PNHP

Failure to Address Homelessness Harms Health

Finland is effectively addressing issues of homelessness, says a new report. Being unhoused is associated with health problems and high medical costs. Yet homelessness is growing in the US, despite our massive resources. We must seriously address this problem.

Finland Sees Housing and Health as Inextricably Linked, The Commonwealth Fund, International Insights, Vol. 24, by Munira Z. Gunja

Itā€™s hard to imagine that just four decades ago, there were some 20,000 people in Finland without a home. By last year, this number had fallen to less than 3,700, a roughly 82 percent decline that represents the most significant decrease in homelessness within the European Union.

Itā€™s a completely different story in the United States, where the number of people experiencing homelessness is the highest itā€™s been in decades. About 20 of every 10,000 Americans lacked stable housing in 2023, a 12 percent increase over the previous year. Black people, Native Americans, and Pacific Islanders are unhoused at disproportionately high rates, while Asian Americans had the sharpest percentage increase in homelessness compared to all other races and ethnicities.

The health consequences of not addressing the U.S. housing crisis are clear:

  • People who experience homelessness have higher rates of illness and die an average of 12 years earlier than the general U.S. population.
  • Unhoused people are more likely to have behavioral health needs.
  • Low-income and unhoused people are the top 5 percent of hospital users and account for 50 percent of health care costs.
  • One-third of emergency department (ED) visits are made by people experiencing homelessness, with nearly 80 percent of those visits for concerns that could have been preempted with preventive care. ED visits are estimated to cost $18,500 annually for each unhoused person.

The evidence shows that stable, affordable housing improves mental and physical health outcomes.Ā  Finlandā€™s government recognizes this and has worked to ensure that thousands of its residents who would otherwise be forced to sleep on the streets have access to dignified housing.

(Finlandā€™s) Housing First moves people into stable housing right away ā€“ with no conditions ā€“ and then provides additional social services as needed. People receive a rental unit as well as access to support staff to help them navigate their finances, find jobs, and address any other needs. To build community, tenants are invited to participate in group activities and undertake charity work. To foster financial independence, they pay a percentage of the overall rent with the help of financial subsidies, if needed.

How is the U.S. addressing homelessness?

The federal government encourages the use of Housing First practices, and several U.S. cities and states have adopted the model.

But success hinges on filling significant gaps in funding. Currently, communities across the U.S. lack the financing necessary to provide housing for everyone who needs it, a problem that will likely get worse. Nationally, the number of people losing housing each year is outpacing the number of people gaining it.

Half of U.S. primary care physicians report a lack of sufficient coordination with specialists and hospitals for their patientsā€™ care. But fully addressing the needs of unhoused patients, such as through community-based care models that offer supportive housing, requires just that.

Comment:

By Don McCanne, M.D.

Whoa. Didnā€™t we end this article synopsis with the resolution of this crisis up in the air? If we go ahead and address the problem of homelessness, we can simultaneously address the problem of deficiencies in mental and physical health and also the increasing need for other social services as well.

This report states that many communities lack the financing necessary to provide adequate housing, but the nation as a whole certainly does not lack the potential resources. We now have large numbers of individuals and corporate entities with great wealth which would not be impacted at all negatively by relatively modest tax policies that would be required to ensure the presence of community-based care models that included assurances of adequate housing. Theyā€™ve done it in Finland; we can surely do it here in ā€œthe greatest nation on earth.ā€ Or are those with mega wealth going to argue that this is no longer the greatest nation?

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