Housing as healthcare might be the most straight-forward prescription a doctor could ever write. It is no secret that homelessness compounds existing medical conditions, creates new health challenges, and complicates access to receiving treatment. Unsheltered homelessness, in particular, contributes to poor health, rapid aging, and often death.
In recognition that people living on the streets face many barriers to accessing health in traditional settings—for reasons of cost, access, stigma, discrimination, etc.—schools, providers, and grassroots organizations have mobilized to provide a range of clinical services directly to people on the streets and in encampments, including chronic disease management, wound care, routine vaccinations, and even antiretroviral therapy and monitoring for people living with HIV.
The rise of street medicine, for example, as a response to unmet medical needs in homeless communities represents the best of what we know works, serving people where they are in a low barrier setting, whether that is on the sidewalk, in a creek bed, or under an overpass. Through providing trusted, affordable, and accessible care directly to the community, street medicine can help advance the public health principles of respecting autonomy and meeting people’s basic health needs..
Yet, in place of reshaping systems that fail the public health needs of people both housed and unhoused, too many decision-makers instead crack down on encampments and people living outside under the guise of public health. Ultimately, public health is often invoked to justify the criminalization of homelessness, even though this approach is both antithetical to the principles of public health and counterproductive, as criminalization itself worsens health outcomes.
With an affordable housing crisis, cuts to healthcare, and incomes that will not keep up with soaring rent, homelessness in the past several years has increasingly become more visible. What has followed is an increase in punitive policies that fine, cite, arrest, and jail people for experiencing homelessness that do nothing to promote public health, and instead create additional health challenges for an already medically vulnerable population.
These cruel policies are not new, yet have passed with increased frequency thanks to fear mongering, public pressure, and a recent Supreme Court decision, with hundreds more communities adopting them in just the past few years. When passing and enforcing these ordinances, many decision-makers invoke public health as a justification when displacing people from their homes. In practice, this looks like cities taking away people’s autonomy, throwing away their medicine, IDs, and lifesaving possessions, and displacing them from public view under the guise of keeping communities healthy. Locking up someone who is on a treatment waitlist or ticketing someone who has nowhere else to sleep traumatizes people and robs them of their dignity—and these are everyday policies in practice all around us.
Worse, decision-makers often justify these crackdowns with appeals to public health, when these same punitive policies exacerbate existing health disparities. For example:
- In Boston, police enforced encampment sweeps widely due to drug use, which researchers found led to suboptimal health behaviors, outcomes, and healthcare access for people who use drugs. Among those displaced, 73% cited difficulty accessing health or social services following sweeps, while case managers worried about fatal overdoses while they tried to track down their clients. The Journal of the American Medical Association has shown that “encampment sweeps, bans, move-along orders and cleanups that forcibly relocate individuals away from essential services will lead to substantial increases in overdose deaths, hospitalizations and life-threatening infections as well as hinder access to medications for opioid use disorder.”
- Phoenix recently passed a municipal ordinance to keep “parks clean, safe and accessible for everyone,” by restricting certain medical services at public parks, which the Arizona Medical Association, local physicians, and other healthcare advocates vocally opposed due to the anticipated “escalation of preventable conditions, forcing patients into the city’s already overwhelmed emergency rooms.”
- Instead of addressing the extreme shortage of supportive services that can stabilize people’s mental health, the Administration’s Executive Order on “Ending Crime and Disorder on America’s Streets” intentionally misrepresents data on mental health condition rates among people experiencing homelessness to justify expanding institutionalization, forced treatment, and use of civil commitments for those with behavioral health conditions, threatening people’s safety and civil rights.
The National Alliance to End Homelessness recently partnered with a group of researchers to follow the evidence, echoing what advocates and people with lived experience have been saying to these decision-makers: punitive policies in the name of public health actually make communities sicker.
- Involuntary seizure of property results in the loss of life-sustaining and medically necessary items, such as medication and inhalers.
- Confiscating cherished personal belongings inflicts psychological harm.
- Even the threat of property seizures can harm health, as many people experiencing homelessness are forced to stay with their belongings to avoid thefts or property seizures.
- The fear of punishment pushes people away from crucial resources and support systems, as people are displaced from public view into more hazardous environments (i.e. people pushed into underpasses that expose them to more toxins).
- Fear of enforcement can impact access to medical and social services, as people often miss appointments and services due to the threats and resultant fear of involuntary displacement.
- Enforcement of laws that criminalize homelessness can increase the spread of infectious diseases, as displacement can spread diseases further and isolate people from existing support systems.
- Criminalizing homelessness burdens the medical system, as elongating people’s experiences of homelessness and worsening their health leads to more reliance on expensive emergency rooms and emergency services.
Meeting fundamental needs through street medicine, sanitation services, and emergency housing is urgently necessary to keep people alive in the short term. But these measures cannot substitute for structural reforms required to end the public health crisis of homelessness. Meaningful progress demands sustained investment in affordable housing, healthcare, social services, economic policy, and reforms to laws that punish people for surviving without shelter.
As long as public health is invoked as a justification for criminalizing homelessness, we will continue to undermine the very health we claim to protect. Our advocacy must reject this false equivalence and insist on a simple truth: criminalizing homelessness is not a public health intervention, it is a driver of poor health for individuals, communities, and society as a whole.