Marcel Slockers

41 Health status of homeless people measured by mortality rates be more negatively selected than their male peers. But apart from selection processes also causation processes may play explain the even worse health situation of homeless women. Homeless, women may be more vulnerable to the adverse health effects of the social environment 33 and may experience more barriers to care. 35 The most vulnerable groups need to be reached, including women with mental health problems and excessive use of alcohol/drugs, for instance by better aftercare following detention or admission to psychiatric care. However, in general the overall excess mortality among homeless people is high. This also suggests the need for a broad approach. For example, in 2006 the Dutch government, together with the four major Dutch cities (Amsterdam, Rotterdam, The Hague and Utrecht) started a program to guide all homeless persons into temporary care and social rehabilitation and, subsequently, into clustered or individually supported housing projects, with social education training and guidance into jobs. Conclusion In this century, and even in the Netherlands with its relatively extensive social safety nets, homelessness is associated with substantially higher mortality and a dramatic loss in life expectancy. The disparity in mortality between homeless people and the general Rotterdam population is greatest for women and younger persons. Subsets of the general population who tend to have a survival advantage (i.e. females and younger ages groups) are those who are most adversely affected by homelessness. Author Contributions Analyzed the data: WJN CWNL. Wrote the paper: WJN. Conceived the study: MTS EFvB. Collected the data: LK CTS MTS. Provided critical input for revision of the manuscript: MTS EFvB LK CTS CWNL.