UCLA CHPR Issues Policy Paper on Health, Housing, and Homelessness

The University of California, Los Angeles (UCLA) Center for Health Policy Research (CHPR) recently published a policy paper entitled, “Opening Doors for All: Improving Health in Housing and Homelessness.” The policy paper follows a 2021 virtual event convened by UCLA CHPR focused on the intersection of health and homelessness, emphasizing lessons learned to inform California decision-makers.

UCLA CHPR notes California’s current homelessness crisis is unprecedented as over 160,000 persons experienced homelessness on any given day in early 2020, representing a 40 percent increase since 2015. Effects on individuals experiencing homelessness and housing insecurity and the community’s public health have been profound, according to CHPR, including recent outbreaks of hepatitis A and typhus in communities experiencing homelessness.

Key takeaway findings from the UCLA CHPR policy paper include:

• Good health is not possible without housing – Lack of housing leads to deterioration of mental and physical health due to high stress, exposure to elements, inadequate sanitation, lack of access to hygiene supplies, and poor nutrition.
• Homelessness is often the result of structural issues rather than individual characteristics – The primary driver of homelessness in California is the lack of affordable housing. Other drivers of homelessness including historical discrimination and structural racism.
• To address the effects of structural racism, any new project should begin with a racial equity analysis –An analysis should assess potential effect on different racial and ethnic groups to reduce inequities and avoid unintended negative consequences that affect marginalized groups.
• Persons experiencing homelessness need privacy, autonomy, and safety – Small single cabins (tiny homes) where individuals can secure their belongings, get sleep without interruption, bring a spouse, partner, children, or pets, and be linked with services and permanent housing is a better option than traditional congregate shelter.
• Permanent supportive housing should be the goal – This model provides long-term housing coupled with intensive case management services linking individuals with medical, psychological, and other important social services.
• Programs to assist persons experiencing homelessness funded by federal, state, and local governments have varied and inconsistent requirements for entry – Programs may exclusively target veterans, mothers with children, or persons with disabilities. While well-intended, this approach leads to “tweezing” the homeless population, extracting individuals from their community support systems and neglecting some chronically unhoused individuals.
• Private funded initiatives have more flexibility than publicly funded programs, which are also sometimes limited – Due to fewer rules and regulations, private aid may result in more innovation and experimentation than possible in public programs.
• Importantly, policy and program development should always involve persons with lived experience – Individuals’ historical exclusive from these discussions has resulted in missed opportunities and wasted resources.

The full UCLA CHPR report details structural causes of homelessness, intersections of housing security and health, homelessness prevention, and supportive services, among others.

The full report is available here.