Homelessness as a Public Health Concern
Homelessness is an epidemic within many cities in the United States. According to a study conducted by the National Alliance to end homelessness, the District of Columbia, New York, Pennsylvania, Washington, and Nevada all saw marked increases in their rates of homelessness between 2013 and 2014, demonstrating that the issue of homelessness is prevalent in many regions within the U.S. (Chapman and Goodwin). The number of impoverished people living in the U.S. as a whole has steadily increased between 2007-2013, which puts more people within the at-risk population of falling into homelessness (Chapman and Goodwin). Washington D.C. experiences very high rates of homelessness, with approximately 8,000 homeless people counted in 2015, with at least 544 people without shelter on any given night (2015 Point in Time Fact Sheet). Due to these increasingly high rates, various organizations in D.C. have taken it upon themselves to implement different programs and provide resources to the homeless population in the city. One factor that is causing these high rates of homelessness is lack of healthcare opportunities for both impoverished and homeless people, and ensuring healthcare access is one of the first steps that should be taken in combating chronic homelessness in D.C.
Homelessness is a multiple headed monster, with many different factors at play with one another that create conditions where people are no longer able to provide for themselves and are not able to afford housing and other necessities. Multiple factors keep homeless people from being able to find permanent employment or housing, among those factors, one of the biggest is lack of healthcare opportunities and lack of mental health services. According to a Commonwealth Fund study “40 percent of uninsured respondents had difficulty paying for basic necessities such as food, rent, and utilities as a result of high medical bills”, which in turn causes homelessness (McCauley). Other factors such as addictions, family breakdown, and mental illness when combined with institutional inequities such as “lack of available low-cost housing, poor economic conditions, and insufficient mental health services” impact people’s level of homelessness and their vulnerability to and likelihood of falling into the cycle of homelessness and poverty (Health and Homelessness). Providing people accessible and affordable healthcare is a key factor in preventing future homelessness, and empowering those who are currently without a permanent home.
Medically insuring people is an important step to ensuring adequate health care. Studies have proven that individuals without insurance, including homeless people, do not seek preventative care and do not receive high-quality care in cases of illness or emergency. Uninsured people are more likely to be hospitalized for preventable illnesses such as pneumonia or diabetes (McCauley). The rates of uninsured people in D.C. dropped from 8.9% to 7.5% under implementation of the Affordable Care Act, but the effects of the ACA do not necessarily reach those who have the most need for accessible and affordable health care (Key Facts about the Uninsured Population). Insuring homeless people is an important step to getting them off the streets, due to the fact that it can lead to “more routine medical care” and regular doctor visits, decreasing the number of homeless and/or impoverished people ending up in hospitals for preventable diseases, racking up medical bills that they are unable to pay (Gorman). The effort also may help get them off the streets through addressing unmet health needs, simultaneously giving them visibility and connecting them to housing and other necessary services (Gorman).
The path to insuring the homeless population has proven to be difficult, due to invisibility, mental disability, and a general distrust of the government and other organizations affiliated with the state. The National Association of Community Health Centers (NACHC) has proposed multiple options to try and integrate regular health care into the homeless populations, all of which combine federal and local efforts, focusing on the patient and each individual need. The NACHC proposes that collaboration between Local Health Center and Federally Qualified Health Centers is key to providing healthcare to impoverished and at risk communities. After the passage of the Affordable Care Act, a significant financial investment was put towards “public health, primary care, and community collaboration”, which focused on combining the efforts Federally Qualified Health Centers and Local Health Centers (National Association of Community Health Centers). This collaboration includes connecting workers from Local Health Centers to primary care providers at hospitals, giving a multifaceted coordinated effort to caring for the homeless and impoverished population, as well as holding each other accountable while reviewing the efficacy of each program and clinic. It also creates an environment where patients have “multiple points of entry” to receiving care (National Association of Community Health Centers). Additionally, Local Health Centers receive more funding under this plan and are able to “successfully overcomes barriers” due to the fact that they are located in high-risk areas, and can open their doors to all residents and people (National Association of Community Health Centers). Under this funding, they are also able to provide transportation for those who physically are not able to make it to the center, creating an environment that enables the ability to provide care for all people. One of the primary reasons why Local Health Centers are effective is because they contextualize the needs of the community, and understand how different social determinants impact the livelihoods of those living in these communities. This funding and this collaboration allows for optimal ability to deliver health care services efficiently to populations who need them.
