 30 years and in people with a non-western migration background. 1 According to a report of the Rotterdam Ombudsman, 3,034 adults older than 23 and 999 younger people registered for homeless shelter. 8 1,015Adults were given a pass which gave access to shelter accommodation. Rotterdam has 37 places for young people in emergency accommodation, with an average waiting time of 45 days. Many of the young people have short episodes of homelessness and are couch surfers out of necessity. The Rotterdam Ombudsman blames the lack of shelter capacity. 2. What is known about mortality and health problems among homeless people, internationally and in the Netherlands? International literature often shows a shorter life expectancy among homeless people and a higher occurrence of health problems and accidents than in the general population. According to recent reviews, mortality rates among homeless people are three times as high as in the general population and excess mortality is highest among homeless people aged 25 to 44. 4,9 The effects of this excess mortality on life expectancy have not been reported often. In a large Danish study, lasting ten years, 32,711 homeless people aged 15-24 were observed. This study showed a shortened life expectancy of 21.6 years for men and of 17.4 years for women. 10 How specific causes of death contribute to this excess mortality has not yet been studied extensively. A limited number of studies in several countries has shown a higher percentage of mortality as a result of drug abuse, accidents, suicide and murder, psychiatric problems, infectious diseases and ischaemic heart diseases. 4,11,12,13,14 The prevalence of health problems and healthcare use among homeless people has only been documented in a limited number