The Body Economic (37 page)

A national UK audit of the homeless also found that four-fifths had a physical health problem, and about three-quarters had mental health issues, with similar patterns found in the US.

19
. “Hunger and Homelessness Survey,” p. 45; Institute for Children, Poverty and Homelessness, “Foreclosures and Homelessness: Understanding the Connection,” 2013. Available at:
http://www.icphusa.org/filelibrary/ICPH_policybrief_Foreclosuresand-Homelessness.pdf
. We estimated that across the country there were about twenty-five homeless persons for each 1,000 foreclosures.

20
. Homeless Assistance, US Department of Housing and Urban Development. Available at:
http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/homeless

A. Lowrey, “Homeless Rates in the U.S. Held Level Amid Recession, Study Says, but Big Gains Are Elusive,”
New York Times
, Dec 10, 2012. Available at:
http://www.nytimes.com/2012/12/10/us/homeless-rates-steady-despite-recession-hud-says.html?_r=0

21
. However, for many such programs, to qualify, people had to be sober, which meant that the highest-risk groups—the heaviest drinkers, the crack and the heroin users—weren't eligible.

One “Housing First” program in Seattle launched in December 2005 sought to help an estimated 500 chronically publicly inebriated persons in downtown Seattle. The
program came to be known as 1811 Eastlake, the street address where seventy-five units of residential housing were built. The researchers tried to assess what might happen if these high-risk groups were included, even allowing participants to drink in their rooms. Needless to say, 1811 Eastlake was overrun with homeless applicants wishing to take part.

The situation created a unique opportunity for researchers to conduct a natural experiment. The researchers were able to compare people who participated in Seattle's Housing First program for chronically homeless persons with severe alcohol problems against people who were on a wait-list for the program.

Participants in the program were estimated to cost society $4,066 per person per month in hospital, jail, and housing bills. Once provided with permanent housing, their total costs dropped to $1,492 after six months, and to $958 by the end of the year. The benefits had largely come from participants drinking less than those who remained homeless.

Finding housing helped avoid health hazards, but the ultimate health effect depended on the quality of the neighborhood. A 2011 study published in The
New England Journal of Medicine
randomly assigned 4,498 women with children living in public housing in high-poverty urban areas to one of three groups: 1,788 received housing vouchers, which could be redeemed only if they moved to a low-poverty area (where less than 10 percent of residents are poor); 1,312 received unrestricted, traditional vouchers; and 1,398 placed into a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up study, researchers measured data on their health outcomes. They found that simply moving from a neighborhood with a high level of poverty to a community with a lower level of poverty was associated with significant reductions in the obesity and diabetes. These remarkable benefits appeared to happen because wealthier neighborhoods offered their residents better access to healthier food, along with more green space that made it easier and more desirable to walk without the fear of crime and gang-related violence.

22
. Fairmount Ventures Inc.
Evaluation of Pathways to Housing Philadelphia,
2011. Available at:
https://www.pathwaystohousing.org/uploads/PTHPA-ProgramEvaluation

Finding housing helped avoid health hazards, but the ultimate health effect depended on the quality of the neighborhood. A 2011 study published in The
New England Journal of Medicine
randomly assigned 4,498 women with children living in public housing in high-poverty urban areas to one of three groups: 1,788 received housing vouchers, which could be redeemed only if they moved to a low-poverty area (where less than 10 percent of residents are poor); 1,312 received unrestricted, traditional vouchers; and 1,398 placed into a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up study, researchers measured data on their health outcomes. They found that simply moving from a neighborhood with a high level of poverty to a community with a lower level of poverty was associated with significant reductions in the obesity and diabetes. These remarkable benefits appeared to happen because wealthier neighborhoods offered their residents
better access to healthier food, along with more green space that made it easier and more desirable to walk without the fear of crime and gang-related violence.

23
. J. Eng, “Homeless Numbers Down, but Risks Rise,” NBC News, Jan 18, 2012. Available at:
http://usnews.nbcnews.com/_news/2012/01/18/10177017-homeless-numbers-down-but-risks-rise?lite

The number of beds of permanent supportive housing rose from 195,724 in 2008 to 274,786 in 2012, with significant financing from the HPRP program. Available at:
https://www.onecpd.info/resources/documents/2012AHAR_PITestimates.pdf

24
. V. Busch-Geertsema and S. Fitzpatrick. 2009. “Effective Homelessness Prevention? Explaining Reductions in Homelessness in Germany and En gland,”
European Journal of Homelessness
v2:69–96. UK Housing benefit fact sheet. Available at:
https://www.gov.uk/housing-benefit/what-youll-get
; where this was not enough to meet rent payments, it was also possible to apply for “discretionary housing payments” to help make up the difference.