The different levels of government in D.C. need to work together in order to create better conditions for the homeless. The current mayor of D.C, Muriel Bowser, ran on the platform of ending chronic homelessness in the District, but her first winter in office, 2014-2015, had one of the highest rates of people being housed in emergency care that the city has ever seen (Cox). She put many temporary housing options in place, such as housing people in motels and other vacant locations, but no sustainable or long term options to serve the homeless community and improve services within the D.C. area were implemented (Cox). The Washington Legal Clinic for the Homeless recently wrote an article criticizing D.C.’s inaction on caring for the District’s homeless population, and not providing sufficient resources. Mayor Bowser is currently making efforts to close D.C. General, a shelter that is notorious for its bad conditions and lack of safety for residents. She is planning to open up smaller, more manageable clinics, which in and of itself it a good idea, but, she is making a huge mistake: she has proposed an act that the D.C. Council will vote on that would effectively lower the standards for living conditions within said shelters. These shelters will further expose the homeless community to “poor public health conditions” wherein the shelters will not provide those who are housed there privacy, individual bathrooms, or space to clean, and most importantly, space to heal from their trauma (Tell the DC Council That Homeless Families Deserve Dignity and Privacy). There is also not enough space for an office to exist within the shelter for health advocates or simply for an official to have sufficient space, which inhibits the efficient processing of those who are housed, and makes it difficult to keep track of records and progress. The Washington Legal Clinic in turn proposed another budget that accounted for all that was lacking, but it has yet to be decided if the changes will be adopted (Tell the DC Council That Homeless Families Deserve Dignity and Privacy). This is just one example of how services for the homeless in D.C. could be improved with more cross-communication and collaboration between governmental bodies and outside organizations that advocate for the interests of the homeless.
There is a direct correlation with improvement in mental and physical health and the length of one’s stay long term housing. Homelessness often comes with a co-occurring illness, which in many cases developed before the person was no longer able to provide for themselves. In order to begin the healing and treatment process many people require nearly constant supervision and care, as well as a stable environment. Pathways Housing First, an organization that advocates for the needs and rights of the homeless population in D.C. implemented a program wherein community based housing programs were combined with comprehensive psychiatry and behavioral evaluation and treatment. In order to provide the best care to each client, only 36 people were allowed to be housed at a given time. The clients are given complete autonomy of how much treatment they want, and what types of treatment they want. The basis for this program is treating the individuals with respect and empowering them to begin living a sustainable and healthy lifestyle (Tsemberis, Kent, Respress). Within the first year of the program “highly distressed individuals showed significant reduction in psychiatric symptoms” (Tsemberis, Kent, Respress). Those who completed the two year program were moved into halfway houses, and 27 of the 36 people involved with the program were able to retain permanent housing. Programs similar to this one should be implemented throughout the city, as this study proved the effectiveness and importance of combining stable housing options with quality medical and psychiatric care.
Not really sure how to proceed with paper from here.. suggestions?
Bibliography:
"Health and Homelessness." American Psychological Association. N.p., n.d. Web. 15 Nov. 2015. <http://www.apa.org/pi/ses/resources/publications/homelessness-health.aspx>.
Chapman, Hilary, and Greg Goodwin. Homelessness in Metropolitan Washington. Washington, D.C.: n.p., 2014. Metropolitan Washington Council of Governments. Web. <http://www.mwcog.org/uploads/pub-documents/ql5bX1820140714163555.pdf>.
McCauley, Maura. Lack of Healthcare: A Root Cause of Homelessness. N.p.: Chicago Coalition for the Homeless, n.d. Print.
"Key Facts about the Uninsured Population." Kaiserr Family Foundation. N.p., n.d. Web. 15 Nov. 2015. <http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/>.
Gorman, Anna. "Signing up Homeless for Health Care Takes Persistence."USA TODAY. N.p., Jan. 2014. Web.
"2015 Point in Time Fact Sheet." District of Colombia Interagency Council on Homelessness. Dc.gov, n.d. Web. <http://ich.dc.gov/publication/2015-point-time-fact-sheet>.
<http://www.usatoday.com/story/news/nation/2014/01/16/outreach-health-insurance-homeless/4480053/>.
Fugere, Patty Mullahy. "D.C. Must Plan a Way to Serve Minor Children on Freezing Nights." The Huffington Post. wwww.thehuffingtonpost.com, n.d. Web. 24 Oct. 2015. <http://www.huffingtonpost.com/patty-mullahy-fugere/dc-must-plan-a-way-to-ser_b_4110808.html>.
"Tell the DC Council That Homeless Families Deserve Dignity and Privacy."The Washington Legal Clinic for the Homeless. N.p., 31 Oct. 2015. Web. 15 Nov. 2015. <http://www.legalclinic.org/tell-the-dc-council-that-homeless-families-deserve-dignity-and-privacy/>.
Cox, John Woodrow. "D.C. on pace for Worst Year on Homelessness."Washington Post. The Washington Post, n.d. Web. 24 Oct. 2015. <https://www.washingtonpost.com/local/dc-politics/with-4000-in-homeless-shelters-dc-on-pace-to-eclipse-record-set-last-year/2015/01/29/e74de4ca-a7c4-11e4-a06b-9df2002b86a0_story.html>.
Tsemberis, Sam, Kent, Douglass, and Respress, Christy. "Housing Stability and Recovery Among Chronically Homeless Persons With Co-Occuring Disorders in Washington, DC." American Journal of Public Health. American Public Health Association, n.d. Web. 15 Nov. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490566/>.
National Association Of Community Health Centers. Partnerships between Federally Qualified Health Centers and Local Health Departments for Engaging in the Development of a Community-Based System of Care(n.d.): n. pag. Web.