Homelessness: The Overlooked Public Health Crisis

Photo by Levi Meir Clancy on Unsplash

The term “public health crisis” has taken on a whole new meaning in the past few years. When prompted to think about a public health crisis, many of our minds drift to disease or virus-related outbreaks that populate media outlets. Typically, these issues receive intense public attention and response, gaining the world’s regard, including that of governments, charitable organizations, and the general public. These crises, such as COVID-19, warrant the attention they receive, but there is another public health crisis that is being overlooked and has not been getting needed attention or resources—homelessness.

But what defines a public health crisis? Boston University's School of Public Health argues that an issue must meet three qualifiers: 1) The problem must affect a large number of people; 2) It must threaten health over the long-term; 3) It must require the adoption of large-scale solutions. With this definition and specific qualifiers in mind, one can point out that the state of homelessness in the United States should be classified as a public health crisis and therefore receive more attention, resources, and progress taken toward ending it.

1) The problem must affect a large number of people.

According to the National Alliance to End Homelessness 2020 point in time survey, there are an estimated 580,466 people in the United States that experience homelessness on a given night, a number that is likely a vast underestimate. The number of individuals affected by homelessness has been increasing over the last four years and is observed to be only 10% lower than it was in 2007—13 years ago. With millions of individuals and families confronting this crisis, we revisit the question of why this is not being talked about more, given more resources, or prioritized.

If we compare the state of homelessness to the Zika outbreak in the US, a public health crisis deemed an emergency and vastly covered by the media from 2015-2017, we can ascertain why homelessness deserves recognition as a public health crisis. The CDC reports that in the three years that the Zika virus was of concern in the US, fewer than 6,000 cases were reported in the United States. Zika Virus is a serious threat—and so too is homelessness. This comparison underscores how homelessness, a crisis affecting the health and wellbeing of millions of individuals, and is estimated to cause up to 46,000 deaths per year, deserves a similarly urgent response.

2) It must threaten health over the long-term.

Looking deeper into homelessness and health, we can see the interconnectedness of how one’s housing status affects one's mental and physical health significantly. The social determinants of health, a foundational concept in the field of public health, explain how the conditions one finds in their environment influence health, wellbeing, and quality of life. Furthermore, homelessness creates new health problems while also exacerbating existing ones. Among others, chronic health conditions such as high blood pressure, diabetes, and asthma are observed to be especially exacerbated in populations composed of people experiencing homelessness. These conditions worsen when one does not have adequate access to healthcare, a safe place to store medications, or the ability to maintain a healthy diet.

Additionally, living conditions, whether that be overcrowded shelters, cars, alleys or other places not meant for human habitation, put individuals at high risk for a wide range of communicable diseases. Being exposed to the elements for hours on end brings about exposure to extreme heat or cold, while indoor alternatives can harbor dangerous diseases, including Covid-19, as well as the flu and other communicable diseases. .

Those experiencing homelessness are at far higher risk of short and long term health problems. For this reason, many studies have found that this population is 3-4x more likely to pass away prematurely in comparison to the housed population. Homelessness threatens both immediate and long term health outcomes, demonstrating how housing is critical to any individual’s physical well being.

3) It must require the adoption of large-scale solutions.

Homelessness will continue to persist until large-scale government solutions are implemented. As we begin to recover from COVID-19, it is crucial that policymakers deliver solutions to better the health of those experiencing homelessness while simultaneously working to end the crisis as a whole. The Housing First model, an evidence-based approach that prioritizes permanent housing, is a crucial stepping stone in ending homelessness. We witnessed our public health infrastructure’s vulnerability and its relationship to housing right at the start of the pandemic; people experiencing homelessness were not able to shelter in place or socially distance, putting this population at high risk of contracting COVID-19 and leading to especially high rates of morbidity and mortality from the virus.

The Housing First Approach ends an individual's homelessness and shifts them to a safe and healthy environment that allows them to pursue personal goals and overall improve their quality of life. Breaktime, as a partner in the Housing First approach, believes that any and all policies dedicated to increased access to housing for all residents of Massachusetts is the paramount solution to ending the cycle of young adult homelessness.

Communities across the country need to come together to advocate for more attention to be placed on the homelessness crisis. Pressure your state and local representatives to create more affordable housing, increase access to sanitation necessities, and prioritize the health and wellbeing of this group. You can make a difference by advocating with Breaktime on social media, donating sanitation supplies to your local shelters, and overall initiating conversations about the state of homelessness in order to raise awareness.

Housing is a right, not a privilege. Housing is health care.