Opinion: Using public health to solve homelessness

Communities across nation prove there is an effective path forward.

On any single night just before the COVID-19 pandemic, an estimated 568,000 people experienced the misery of homelessness in the United States. Without federal action to assist households at risk of eviction, economists project that homelessness may increase by more than 40% after the eviction moratorium ends.

Many of those at higher risk are Black or Native American, young, LGBTQ, those with disabilities, and people leaving foster care or prison. Increasingly, the elderly and working poor are also vulnerable to homelessness. Like COVID-19, homelessness disproportionately affects the most vulnerable amongst us and highlights systemic inequities.

Awakened by the pandemic, we’re seeing a new sense of urgency to solve homelessness, an eagerness to know what works and what policies and approaches to support. Communities across the country have proven homelessness is solvable. By shifting our mindset -- from a housing supply problem to a public health challenge -- we can solve it.

Rosanne Haggerty

Credit: contributed

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Credit: contributed

One of us, Rosanne, leads a not-for-profit that supports more than 80 cities and counties working together toward “zero” homelessness in their communities. Each “Built for Zero” community has a local team and coordinated system in place to re-house more people than are becoming homeless in any given month. Participation in this network of communities is voluntary. In each, leaders took stock and saw that their existing efforts weren’t adding up to fewer people experiencing homelessness. Since 2015, more than half of these communities have reduced — and in 14 cases thus far have ended — chronic or veteran homelessness. They did it by using a public health approach.

Public health differs from health care. Healthcare professionals are responsible for the people who walk into their offices, hospitals or, nowadays, appear via telemedicine screens. Public health professionals, on the other hand, are concerned with the health and well-being of the whole population, including people they’ve never met and even those not yet born.

Mark Rosenberg, former president and CEO of the Task Force for Global Health, said his contacts inside the CDC “tell me that they never, ever have seen censorship as limiting and pervasive as it is right now.” SPECIAL

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In our view, there are three pillars to a public health approach to solving this problem.

First, public health is based on science. It seeks to answer four basic questions:

1.) What is the problem? How many people are homeless, who are they, where are they, when did it happen, how did it happen and are these numbers increasing or decreasing?

2.) What are the causes of homelessness?

3.) What works to prevent homelessness?

4.) How do you implement and scale up those things that work?

Public health policies and practices should be based on evidence, and support quality data and data sharing. Having a comprehensive, accurate view of homelessness at all times is key to a community knowing what’s working and how the issue is changing. HUD, the VA and other federal agencies have worked to help communities improve the quality of their local data, but it remains a problem. Bad technology also makes it too difficult to use that data to drive continuous improvement. We need simpler federal and local policies that create common data quality standards. Homelessness must be measured in real time with real rates, with each individual accounted for, and actions taken to reduce homelessness reported publicly and frequently.

Second, public health focuses on prevention. We should try to prevent people from becoming homeless in the first place and protect each other from ever experiencing it.

Third, public health requires collaboration. A public health approach must bring together leaders from not-for-profit organizations and other local stakeholders, as well as many separate departments at all levels of government. Investment in adequate housing is also necessary, and we can draw on our long history of partnership between public health and housing -- cleaning up squalid tenements, removing lead paint, assuring adequate sanitation -- to guide policies now: expanded rental assistance, more choice, and equitable policies that keep pace with changing demographics and housing needs.

And the system must demand accountability. Those experiencing homelessness typically interact with many organizations to try and piece together needed help. Organizations must eliminate the fragmentation that harms vulnerable people and adds unnecessary time and cost. Voters must support policies that reinforce collaboration, reduce bureaucracy, and incentivize reducing homelessness.

Toward these ends, the CDC is a science-based prevention agency that has experience mobilizing interdepartmental responses toward large and complex problems. It has best-in-class experience setting standards for reporting and monitoring public health data and rapidly improving coordination in the face of evolving public health crises. The dedicated team at HUD could find no better-qualified partner than the CDC, based right here in Atlanta, to help take the national effort to end homelessness to the next level.

On the heels of the COVID-19 crisis, the Biden Administration should ask CDC to convene a task force on the elimination of homelessness as an urgent public health imperative. It would be the task force’s mission to work with HUD and other agencies to improve homelessness data standards, reporting requirements and infrastructure as part of the Public Health Data Modernization Act, and to integrate homelessness and public health data at the local level. CDC should also be asked to join the U.S. Interagency Council on Homelessness. The Council supports new research to inform effective practice, provides evidence-based intervention guidance to communities and helps coordinate federal homelessness policy.

Elevating CDC to a formal role on the Council could open new avenues for partnership with state and local public health agencies and help fully institutionalize a public health approach to eliminating homelessness.

We can make great progress towards ending homelessness if we make it a shared national mission -- now. Without a secure place to live, those experiencing homelessness are at greater risk of illness, hospitalization and death.

A public health program for eliminating homelessness will help millions of people in the U.S. Misguided policies created homelessness. A public health approach -- with CDC fully at the table -- can end it.

Rosanne Haggerty is president and CEO of Community Solutions, a nonprofit that supports governments to help end homelessness. Mark Rosenberg, M.D., is president emeritus of The Task Force for Global Health and founding director of the National Center for Injury Prevention and Control at CDC, where he worked for 20 years and retired as assistant surgeon general.