Marcel Slockers

63 The effects of the Action Plan for Social Support on the health of homeless people Introduction Mortality in homeless people is generally 3–5 times higher than could be expected given their age and sex. 1–13 This has raised a call for more sustained efforts to improve the health of this vulnerable group. 10 In 2006, the Dutch Government, together with the four major Dutch cities (Amsterdam, Rotterdam, The Hague and Utrecht) started an ambitious programme to guide all homeless persons into temporary care and social rehabilitation and subsequently into clustered or individual supported housing projects, with social education training and guidance into jobs. Since 2006, substantial local policy efforts have been made in Rotterdam, which have led to large improvements of the living conditions of homeless people in this city. In 2010, a policy evaluation showed that in Rotterdam, 3634 homeless persons had started an individual help trajectory and 2108 homeless people had been provided with housing for at least 3 months, were acquiring a legal income and had stable contacts with community services. 14 The aim of this article was to assess whether mortality among homeless people decreased after 2006, in response to the policies that improved their living conditions. Methods We conducted a register-based 10-year follow-up study of homeless adults (aged 18 + years) who visited one or more institutions providing care to homeless people in Rotterdam in 2001. Institutions providing services to homeless people ranging from the provision of meals to night care facilities and convalescence care were approached to provide full name, date of birth and sex of persons who visited their facility in 2001. This information was largely available because in 2001 homeless people were counted for research purposes. 15 Both institutions subsidized by the local government and services provided by the church were included, covering services at different locations in Rotterdam. Pooling the lists of different facilities and removing duplicates yielded a cohort of 2130 persons, 1870 men and 260 women. Details on how the cohort with homeless people was identified have been described elsewhere. 16 Data on mortality within this cohort were extracted from the municipal population registers with national coverage, extended with other registries (i.e. from general practice, health insurance and municipal public mental health care). Poisson regression with offset (days at risk) was used to assess the association of mortality with period/calendar year. For this purpose, follow-up time of homeless people was split into 1-year periods of follow-up time by age (in complete single-years), and calendar year and sex were added. Poisson regression yields rate ratios, which in our model indicate the increase/decrease in the mortality rate relative to the reference category (e.g. up to