Housing has long been a key target of public health intervention. The founder of the Yale School of Public Health, C. E. A. Winslow, gave a famous speech to the American Public Health Association in 1937. “Housing as a public health problem,” he argued, was a fundamental goal in public health. “We call you today to a new contest even harder than the old ones—the fight for decent hygienic housing for the American peoples.” He pointed to the example of Britain, noting, “No British health officer publishes an annual report without a section on housing in the positive sense, and the same inevitable laws of social progress are pressing on us in this country that have operated there.”

25
. R. Ramesh, “Warning on Benefit Cuts amid Rise in Homelessness,” The
Guardian
, Dec 4, 2012. Available at:
http://www.guardian.co.uk/society/2012/dec/04/benefit-cuts-rise-homelessness

The total austerity figure was later slightly revised down to reach total spending cut of £81 billion by 2014–15 as set out in the June budget. This included 11 billion in welfare reform savings and 3.3 billion from a two year freeze in public-sector pay. HM Treasury Spending Review 2010. Cm 7942. UK Trea sury, Oct 2010.

R. Bury, “Social Housing to Be Hit With £8bn Cuts,”
Inside Housing,
2010. Available at:
http://www.insidehousing.co.uk/social-housing-%E2%80%98to-be-hit-with-%C2%A38bn-cuts%E2%80%99/6512119.article

“Housing Benefit Cuts,”
Crisis UK,
2012. Available at:
http://www.crisis.org.uk/data/files/publications/Crisis%20Briefing%20-%20Housing%20Benefit%20cuts.pdf
. The Scottish government followed suit, cutting its own affordable housing budget by 31 percent.

“Social Housing budget ‘To Be Cut In Half',” BBC, Oct 19, 2010. Available at:
http://www.bbc.co.uk/news/uk-politics-11570923

26
. US Department of Housing and Urban Development,
Point-in-Time Estimates of Homelessness: Volume I of the 2012 Annual Homeless Assessment Report
(AHAR), 2012. Available at:
https://www.onecpd.info/resource/2753/2012-pit-estimates-of-homelessness-volume-1-2012-ahar/
;
UK Government, “Live Tables on Homelessness.” Available at:
https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness
. Homelessness rose in London from 9,700 households to 11,680 households between 2010 and 2011 (Department for Communities data). In the city of London, the number of people sleeping on the streets rose by 8 percent; youth were particularly negatively affect, as among those aged under twenty-five, homelessness rates rose by a third.

27
. SSAC (November 2010) Report on S.I. No 2010/2835 and S.I. No. 2010/2836. Cited on p. 19 in
http://www.crisis.org.uk/data/files/publications/Crisis%20Briefing%20-%20Housing%20Benefit%20cuts.pdf

28
. “Homelessness: A Silent Killer,”
Crisis UK,
2011. Available at:
http://www.crisis.org.uk/data/files/publications/Homelessness%20-%20a%20silent%20killer.pdf
The epidemiological study tried to disentangle homelessness from pre-existing health problems by evaluating people's health over time. These researchers identified and followed 6,323 homeless adults over five years and compared them with 12,451 people of the same age and gender in the general population. The homeless people, they discovered, were 4.4 times more likely to die than those with homes. But more interestingly, even when the researchers adjusted for the risks linked to past hospitalizations and current disabilities, it was found that not having a house posed a significantly greater risk of dying prematurely. In other words, the homeless who started out being healthy ultimately ended up being sicker.

