This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.



Background: Homeless people are at high risk for illness and have higher death rates than the general population. Patterns of mortality among homeless men have been investigated, but less attention has been given to mortality rates among homeless women. We report mortality rates and causes of death in a cohort of women who used homeless shelters in Toronto. We also compare our results with those of other published studies of homeless women and with data for women in the general population.

Methods: A cohort of 1981 women not accompanied by dependent children who used homeless shelters in Toronto in 1995 was observed for death over a mean of 2.6 years. In addition, we analyzed data from published studies of mortality rates among homeless women in 6 other cities (Montreal, Copenhagen, Boston, New York, Philadelphia and Brighton, UK).

Results: In Toronto, mortality rates were 515 per 100 000 person-years among homeless women 18–44 years of age and 438 per 100 000 person-years among those 45–64 years of age. Homeless women 18–44 years of age were 10 times more likely to die than women in the general population of Toronto. In studies from a total of 7 cities, the risk of death among homeless women was greater than that among women in the general population by a factor of 4.6 to 31.2 in the younger age group and 1.0 to 2.0 in the older age group. In 6 of the 7 cities, the mortality rates among younger homeless women and younger homeless men were not significantly different. In contrast, in 4 of the 6 cities, the mortality rates were significantly lower among older homeless women than among older homeless men.

Interpretation: Excess mortality is far greater among homeless women under age 45 years than among older homeless women. Mortality rates among younger homeless women often approach or equal those of younger homeless men. Efforts to reduce deaths of homeless women should focus on those under age 45.¹

Jackie, Hunts Point. Courtesy of Chris Arnade.

Jackie died of an overdose, they say. Rumors can't wrap well around the simple act of injecting too much, but they try, spreading out in tendrils of a dozen wandering voices.

The sense of disbelief manifests in talking about it, in saying you do the same things that she did, buy from the same dealers, did drugs for the same span of time. You talk about it while looking for dates to buy your next hit. Overdose becomes diabetic shock becomes something involving lupus.

Most likely what happened involved heroin, but no one was there to take part in the act. No one to witness or to have purposefully inflicted harm. This isn't a snatched-on-the-track-cut-into-pieces death rumor.

Truer things are often quieter.

It happened inside a big apartment building, in a one-bedroom that operated as a crack house along the truck route. Someone went into the apartment and called 911, and that's it.

No one in Hunts Point is family. No one was real husband or wife. No one knows what happened medically or has access to such information. After all, they're not family; they're only those with which she's spent the last years.

No one has a cell phone and access to city numbers to call between 9 a.m. and 4:30 p.m. Monday through Friday, to tap numbers to be transferred between departments, to find someone in the medical examiner's office willing to buck the legal rules to help a dead woman's desperate friend. Can it be confirmed that she died? Can you say where her body is?

No one knows Jackie's last name. You know her last court date, whether or not she has a warrant, the abuse she's endured from men she's known, what she wanted to do in life: become a nurse, regain custody of her kids from the state. Who cares about such a trivial thing as a last name? You care about matters of immediacy, whether she was sick from withdrawal or if she found a new place to stay.

No one knows who or where her family is, whether someone will claim her body at the city morgue, or whether she's already been taken to potter's field on Hart Island.

To call the system is to be reminded that you're not real family, that you don't count, even if you don't know where those who do count are, if they exist at all. What are you trying to do, calling? What's your angle? The voices on the phone tell you those things.

What is family?

Jackie, Hunts Point. Courtesy of Chris Arnade.

In memory of Jackie, in honor of her family in Hunts Point: 9/16/91 - 8/8/14


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