The U.S. homeless problem has proven to be a persistent one. About 580,466 Americans were homeless in 2020 an increase of 12,751 or 2.2 percent over 2019 numbers tracked by the U.S. Department of Housing & Urban Development. These numbers are checked every year over 10 days in the month of January to capture what is called a Point-in-Time (PIT) estimate which provides a snapshot of sheltered and unsheltered homeless populations.

From 2010 – 2016 homelessness was on a steady decline but over the last four consecutive years the numbers trended higher through 2020. People of color are over-represented in the homeless populations compared with their percentage in the U.S. population as a whole. In 2021 during COVID there were fewer homeless and there was more effort in controlling disease transmission to support housing and COVID testing for homeless populations.

A recent study indicated more people over age 65+ are becoming homeless. Rising homelessness can harm entire communities, not just the persons experiencing homelessness. It increases financial and staffing demands on local governments and non-profit organizations who manage shelters and provide food assistance and other social services. Homeless persons also have higher prevalence of medical conditions such as 24 percent rate of asthma compared to 17 percent for a control group, 26 percent diabetes compared to 22 percent for the control group, lung disease 23 percent verses 11 percent for the control group, serious heart condition 45 percent verses 38 percent for the control group. Tobacco use rate was 63 percent verses 38 percent for the control group.

The prevention approach is of course to avoid loss of rental housing by protecting renters from drastic and unexpected price increases. It is much less expensive to keep housing than it is to rehouse persons once they have gone homeless. Next is the housing first approach that provides secure and supportive housing while the homeless person can get well from health conditions and can get services for mental health, substance use disorders and other underlying health conditions. Research has shown the street homeless persons that make this transition remain in stable housing and experience significant improvements in their wellness. These housing options are both more effective and less costly to operate than temporary shelters. Also avoids abuse of limited resources like emergency department visits coupled with institutional care space.

There is much work to do to reduce and solve America’s homeless challenges. Though communities can work with public health professionals to utilize the best practices and set up the necessary program structures to facilitate the transition of street homeless populations back to stable members of the community. Getting the persons well, ensuring access to basic needs of food, safety and security are met will go a long way to returning the persons to a productive and stable life from the desperation and decline of homelessness.