Each year, an estimated 5,800 to 46,500 lives are taken due to homelessness in the United States. In 2023, homelessness increased by more than 12%, and this statistic is continuously increasing.
Homelessness isn’t just a housing crisis — it also has profound implications for public health. Individuals experiencing homelessness face significantly higher rates of chronic illnesses and mental health disorders, yet often struggle to access necessary medical care. Healthcare access remains a significant challenge in many areas of Nashville, disproportionately impacting marginalized communities and those that live in rural areas. About 60% of individuals experiencing homelessness don’t have health insurance and 73% have reported at least one unmet healthcare need in the past year.
Street medicine refers to a medical care approach aimed primarily at people who deal with homelessness that takes place outside the walls of a traditional medical clinic. People have been advocating for such programs since the 1980s, pushing for initiatives where healthcare providers can meet homeless individuals where they are. Since 2009, the Street Medicine Institute (SMI) has been at the forefront of facilitating and enhancing healthcare opportunities to unsheltered homeless. With programs in over 27 countries and 140 cities, including Nashville, the SMI has become a global leader in equipping communities with services worldwide. The SMI also started a Student Coalition in 2018 where students can participate in promoting person-centered care for local homeless community members.
Recognizing the need for such initiatives, hospitals around the nation, including Vanderbilt University Medical Center, have started to establish “street medicine” programs that will provide basic healthcare services to the homeless. Assistant Professor of Clinical Emergency Medicine at Vanderbilt University Medical Center Dr. Chase Palisch has been at the forefront of such initiatives. Every Thursday, Dr. Palisch goes out and provides street medicine to those in the community. Usually this includes checking in on patients with housing insecurity who had previously been in the Emergency Department prior. Vanderbilt has also developed a program known as the Vanderbilt Homeless Health Service, which began two years ago with Dr. Jennifer Hess. The newly developed program is dedicated to delivering both medical and psychiatric care to individuals experiencing homelessness. The team has also formalized community partnerships for the program.
Neighborhood Health, a community health center located in Nashville, has also been an invaluable resource. They began their program during the pandemic and have only expanded their services since. Today, their street medicine team goes into the city and provides mental health services to and monitors chronic diseases in patients. The team includes doctors, registered nurses, and a patient navigator who connects people to other services.
The key to street medicine is relationship-building. Many individuals experiencing homelessness have faced past discrimination or neglect within previous healthcare settings. However, street medicine is all about ensuring patients feel at ease by delivering care directly in the environments they know best, addressing their primary concerns. Instead of a one-size-fits-all approach, street medicine uses a team-based model. Medical professionals, mental health experts, and social workers collaborate to provide comprehensive, person-centered care.
As Nashville continues to grow, so does its interactions with homelessness. Therefore, expanding and sustaining street medicine initiatives will be crucial in ensuring that healthcare is a right and accessible to all.
References
Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100(7), 1326–1333.
“Homeless Mortality Data Toolkit.” National Health Care for the Homeless Council, Jan. 2021.
Street Medicine Institute. (n.d.). Street Medicine Institute. Retrieved May 23, 2025, from https://www.streetmedicine.org/:contentReference[oaicite:3]{index=3}
Wen, L. S., Hudak, J., & Hwang, S. W. (2024). The role of street medicine and mobile clinics for persons experiencing homelessness: A review of the literature. International Journal of Environmental Research and Public Health, 21(7), 760. https://doi.org/10.3390/ijerph21070760
