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On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.
abstract
On a single night in 2023, 653,104 people experienced homelessness in the United States.1 Minoritized populations-including Black, Indigenous, and Pacific Islander people and gender and sexual minorities-and populations with specific adverse experiences, such as domestic violence survivors, young adults exiting foster care, and people exiting incarceration, are overrepresented within the homeless population.1 According to the federal definition, people are homeless if they lack a fixed, adequate nighttime residence; will imminently lose their residence without another place to go; or are fleeing interpersonal violence.2 The definition includes people staying in homeless shelters.
Characteristics of the homeless population have shifted overtime. In 2023 nearly 40 percent of those experiencing homelessness in the US were unsheltered-an increase from 30 percent in 2014.1 Unsheltered homelessness is associated with disconnection from health care services, a high prevalence of substance use and mental health disorders, exposure to the elements, and risks such as experiencing violence.3 The homeless population is aging: Reflecting a nationwide trend, in 2023 almost half of single homeless adults in California were ages fifty and older, compared with 11 percent in San Francisco in 1990.4,5 Research has shown that homeless adults experience accelerated aging, with...