A 2005 estimate placed the number of homeless people in America at 744,000 but many believe the actual number is higher. Indeed, today's economic conditions and issues surrounding home foreclosures may place an even greater number of people at risk for homelessness. The face of homelessness is also quite different in California than throughout the nation. While nationally about 41% of the homeless are persons living in families, in Orange County that number is estimated at 70%. The staggering number of children in the emergency homeless shelter at the National Guard Armory in Santa Ana appalled me as a pediatrician and parent.

While public health concerns regarding the homeless once focused on communicable diseases like tuberculosis, awareness of the burden of chronic diseases among those without permanent homes is increasing. In one study, 46% of the homeless reported chronic conditions such as high blood pressure or diabetes. Because preventive care and disease management services are universally unavailable to the homeless, many end up in emergency rooms with complications and, once hospitalized, have a length of stay that is 36% longer than that of low income, non-homeless individuals. Sadly, another study found that homeless adults have an age-adjusted mortality rate nearly four times that of the general population.

The Orange County Health Care Agency works with other local organizations to build a public-private partnership to provide the healthcare resources needed by homeless families and individuals, while participating in the development of a strategic plan that will address the broad spectrum of needs of the homeless. The Health Care Agency has developed a Comprehensive Health Assessment Team for the Homeless (CHAT-H) consisting of a Public Health Nurse and a Behavioral Health Nurse Specialist. This team has focused on the homeless population including those individuals that find winter shelter at National Guard Armories in Santa Ana and Fullerton. The County's Social Services Agency has provided a Benefits Specialist to assist individuals in the enrollment process for public health care programs and efforts are underway to integrate other community partners into CHAT-H.

Another important part of this process is to raise awareness of the multiple issues faced by those who are homeless. Because there is no better way to understand a problem than to experience it first hand, we take representatives of healthcare organizations and other interested community groups to homeless shelters. At the shelter, they see people who differ tremendously from the stereotypical picture of the homeless portrayed in movies and television. Individuals ranging from a one-week old infant to a person in their seventies or eighties can often be seen, providing a glimpse into the complex medical problems faced by not only the patients, but also by those delivering services in this stark environment.

Since CHAT-H was formed in May 2007, much progress has been made. Organizations including Kaiser Permanente, CalOptima, UCI Medical Center, Children's Hospital of Orange County and others are bringing needed resources to this countywide effort. The Health Funders Partnership of Orange County recently convened a meeting attended by more than 80 people who will play vital roles in this effort. Our hope is that a strong health care component will emerge to bolster the existing network of services available to those in Orange County who do not have a permanent home. We have been very encouraged by the enthusiastic response of community partners and their sincere interest in serving the homeless.

Whether you live in Orange County or another region of Southern California, there are homeless individuals with challenging medical needs in your community who need your assistance. Volunteers including physicians, nurses, mental health professionals, medical students and others make valuable contributions to meeting the health care needs of the homeless. Please feel free to contact me by email at ehandler@ochca.com for more information on how you or your organization can help.

Eric G. Handler, MD, MPH, is health officer for the Orange County Health Care Agency. His previous experience includes serving as the deputy secretary for Children's Medical Services in the Florida Department of Health and as chief medical officer for the Boston Regional Office of the Centers for Medicare and Medicaid Services. Dr. Handler received his medical degree from Chicago Medical School and completed his pediatrics training at LAC+USC Medical Center.