Upstream causes of homelessness and the search for solutions

American cities have been struggling with chronic homelessness for decades. Many have launched initiatives with great fanfare only to see, by the end, even greater numbers of men, women and children living on the streets. I share others’ frustration when I constantly see city leaders pledge to eliminate homelessness, but the problem continues to get worse. 

At Providence St. Joseph Health, we believe safe and affordable housing is a basic human right. That is why we own and operate supportive housing units for nearly 1,000 low-income residents in California, Washington and Oregon. We also advocate for policies that offer sustainable solutions to homelessness and work closely with local leaders on responses to crisis-level housing insecurity in many of the communities we serve.

How did we get here?

Let’s be clear: chronic homelessness is a uniquely American invention. We have deeply ingrained the conditions that lead to persistent homelessness by how we choose to spend our resources. Cities that attempt to “solve” homelessness at the local level are in fact grappling with the downstream consequences of systems and structures that are established at the national level, and that most of us simply take for granted. 

A prime example is our system of employer-sponsored health insurance that ties health care coverage to employment. Employer-based health insurance is the single largest tax expenditure in the U.S. and benefits the well-off far more than the poor. Moreover, medical debt is the number one source of personal bankruptcy filings in this country. We have a health insurance system that divides the haves and the have-nots and creates significant financial insecurity, and therefore housing insecurity, for millions of people. 

The lack of access to mental health services exacerbates this problem. Within the last 20 years, the U.S. government has tried to raise the profile of mental health and help bolster coverage parity. But mental health providers continue to be overwhelmed and underfunded. Moreover, mental illness retains a stigma that creates an additional barrier for people to get the help they need. Providence St. Joseph Health founded Well Being Trust in 2016 to advance comprehensive solutions to improve access to care and reduce stigma, but as a country, we have a long road ahead. 

Our arcane federal tax system contributes to chronic homelessness in other ways as well. The mortgage interest deduction, for example, was designed to incentivize homeownership by the middle class. But today the deduction primarily benefits higher-income households and fails to address the severe shortage of affordable housing for people with extremely low incomes. The mortgage interest deduction is a $70 billion tax expenditure that could be used to invest in affordable housing for people in need.

Searching for solutions

Even with our country’s many accomplishments, the American experiment has been starkly imperfect, particularly on matters of wealth and poverty. It is heartening to see the strong desire among policymakers and the public to make serious progress on homelessness. I hope that desire is coupled with a willingness to reconsider some of our systems and assumptions that act as barriers to finding real solutions. If we learn from our past, we can build a better future.  

This blog post is the second in a series about housing and health authored by Timothy Zaricznyj. Read the first in the series, Housing is Health Care. The next will explore how supportive housing programs such as ours can improve health outcomes, particularly for those with Medicaid coverage.

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