May 24, 2023
This white paper advocates for a critical social research approach that challenges prevailing narratives and explores the underlying social structures contributing to houselessness. The Health Equity Research and Education (HERE) Center’s Equitable Housing Research Project aims to address the gap in critical social research concerning houselessness. This project focuses on investigating the multifaceted aspects of houselessness and promoting equitable housing solutions. Through rigorous research and analysis, the HERE Center generates valuable insights and actionable recommendations for policymakers, organizations, and communities. By bridging the knowledge gap, this initiative endeavors to catalyze positive change in addressing houselessness and fostering equitable housing opportunities for all.
Houselessness is a public health crisis, yet the dominant conversation around health focuses mainly on medical attention and health insurance (Willison, 2021). While the aforementioned issues are important, houselessness, like other public health issues, has dire consequences on a population’s health, quality of life, and upward mobility. Houselessness is also a threat to health equity, as the most marginalized populations in the country experience houselessness more than any other. Each year, more than 3.5 million young Americans are impacted (Chapin Hall, 2018). Additionally, Black Americans are four times more likely and Hispanic Americans are twice as likely to face homelessness than White Americans (Fusaro et al., 2018). Houselessness has long-term effects that can lead to chronic illness, behavioral health issues, and even mortality (Maxmen, 2019). Furthermore, longer periods of houselessness are linked to even greater risks of severe mental illness, substance abuse disorders, and chronic medical conditions; those who experience chronic houselessness are more likely to remain unhoused for longer periods (Henwood et al., 2015, Kersetz, et al., 2016). Thus, houselessness is a threat to health equity because it worsens existing health disparities among low-income and minority populations.
Defining Key Terms
To begin discussing the state of houselessness in Los Angeles and the Health Equity Research and Education (HERE) Center’s critical social research approach on houselessness, it is crucial to define key terminology examined in this report.
Homelessness. The U.S. Department of Housing and Urban Development (HUD) devised a criteria used to define homelessness, as well as the recordkeeping requirements based on four categories that individuals and families may fall under to qualify as homeless. The categories are: 1) literally homeless; 2) imminent risk of homelessness; 3) homeless under other Federal statues and 4) fleeing or attempting to flee domestic violence (U.S. Department of Housing, 2012a).
Houselessness. The Urban Secretariat of the United Nations Center for Human Settlements proposed a change to the official terminology used to refer to people without homes in order to create a more inclusive, global definition of homelessness. Specifically, they suggested that the term “houselessness” should replace “homelessness” (Springer, 2000). The definition uses “inadequate shelter” as its core, and it is defined as follows:
… a housing unit without a roof and/or walls that does not allow privacy; without adequate space, adequate security, adequate lighting, heating and ventilation and adequate basic infrastructure, such as water-supply, sanitation and waste management facilities; without suitable environmental quality and health-related factors, and with housing costs that are not reasonable. (Springer, 2000, p. 481)
The proposed term is more inclusive as it encompasses more than just refugee populations who live in inadequate camps or tent cities due to conflict or environmental calamities. It also includes people such as ex-prisoners who lack a permanent residence, those who live with family members because they cannot afford their own housing, victims of domestic and family abuse, and shelter and street populations that do not have access to housing (Jobe, 2019). Due to its more inclusive definition, this report will use the term “houselessness.”
Sheltered. HUD defines sheltered houseless individuals as those who live in shelters specifically designated for the unhoused. This includes beds that have been allocated for use by the unhoused population, including emergency shelters, safe havens, and transitional housing (U.S. Department of Housing, 2012a).
Unsheltered. HUD defines sheltered houseless individual as those who live in places not meant for human habitation. These include streets, parks, alleys, parking ramps, parts of the highway system, transportation depots, abandoned buildings, stairwells, and other similar places (U.S. Department of Housing, 2007).
Causes of Houselessness
The five major catalysts for houselessness are the following: the lack of affordable housing, income affordability, health issues, domestic violence, and racial disparities.
Lack of Affordable Housing
The country is currently experiencing the most egregious housing crisis in history. Years of record inflation and a loss of affordable rental housing have affected renters across the country (National Low Income Housing Coalition, 2019). Inflation and rental prices are subdued entering 2023, but the country’s lowest-income renters still face major challenges in finding safe and affordable housing. The National Low Income Housing Coalition (NLIHC) concluded the following in 2023: 1) the lack of affordable housing mainly affects renters with the lowest incomes, 2) the pandemic exacerbated the shortage of affordable housing, 3) Black, Latino, and Indigenous households are disproportionately low-income renters are disproportionately affected by the shortage, 4) the lowest-income renters are more likely to spend most of their income on rent than their counterparts, and 5) the lack of affordable homes for the lowest-income renters affects all states and 50 metro areas, none of which have adequate solutions to address this issue (National Low Income Housing Coalition, 2019).
For renters with extremely low income—those making less than the federal poverty level or 30 percent of the area's median income—there is a shortage of 7.3 million affordable rental homes in the United States. There are just 33 affordable and available rental homes for every 100 extremely low-income renter households. Among the states, there are 17 affordable and available rental dwellings for every 100 severely low-income renter households in Nevada and 58 in South Dakota. At least half of the income goes toward housing for 11 million extremely low-income households today, putting them at risk of houselessness (National Low Income Housing Coalition, 2019).
Low-income households are often unemployed or underemployed, and this can be due to a variety of factors including an extremely competitive job market, limited education, gaps in work experience, an existing criminal record, unstable housing or unreliable transportation, and health issues or a disability.
Low-income workers' salaries have stagnated and have not increased to keep up with rapidly rising housing costs. Most American workers almost have never seen any growth in their weekly salary over the last three decades. Low income, coupled with the decreasing availability of affordable housing, leaves many at risk for houselessness (National Alliance to End Houselessness, n.d.-a).
A physical or behavioral health crisis or any long-term debilitating condition may lead to houselessness. Houselessness can also worsen chronic medical conditions (National Alliance to End Houselessness, n.d.-b). For instance, when a person's health condition becomes incapacitating, and permanent housing is too difficult to maintain without assistance, they may become chronically unhoused (National Alliance to End Houselessness, 2023a).
In comparison to the general population, those living in shelters are more than twice as likely to have a disability (U.S. Department of Housing, 2017). In 2022, 16 percent of the unhoused population reported having disorders associated to chronic substance addiction, 21 percent reported having a major mental disease, while around 9,000 reported having HIV/AIDS (U.S. Department of Housing, 2022).
The houseless population have high rates of diseases such as diabetes, heart disease, and HIV/AIDS, and these rates are sometimes three to six times higher than those of the general population. The houseless population is also more likely to have urgent, life-threatening physical ailments and live in hazardous conditions compared to those without mental health or substance abuse disorders. Additionally, more than 10 percent of those who seek treatment for substance misuse or mental illness through our public health system are unhoused (National Alliance to End Houselessness, n.d.-b).
Opioid abuse has reached national crisis levels as the number of people consuming heroin and prescription narcotics has sharply increased, and the rate of deaths from opioid overdoses has quadrupled since 2010 (National Institute on Drug Abuse, 2023). While the epidemic is famous for affecting people of all racial, gender, and socioeconomic backgrounds, the unhoused feel its repercussions in devastating ways. Substance misuse has a disproportionately negative effect on the unhoused, and substance use disorders are acknowledged risk factors for houselessness.