Holly A. Holtzen

in Public Health

ISBN: 9780199756797
Published online November 2012 | | DOI:


Homelessness has existed throughout human history, and as far back as the 17th century in the United States. The causes of homelessness are complex and include both environmental and individual factors. External environmental factors include economic conditions, social policy changes, and demographic shifts. Individual vulnerabilities and circumstances also contribute to the risk of homelessness. Descriptions of homelessness as a social issue have shifted from the early “tramps,” to Skid Row with its extreme poverty and addiction, to the present-day view of invisible homelessness consisting of men and women, children, and veterans. Defining homelessness as a practical matter has proven difficult for policy makers and researchers. A decision about how to classify homeless people living in shelters, those receiving services, and those on the streets dramatically alters the count. Recent estimates suggest that 656,129 people were homeless at a single point in time (i.e., measured on one night in January annually) in the United States in 2009. Efforts to demonstrate the extent of homelessness guide social and housing policies. The varied counting methodologies influence the public policy response to homelessness differently, guiding housing policy and health and social services based on their inherent assumptions. Attempts to quantify homelessness as a social problem began with efforts by Peter H. Rossi in the Chicago studies and have continued with studies by the US Census Bureau, and most recently with biannual point-in-time counts conducted by the Continuum of Care. Providing homeless services and housing dramatically changed in the late 1980s with the passage of the Stewart B. McKinney Homeless Assistance Act (P.L. 100-77), which eventually created the Continuum of Care (CoC) system in the 1990s to provide coordinated outreach and assessment, prevention, permanent housing, and services. This legislation shifted the response to homelessness from a primarily grassroots effort to a national campaign to end homelessness. Under this act, funding and homeless services were consolidated to have a more regional approach to homeless services and housing. This coordinated approach was developed to address the diverse needs of the homeless, extending beyond providing shelter to addressing the causes of homelessness and the health-related risks. Homeless populations have a higher prevalence of infections and chronic diseases. Moreover, their mortality rate is four times higher than that of comparable housed populations. The homelessness literature is cross-disciplinary and reflects the diversity of homelessness, especially in the United States.

Article.  10731 words. 

Subjects: Public Health and Epidemiology

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