Opinion
“Health care for the homeless” is just a start. People need housing.
On a sweltering July morning last year, I met a new patient. His cracked and calloused feet suggested he had spent nights awake and wandering the streets, afraid of falling asleep on a park bench and getting mugged, and I noticed a weariness in his gaze. He’d been admitted to the hospital with dangerously high blood pressure and pains in his chest.
Two months earlier, he’d undergone a thorough workup at this very hospital, and been discharged with medications to lower his blood pressure and treat his heart conditions. But he’d lost his medications when his backpack had been stolen, he told me, and it had been nearly impossible to follow a regimen that required him to take pills four times a day when he didn’t have a place to store his medications or even a watch.
After a day in the hospital, his blood pressure returned to normal and his chest pain disappeared. Our team tried to find him housing, but we could only arrange an urgent referral to the city’s overburdened social services programs. I felt powerless as I discharged him to a nearby shelter, anticipating he’d be admitted again.
This story is typical for many people experiencing homelessness—a population that has been on the rise in the United States since 2016. The most recent national survey estimated 650,000 people experienced homelessness on a single night in 2023, up 12 percent from 2022. People experiencing homelessness seek medical attention for ailments directly attributable to their living conditions—and yet the health care system fails to address the underlying problem, which creates a cycle of hospitalizations. Without more housing that people like my patient can afford, the care that doctors like me provide can be futile.
Sign up for Harvard Public Health
Delivered to your inbox weekly.
As the number of people who are unsheltered—living in tents or on the street, not in shelters—has increased, so have attempts at displacement. The Supreme Court is considering whether a law in Grants Pass, Oregon that bans sleeping on public property or in public parks constitutes cruel and unusual punishment. Around the country, cities regularly clear encampments of people experiencing homelessness. Research suggests that encampment sweeps worsen the health of the displaced inhabitants.
In their book Homelessness is a Housing Problem, authors Gregg Colburn and Clayton Page Aldern argue that affordable housing scarcity is driving rising homelessness. Rents and home prices soared during the COVID-19 pandemic, exacerbating an already dire housing market situation. Creating affordable housing will not end homelessness—unmet behavioral, mental, and physical health needs are both the cause and consequence of homelessness, and they will need to be addressed—but affordable housing is a necessary step.
Several studies have shown the cost benefits of supportive housing for homeless people with chronic illness, mental health issues, and substance abuse. The savings are highest when housing programs target individuals who are frequent users of health care. For example, a housing program for people experiencing homelessness and severe alcohol problems in Seattle saved about $43,000 in health costs per person each year, while the housing provided cost about $13,000. However, not all studies have found the same results. We need more research to understand the most cost-effective ways of implementing housing programs.
Health care systems have traditionally focused on providing and improving health care for people experiencing homelessness. It’s time for them to do more. A few innovative health systems have already begun to do so. In New Jersey, St. Joseph’s Health financed the development of 56 units of affordable housing on land that the hospital owned. In New Orleans, the managed care organization Aetna invested $26.7 million in a 192-unit affordable housing complex. In Toronto, where a large number of people are experiencing homelessness, the University Health Network partnered with the city to build 51 units of affordable housing on a parking lot it owned. And Kaiser Permanente has committed $400 million to creating or preserving 30,000 affordable housing units in parts of California, where the homeless population is the country’s highest, by 2030. Since health care systems are primary partners in these developments, they frequently provide residents with on-site health care and social services.
More hospitals, provider networks, insurers, and government agencies should take on a role in directly addressing the housing shortage. They should invest in housing development, especially projects that create affordable or supportive housing units, and donate unused land to further this goal. For too long, players in health care have focused on mitigating the consequences of homelessness, rather than addressing the root problem. Now, it’s time for them to be a part of the solution and create healthier communities for all.