A Department of Health report in 2010 estimated the healthcare costs alone of UK homelessness at about £2,115 per person per year. Department of Health. March 2010. Healthcare for single homeless people. March 2010. Based on 10,000 persons made homeless, this would result in a cost of an additional £20 million per annum. Unison Briefing on the Coalition Government's Housing Policies, Unison, London. Available at:
http://www.unison.org.uk/acrobat/B5199.pdf

S. Salman, “How Have the Cuts Affected Housing?” The
Guardian,
Mar 30, 2011. Available at:
http://www.guardian.co.uk/society/2011/mar/30/cuts-housing

29
. “Tuberculosis Rises 8% in London—HPA Figures,” BBC News, 2012. Available at:
http://www.bbc.co.uk/news/uk-england-london-17485728

A. Gerlin, “Ancient Killer Bug Thrives in Shadow of London's Canary Wharf,” Bloomberg, Feb 23, 2012. Available at:
http://www.bloomberg.com/news/2012-02-23/ancient-killer-bug-thrives-in-shadow-of-london-s-canary-wharf-skyscrapers.html

30
. “Homeless Crisis as 400 Youths a Day Face Life on the Streets of Britain,”
Mirror,
2011. Available at:
http://www.mirror.co.uk/news/uk-news/homeless-crisis-as-400-youths-a-day-95173

L. Moran, “Is Greece Becoming a Third World Country? HIV, Malaria, and TB Rates Soar as Health Services Are Slashed by Savage Cuts,” The
Mail
, 2012. Available at:
http://www.dailymail.co.uk/news/article-2115992/Is-Greece-world-country-HIV-Malaria-TB-rates-soar-health-services-slashed-savage-cuts.html

31
. ECDC, “West Nile Virus Infection Outbreak in Humans in Central Macedonia, Greece,” ECDC Mission Report, July–August 2010. Available at:
http://www.ecdc.europa.eu/en/publications/publications/1001_mir_west_nile_virus_ infection_outbreak_humans_central_macedonia_greece.pdf

32
. Greece estimates that the homeless population rose to 20,000 in 2011, a rise of 25 percent between 2009 and 2011. Ireland's number of households increased from 1,394 in 2008 to 2,348 in 2011. See “Major Increase in Homelessness,”
Irish Times,
Dec 19, 2012. Available at:
http://www.irishtimes.com/newspaper/breaking/2012/1219/breaking53.html
. See also “On the Way Home?” FEANTA Monitoring report on homelessness and homeless policies in Europe. The European Federation of National Organisations Working with the Homeless, 2012. Available at:
http://www.feantsa.org/IMG/pdf/on_the_way_home.pdf

33
. See “On the Way Home?”

34
. Markee, “Unfathomable Cuts in Housing Aid.”

35
. “Stampede Chaos as Thousands of Dallas Residents Apply for Housing Vouchers,”
Above Top Secret,
July 16, 2011. Available at:
http://www.abovetopsecret.com/forum/thread729362/pg1

“Oakland Opens Waiting List for Section 8 Vouchers,”
SFGate,
Jan 26, 2011. Available at:
http://www.sfgate.com/bayarea/article/Oakland-opens-waiting-list-for-Section-8-vouchers-2478260.php

“City's Homeless Count Tops 40,000,”
Wall Street Journal,
Nov 9, 2011. Available at:
http://online.wsj.com/article/SB10001424052970204190704577026511791881118.html?mod=googlenews_wsj

36
. RealtyTrac, January 2013 Foreclosure Rate Heat Map, 2013. Available at:
http://www.realtytrac.com/trendcenter/default.aspx?address=Duval%20county%2C%20FL&parsed=1&cn=duval%20county&stc=fl

Council on Homelessness. 2011 Report. Submitted June 2011 to Governor Rick Scott, p. E-2. Available at:
https://docs.google.com/viewer?a=v&q=cache:lQVqDby8TywJ
:
www.dcf.state.fl.us/programs/homelessness/docs/2011CouncilReport.pdf+&hl=en&gl=uk&pid=bl&srcid=ADGEESjrwRb_ph_ xCzTBGQ4vRvnrVQvXIAnreSVi3MrT6xlXE6f_5aJ9k_iJW1ZegjE0Wt3IxIbP2ENvqMUzgI-HD0CdbLwcge14wysl9dDI6FAp_lHqqjTxoSGwOyc3jkZf9dsuR6b5&sig= AHIEtbTSHKozwOFJZyewSqHKbsh-xJFoIA

37
. As the CDC reported, “This outbreak represents one of the most extensive TB outbreaks that the CDC has been invited to assist with since the early 1990s, both in terms of its size and rapid growth.”