Healthify Blog

Is Housing the Key to Healthcare?

No one thinks homelessness is a healthy lifestyle. But even medical veterans must have cringed to hear Dr. James O’Connell describe what Boston’s “rough sleepers” endure.


(Image Source: Desert News)

On NPR's Fresh Air last month, O’Connell told of his three decades serving Boston’s homeless population. “We see dramatic things that I never saw in medical school or often even in the textbooks.” O’Connell spoke of loss of life and limb – literally. And he’s not alone. CNN recently named O’Connell’s counterpart in Philadelphia, Dr. Jim Withers, one of their “2015 Top Ten CNN Heroes.” “Since 1992,” says CNN, “the group has reached more than 10,000 individuals and helped more than 1,200 of them transition into housing.”

There’s nothing strange about doctors serving underserved populations; what’s odd is that doctors should be acting as housing counselors. What does being an MD have to do with helping someone find an apartment?

What we do know is that life on the streets correlates with significantly worse health status.

America’s ambivalence about homelessness isn’t news. But when the American dream of home ownership and the perniciousness of American cycles of homelessness and poverty meet, some strange headlines emerge. This month saw Hawaii hemming and hawing on the issue, clearing out one of the nation’s largest homeless encampments – a move being challenged by the ACLU – and a week later issuing an emergency proclamation geared towards “dealing with the problem of homelessness.” Whether or not this signals a cognitive dissonance is something of a litmus test on where you stand on the homeless. What does it mean to “deal with” the chronically homeless? And, seeing as it’s not something we seem capable of tackling in itself, why and how should we respond to the homelessness crisis? In New York City, the question of a crisis was itself under dispute this summer. A Quinnipiac poll and the NYPD were focusing on “increased visibility,” which had Mayor Bill de Blasio claiming that a rise in visibility does not equate to a rise in homelessness. So what are we actually talking about?

Homelessness is not just a big city issue, and some of the most forward-thinking responses are coming from unexpected places – like Utah. The question almost sounds tautological, but if we could just get everyone in a home, would that solve homelessness? The "Housing First" movement answers with a resounding “Yes.” As the name implies, the movement centers on getting the homeless into permanent, stable housing – not shelters, not “transitional housing,” not shipping containers, boxes, or small geodesic domes – and going from there. Obviously this goes against some deeply-ingrained notions about housing, welfare, and bootstraps, but advocates point to studies indicating the cost savings of simply providing housing first. The jury is still out, and there is little doubt that this won’t solve all of the health issues the homeless face. But with more people taking a look at housing first, it seems the conversation around housing and health is rapidly shifting.

Topics: social determinants of health health disparities public health