People excluded from mainstream society in high-income countries have a tenfold increased risk of early death, according to research from UCL, homeless health charity Pathway and an international team of experts.

The researchers found the mortality rate among socially excluded groups including homeless people, people who sell sex, prisoners and people who use hard drugs, was nearly eight times higher than the population average for men, and nearly 12 times for women. By comparison, mortality rates for 15–64 year olds living in the poorest areas of England and Wales are 2.8 times the rate of those living in the richest areas for men and 2.1 times the rate for women.

The two papers, published in The Lancet journal, highlight the extreme rates of death and disease faced by excluded people and lay out clear evidence for interventions that can help save lives and prevent people from finding themselves in such desperate situations.

The first paper shows that excluded people are more likely to be murdered or take their own life, but also more likely to die from accidents, overdoses, infectious diseases, cancers, liver disease, heart problems and respiratory diseases. In total, researchers analysed data from 38 countries with the UK, USA, Sweden, Australia and Canada providing the highest amount of data.

The lead author of the first paper, Dr Robert Aldridge (UCL Institute of Health Informatics) said: "We know that excluded populations suffer from lack of access to basic healthcare, but this new research shows the frightening extent of the problem: it’s much worse than we thought. People experiencing homelessness, those with drug addictions, prisoners and those who sell sex are far more likely to develop serious health problems and die early."

Professor Andrew Hayward (UCL Institute of Epidemiology and Healthcare), senior author of the first paper, added: “It is no surprise that socially excluded groups have poor health outcomes but the extent of the disparities in wealthy countries is an affront to our values. Socially excluded groups are the canaries in the mine—they point to something toxic in our society.

“Extreme social exclusion affects at least half a million people in England every year, but the true figure is likely to be much higher, as national datasets do not ask about these problems. Exclusion, and its health consequences, often result from many years of multiple problems such as poverty, adverse experiences and psychological trauma during childhood.”

The second paper outlines a range of interventions that work to help excluded people including drug treatment, case management, and psychological therapies. Broader work to tackle poverty, unemployment and housing problems can also prevent social exclusion but have been less well studied for their health effects.

“Our research shows how best we can support the most excluded. We urgently need investment and co-ordination between government, health services and social care providers to deliver high-quality comprehensive services in the community, on the streets and in institutional settings such as prisons and hospitals. Supportive values include providing time, building trust, promoting accessibility, fairness and equality. The inequity we have shown is preventable,” said Ms Serena Luchenski (UCL Institute of Health Informatics & Pathway Public Health Fellow), lead author of the second paper.