The dynamics of homelessness - National Academy of Sciences committee report

Children Today, May-June, 1989

The Dynamics of Homelessness

The fastest growing group of homeless persons in the United States--numbering 100,000 to date--are children under age 18, according to a study published by the Committee on Health Care for Homeless People of the National Academy of Sciences. Entitled Homelessness, Health and Human Needs, the 242-page report defines who the homeless are, discusses the causes and dynamics of homelessness, describes the health problems of homeless people and the barriers they encounter in obtaining health care, and examines health care service programs designed to meet the needs of homeless people.

Directed to policymakers on the national, state and local levels, the study was undertaken at the request of Congress, as stated in the Health Professionals Training Act of 1985. As specified in the Act, the study sought to evaluate whether eligibility requirements of health care programs prevent homeless individuals from receiving health care services; to assess the efficiency of health care service delivery to homeless persons; and to improve access to health care services by homeless people. Members of the Committee visited 11 major cities and improverished rural areas in Alabama, Minnesota, Mississippi and North Dakota to analyze the characteristics of homelessness in these communities and the nature of health services directed to homeless persons. The Committee also commissioned 10 papers written by experts on such topics as rural homelessness, legal barriers to health care service access, and homeless battered women and their children.

Pointing out that the number of homeless children cited excludes runaway, throwaway, or abandoned children on the streets or in institutions, the Committee asserts that "the growing phenomenon of homeless children is nothing short of a national disgrace that must be treated with the urgency that such a situation demands," and calls homelessness "an outrage, a national scandal."

Site visits indicated that while middle-aged male alcoholics constitute a shrinking percentage of homeless people, families with young children are the fastest growing component of the homeless population, comprising an estimated 28 percent of all homeless people. The report notes that the majority of homeless families are headed by single or divorced women raising two or three children who "are spending their critical developmental years without the stability and security of a permanent home." In most cities around the country, minorities--especially blacks and Hispanics--are represented disproportionately among the homeless population. Contrary to popular belief, homeless people tend to be long-term residents of the city where they live, and move to another city for a job, not for welfare or entitlement programs. Moreover, homeless families in both rural and urban areas usually have experienced several stages of doubling up with family and friends before becoming visibly homeless.

The Committee stresses that the lack of decent, affordable housing is a major reason why so many people are homeless in the United States. In the last eight years, federal support for subsidized housing has been reduced by 60 percent. While the supply of housing units for low-income persons has dwindled dramatically--since 1980 there has been a loss of 2.4 million units through conversion, gentrification, abandonment and urban renewal--the number of people needing such housing has increased.

Other factors contributing to homelessness include increasing numbers of poor and unemployed persons, declining employment opportunities for unskilled labor, and a tightening of eligibility standards and reduction in benefit levels for public assistance programs. Because of such policies as deinstitutionalization and noninstitutionalization--prevalent in the last two decades--state mental hospitals, general hospitals, and rehabilitation, correctional and mental retardation facilities have admitted fewer people and released some they would not have in past years. Some homeless families are headed by parents who were cared for in those facilities and who do not have the emotional capability or information to mobilize resources that may be available to them and their children.

The Committee found that homeless people experience a broad range of acute and chronic illnesses and health problems to a much greater extent than that of the population as a whole. Approximately one-third of all homeless people show symptoms of mental illness, especially schizophrenia, which--in the absence of community-based treatment facilities and supportive housing arrangements--is a leading cause of a person's becoming or remaining homeless. Such health problems as alcoholism, drug dependence, AIDS, accidental injuries leading to unemployment, or any major illness resulting in massive health care expenditures are also frequent triggers of homelessness. Health conditions that may result from or be exacerbated by homelessness include malnutrition, hypothermia, parasitic infestations, degenerative joint diseases, and vascular and skin disorders of the legs and feet.