Cardiovascular disease in the Australians experiencing homelessness, and the role of Street Side Medics


“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.

     –  World Health Organisation

Over 100 million people are experiencing homelessness globally, with an estimated 1.6 billion living under inadequate shelter. As of the 2016 Census, there were 116, 427 Australians characterised as homeless(1). Whilst this figure represents less than 1% of Australia’s total population, people experiencing homelessness are over-represented in health statistics, particularly in relation to cardiovascular disease.

Status of CVD in homeless Australians

Cardiovascular disease (CVD) affects 17% of all Australians(2), and is the leading cause of mortality, accounting for a quarter of all deaths in 2019(3). Compared to the general population, CVD amongst those experiencing homelessness has a higher prevalence and mortality, as well as a greater burden of contributing risk factors, and an earlier age of onset (4-6). Whilst Australian data is scarce, international studies have shown a similar or slightly higher prevalence of hypertension, diabetes, and dyslipidaemia in those experiencing homelessness (7-10), and these statistics do not account for the likely under-diagnosis of these conditions. Substance use, particularly tobacco, is significantly more prevalent, with local data demonstrating that up to 81% (11, 12) of those who experience homelessness smoke cigarettes, compared to 15% of the general Australian population(13). Alcohol dependence, as well as cocaine and methamphetamine usage, all of which are detrimental to long-term cardiac health, are more prevalent in the Australian homeless population (14). Similarly, mental health disorders are three times more likely in the homeless population(15), and these have also been linked to poorer cardiovascular outcomes(16), reduced engagement with health services(17) and lower medication adherence(18).

There are various obstacles to delivering healthcare to Australians experiencing homelessness, which can be categorised into personal, practical and relationship barriers (19). Personal barriers refer to competing priorities such as shelter and food instead of medicine or appointments, which lead to many homeless Australians only seeking medical attention in perceived emergencies. Practical barriers refer to the concrete obstacles of finances, transport, and medication security. Finally, relationship barriers encompass the stigmatisation and lack of trust in the healthcare system, arising from prior negative experiences or perceived clinician bias(20).

The role of Street Side Medics

Accessible, opportunistic, and tailored care is essential. Tackling the increased burden of CVD in Australia’s homeless population requires focus on primary and secondary prevention, but also the development of pragmatic interventions which consider and address the underlying social determinants.

One promising strategy is through “drop-in” outreach clinics which make healthcare considerably more accessible. This was the vision of Dr. Daniel Nour, who founded Street Side Medics in August 2020, and for which he won Young Australian of the Year in 2022, recognising the early success of the service. Street Side Medics is a drop-in clinic service, operated from a mobile medical van, which delivers targeted healthcare at homeless food services, shelters, temporary accommodations, and disaster-affected zones in New South Wales. It is a bulk-billed, volunteer run GP led service, which does not require Medicare or identification, and utilises modern medicine technology including point of care testing, portable ultrasound, echocardiography, and spirometry, within a custom-built mobile clinic to provide opportunistic access to healthcare. In doing so, the model strives to alleviate the personal, practical and relationship barriers, which those experiencing homelessness face. This initiative has recently received Australian Federal Government funding in 2022(21)to help expand and adequately deliver its primary care service to homeless Australians. Professor Ravi Bhindi, head of department of the Royal North Shore Cardiology Department has also been involved since conception and has recently initiated a research arm of Street Side Medics, aiming to better understand the burden of cardiovascular disease in Australians experiencing homelessness.

To learn more:

Moving forward, we need continued government proactivity with increased supply of social and affordable housing. Healthcare services must be adaptive and holistic and involve collaboration with the local community. It is imperative that we continue to spread awareness, not only in the medical fraternity, but within all levels of society. We hope to improve the general understanding of the challenges faced by our homeless population, to facilitate constructive conversations towards a more compassionate and caring society.

Dr. Karan Rao

On behalf of Dr. Daniel Brieger, Dr. Daniel Nour, Ms. Alex Baer & Professor Ravinay Bhindi

StreetSide Medics Homeless Health Research Group


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