Source image: SkyAceDesign / iStock
Republish this article
<p>Otherwise, cycles of hospitalization will continue.</p>
<p>Written by Jeremy Cygler</p>
<p>This <a rel="canonical" href="https://harvardpublichealth.org/policy-practice/affordable-housing-is-key-to-end-cycles-of-homeless-hospitalization/">article</a> originally appeared in<a href="https://harvardpublichealth.org/">Harvard Public Health magazine</a>. Subscribe to their <a href="https://harvardpublichealth.org/subscribe/">newsletter</a>.</p>
<p class="has-drop-cap">On a sweltering July morning last year, I met a new patient. His cracked and calloused feet suggested he had spent nights awake and wandering the streets, afraid of falling asleep on a park bench and getting mugged, and I noticed a weariness in his gaze. He’d been admitted to the hospital with dangerously high blood pressure and pains in his chest.</p>
<p>Two months earlier, he’d undergone a thorough workup at this very hospital, and been discharged with medications to lower his blood pressure and treat his heart conditions. But he’d lost his medications when his backpack had been stolen, he told me, and it had been nearly impossible to follow a regimen that required him to take pills four times a day when he didn’t have a place to store his medications or even a watch.</p>
<p>After a day in the hospital, his blood pressure returned to normal and his chest pain disappeared. Our team tried to find him housing, but we could only arrange an urgent referral to the city’s overburdened social services programs. I felt powerless as I discharged him to a nearby shelter, anticipating he’d be admitted again.</p>
<p>This story is typical for many people experiencing homelessness—a population that has been on the rise in the United States since 2016. The most recent national survey estimated <a href="https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf" target="_blank" rel="noreferrer noopener">650,000 people experienced homelessness on a single night in 2023</a>, up 12 percent from 2022. People experiencing homelessness seek medical attention for ailments directly attributable to their living conditions—and yet the health care system fails to address the underlying problem, which creates a cycle of hospitalizations. Without more housing that people like my patient can afford, the care that doctors like me provide can be futile.</p>
<p>As the number of people who are unsheltered—living in tents or on the street, not in shelters—has increased, so have attempts at displacement. The Supreme Court is considering whether a law in Grants Pass, Oregon that bans sleeping on public property or in public parks constitutes cruel and unusual punishment. Around the country, cities regularly clear encampments of people experiencing homelessness. Research suggests that <a href="https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2024/01/16/displacement-of-encampments" target="_blank" rel="noreferrer noopener">encampment sweeps worsen the health</a> of the displaced inhabitants.</p>
<p>In their book <a href="https://www.jchs.harvard.edu/blog/rents-have-soared-across-country-home-prices-grew-even-faster" target="_blank" rel="noreferrer noopener"><em>Homelessness is a Housing Problem</em></a>, authors Gregg Colburn and Clayton Page Aldern argue that affordable housing scarcity is driving rising homelessness. Rents and home prices <a href="https://www.jchs.harvard.edu/blog/rents-have-soared-across-country-home-prices-grew-even-faster">soared during the COVID-19 pandemic</a>, exacerbating an already dire housing market situation. Creating affordable housing will not end homelessness—unmet behavioral, mental, and physical health needs are both the cause and consequence of homelessness, and they will need to be addressed—but affordable housing is a necessary step.</p>
<p>Several studies have shown the cost benefits of supportive housing for homeless people with chronic illness, mental health issues, and substance abuse. The savings are highest when housing programs target individuals who are frequent users of health care. For example, a housing program for people experiencing homelessness and severe alcohol problems in Seattle <a href="https://www.tn.gov/content/dam/tn/health/program-areas/NHC_Invest_Housing_Save_Health_Care_2016.pdf" target="_blank" rel="noreferrer noopener">saved about $43,000 in health costs per person each year</a>, while the housing provided cost about $13,000. However, not all studies have found the same results. We need more research to understand the most cost-effective ways of implementing housing programs.</p>
<p>Health care systems have traditionally focused on providing and improving health care for people experiencing homelessness. It’s time for them to do more. A few innovative health systems have already begun to do so. In New Jersey, St. Joseph’s Health financed the development of <a href="https://www.huduser.gov/portal/pdredge/pdr-edge-inpractice-030524.html" target="_blank" rel="noreferrer noopener">56 units of affordable housing</a> on land that the hospital owned. In New Orleans, the managed care organization Aetna invested $26.7 million in a <a href="https://www.nytimes.com/2024/03/12/business/affordable-housing-hospitals-investment.html" target="_blank" rel="noreferrer noopener">192-unit affordable housing complex</a>. In Toronto, where a large number of people are experiencing homelessness, the University Health Network partnered with the city to build <a href="https://www.thestar.com/news/gta/why-a-hospital-network-is-turning-a-parking-lot-into-affordable-housing/article_7c0f2782-fced-5bbf-b0c9-144a6440a032.html" target="_blank" rel="noreferrer noopener">51 units of affordable housing</a> on a parking lot it owned. And <a href="https://about.kaiserpermanente.org/commitments-and-impact/healthy-communities/improving-community-conditions/housing-security" target="_blank" rel="noreferrer noopener">Kaiser Permanente has committed $400 million</a> to creating or preserving 30,000 affordable housing units in parts of California, where the homeless population is the country’s highest, by 2030. Since health care systems are primary partners in these developments, they frequently provide residents with on-site health care and social services.</p>
