The combination of drugs, alcohol, poor health, lack of hygiene and medical attention mean Oahu’s homeless population has an average lifespan potentially decades shorter than the population in general.

The Honolulu medical examiner’s office said Wednesday that 373 homeless people died on Oahu from 2014 to 2018.

The average age of death was reported to be just under 53 years, about 30 years shorter than Hawaii’s overall life expectancy.

“If we don’t have all those amenities that make things easy, it’s going to be rough,” said John Kaulupali, who lives at one of Oahu’s major homeless communities at Kakaako Gateway Mauka Park.

About 30% died from complications related to drug use. In comparison, Hawaii’s drug-related death rate for the general population is about 14%, according to the National Center for Health Statistics.

About 30% of the homeless deaths resulted from different diseases, and another 7% — about 30 people — died from sanitation- related complications like sepsis, according to information from the medical examiner analyzed by the Star-Advertiser.

“Compared to Oahu’s general population those who are homeless have a higher rate of death from drug abuse, infectious diseases, and in far too many instances, they fall victim to homicide,” said Dr. Christopher Happy, Honolulu’s chief medical examiner.

There are about 4,500 people who are homeless in Honolulu County; Hawaii as a whole has one of the highest rates of homelessness in the country.

“The truly compassionate thing to do for our homeless population is to get them into shelter and off our streets where statistics show they are more likely to die at a relatively early age,” said Mayor Kirk Caldwell in a news release. “The statistics gathered by the medical examiner is a sobering wake-up call, and even for the shelter-resistant population, we need to get them into supportive housing as soon as possible and not allow them to die needlessly.”

Scott Morishige, the governor’s coordinator on homelessness, said providing the homeless with housing would take care of their immediate needs, thus giving them the opportunity to take care of their overall health.

“It provides a stable place where people can recover or recuperate, but also so they’re better suited to pursue treatment for their health condition or for their substance abuse treatment,” he said. “If you don’t have to worry about where you’re going to stay day-to-day, it’s easier to be able to pursue treatment, to see a doctor more regularly, to comply with the requirements of a treatment program.”

Morishige said the Housing First initiative, an approach used around the country that looks to place chronically homeless people, has been shown to help.

“The individuals we were able to place in Housing First and permanent supportive housing see improved health outcomes as well as housing stability,” he said, adding that the state Housing First program has a 92% retention rate.

Morishige said the housing is not the only benefit of the program.

“It’s not just providing the housing, it’s providing the case management and supportive services to better access … those serv­ices … so that they don’t just fall back to the street,” he said.

Kaulupali, who lives in the Kakaako park, said loose dogs can lead to dog bites, that open wounds can turn into staphylococcus infections and that for some people it’s just easy to forget to wash their hands.

Kaulupali said he and many in the community at the park hope to move onto private land made available to them, where they would not feel harassed by police and would be more responsible for the area. He also said it would help create a community.

“We’ll be able to work together as a community, as a family,” he said. “The sky’s the limit after that.”