Homelessness and Health
For a period in the 1980s, homelessness was the cause of the moment. It attracted celebrity advocates (Jesse Jackson, Martin Sheen) and mainstream America's attention, before slipping from the national media spotlight.
The homeless, though, did not disappear, even if they were no longer frequently on television -- even if, through stepped-up enforcement of vagrancy laws, they were no longer quite so apparent on the streets of some cities. In fact, analysts say homelessness actually increased during the 1990s, a decade that saw one of the longest sustained periods of economic growth in American history.
Because rents and mortgages increased faster than incomes for people at the bottom of the economic ladder, "We have a severe affordable housing crisis, pure and simple," says Brad Paul, head of the Housing Justice Project at the National Coalition for the Homeless. "The market has failed miserably to meet the needs of the poorest of the poor."
Getting a fix on the homeless population always has been difficult. What is widely considered to be the best estimate comes from research by sociologist Martha Burt. That estimate says that, on any given day, about 800,000 people are homeless in the United States, including about 200,000 children in homeless families. Because people move in and out of homelessness, up to 3.5 million people experience homelessness during the course of a year, according to Burt's analysis of Census Bureau data for the Urban Institute, a nonprofit think tank. That figure includes between 900,000 and 1.4 million children, Burt estimates.
Though generally understood to be a housing and economic problem, homelessness is also a health issue. The most comprehensive recent study of the homeless, a 1996 survey the Census Bureau conducted at shelters and assistance programs, found high incidences of untreated, serious medical problems among the homeless (see "Homelessness and Health," right).
The National Health Care for the Homeless Council, an organization of clinics and health care professionals, promotes awareness of the health care problems associated with homelessness. These include an increased financial burden for public hospitals and clinics, and an increased prevalence of certain infectious diseases, including HIV and tuberculosis. The health crisis among the homeless exacts "a very significant financial toll for society, (and) a more important public health toll," says John Lozier, Council executive director. "And perhaps most significantly, on a personal level, the health consequences for a person who's homeless are severe."
Who are the homeless? According to the Census Bureau survey, most homeless program clients are single adults, and male. But 15 percent of the homeless clients surveyed were families (at least one parent with children). These families average 2.2 children, and the children are young -- two thirds are under the age of nine.
Most of the homeless in the government survey had less than a high school education. There are homeless in every type of U.S. community, although 71 percent are in central cities. One quarter of all the homeless report physical or sexual abuse as a child; and about one in five were homeless at some point while a child.
Many homeless adults have physical and mental disabilities, and thus qualify for federal supplemental security income (SSI). But many never apply for or succeed in getting SSI -- and if SSI is all they have to live on, they're still at risk. According to research sponsored by a coalition of disabilities groups, there was not one housing market in the country where a disabled person living solely on SSI could afford to rent an efficiency or one-bedroom apartment.
Though the popular conception is that homeless people don't have jobs, the survey found that 44 percent did paid work during the previous month. Philip Mangano, executive director of the U.S. government's Interagency Council on Homelessness, says many people in shelters are actually working full-time. Still, half of all homeless adults reported income of less than $300 a month -- less than 40 percent of the federal poverty level. And even for those doing slightly better, the rising cost of housing in the 1990s often left them without shelter.
The National Low Income Housing Coalition issues an annual report on the disparity between the minimum wage ($5.15 an hour since 1997) and the cost of renting a two-bedroom house or apartment in different parts of the United States. The coalition's Out of Reach 2001 study found that, to afford the average U.S. rent for such a home, a worker would have to earn $13.87 an hour -- that's 269 percent of the minimum wage. In several cities, the hourly wage necessary to rent basic housing was more than $20.
"For the first time in American history, you could be working a full-time job and not afford a place," Mangano says. "I think there's an implicit American promise -- the promise is that if you work full-time, you'll have a roof over your head. For many people in America today, that promise is broken."
By Reed Karaim
Homelessness and Health
A landmark 1996 Census Bureau survey, analyzed in the report Homelessness: Programs and the People They Serve, found high incidences of untreated, serious medical problems among the homeless.
In the survey of homeless clients of shelters and assistance programs, 26 percent of clients reported one or more acute infectious conditions such as cold, bronchitis, pneumonia or tuberculosis; 8 percent had acute noninfectious conditions such as skin ulcers or lice; and 46 percent reported one or more chronic health conditions such as arthritis, diabetes or cancer. The survey also found 66 percent of the people interviewed had alcohol, drug or mental health problems during the previous month.
The homeless, not surprisingly, do not regularly visit doctors. Fifty-five percent of the homeless report they have no medical insurance of any kind, including Medicaid. (for all Americans, the figure is 16 percent). Twenty-four percent of the homeless people told the survey that they needed medical attention in the previous year but were not able to get it, in part because they lacked insurance.
Homeless children are at much graver risk of serious illness than the average American child. A 1993 study of children living in New York City shelters found that 70 percent had delays in their immunizations. Another survey found that children in 40 percent of homeless families average two or more chronic illnesses within a year, including twice as many ear infections, six times more speech and stammering problems and four times more cases of asthma than the national average. "The asthma rates are just appalling," says John Lozier, executive director of the National Health Care for the Homeless Council. "The developmental delays they end up experiencing are also pretty stunning."
The National Coalition for the Homeless Web site has extensive research on the affordable housing shortage and other issues concerning the homeless.
The Urban Institute maintains a database of studies on homelessness and housing, including Martha Burt's brief What Will It Take to End Homelessness?
Homelessness: Programs and the People They Serve, a 1996 study conducted by the Census Bureau, is among the most complete recent compilations of data about the homeless.
The National Low Income Housing Coalition Web site provides an analysis of the hourly wage necessary for a worker to afford a two-bedroom apartment in different parts of the United States, as well as other information.
The National Alliance to End Homelessness works to "to mobilize the nonprofit, public and private sectors of society in an alliance to end homelessness". Their site includes information about policy and legislation as well as statistics and information for children.