<p class=" t-has-endmark t-has-endmark">More hospitals, provider networks, insurers, and <a href="https://www.vox.com/2024/2/13/24064445/medicaid-rent-housing-homelessness-healthcare">government agencies</a> should take on a role in directly addressing the housing shortage. They should invest in housing development, especially projects that create affordable or supportive housing units, and donate unused land to further this goal. For too long, players in health care have focused on mitigating the consequences of homelessness, rather than addressing the root problem. Now, it's time for them to be a part of the solution and create healthier communities for all.</p>
<script async src="https://www.googletagmanager.com/gtag/js?id=G-S1L5BS4DJN"></script>
<script>
window.dataLayer = window.dataLayer || [];
if (typeof gtag !== "function") {function gtag(){dataLayer.push(arguments);}}
gtag('js', new Date());
gtag('config', 'G-S1L5BS4DJN');
</script>
Republishing guidelines
We’re happy to know you’re interested in republishing one of our stories. Please follow the guidelines below, adapted from other sites, primarily ProPublica’s Steal Our Stories guidelines (we didn’t steal all of its republishing guidelines, but we stole a lot of them). We also borrowed from Undark and KFF Health News.
Timeframe: Most stories and opinion pieces on our site can be republished within 90 days of posting. An article is available for republishing if our “Republish” button appears next to the story. We follow the Creative Commons noncommercial no-derivatives license.
When republishing a Harvard Public Health story, please follow these rules and use the required acknowledgments:
- Do not edit our stories, except to reflect changes in time (for instance, “last week” may replace “yesterday”), make style updates (we use serial commas; you may choose not to), and location (we spell out state names; you may choose not to).
- Include the author’s byline.
- Include text at the top of the story that says, “This article was originally published by Harvard Public Health. You must link the words “Harvard Public Health” to the story’s original/canonical URL.
- You must preserve the links in our stories, including our newsletter sign-up language and link.
- You must use our analytics tag: a single pixel and a snippet of HTML code that allows us to monitor our story’s traffic on your site. If you utilize our “Republish” link, the code will be automatically appended at the end of the article. It occupies minimal space and will be enclosed within a standard <script> tag.
- You must set the canonical link to the original Harvard Public Health URL or otherwise ensure that canonical tags are properly implemented to indicate that HPH is the original source of the content. For more information about canonical metadata, click here.
Packaging: Feel free to use our headline and deck or to craft your own headlines, subheads, and other material.
Art: You may republish editorial cartoons and photographs on stories with the “Republish” button. For illustrations or articles without the “Republish” button, please reach out to republishing@hsph.harvard.edu.
Exceptions: Stories that do not include a Republish button are either exclusive to us or governed by another collaborative agreement. Please reach out directly to the author, photographer, illustrator, or other named contributor for permission to reprint work that does not include our Republish button. Please do the same for stories published more than 90 days previously. If you have any questions, contact us at republishing@hsph.harvard.edu.
Translations: If you would like to translate our story into another language, please contact us first at republishing@hsph.harvard.edu.
Ads: It’s okay to put our stories on pages with ads, but not ads specifically sold against our stories. You can’t state or imply that donations to your organization support Harvard Public Health.
Responsibilities and restrictions: You have no rights to sell, license, syndicate, or otherwise represent yourself as the authorized owner of our material to any third parties. This means that you cannot actively publish or submit our work for syndication to third-party platforms or apps like Apple News or Google News. Harvard Public Health recognizes that publishers cannot fully control when certain third parties aggregate or crawl content from publishers’ own sites.
You may not republish our material wholesale or automatically; you need to select stories to be republished individually.
You may not use our work to populate a website designed to improve rankings on search engines or solely to gain revenue from network-based advertisements.
Any website on which our stories appear must include a prominent and effective way to contact the editorial team at the publication.
Social media: If your publication shares republished stories on social media, we welcome a tag. We are @PublicHealthMag on X, Threads, and Instagram, and Harvard Public Health magazine on Facebook and LinkedIn.
Questions: If you have other questions, email us at republishing@hsph.harvard.edu.
More in Policy & Practice
To break cycles of trauma, we need family-friendly addiction treatment
Could the media stop avoiding public health, please?
