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Permanent supportive housing (PSH) is an intervention to address long-term homelessness. Evidence has resulted in a shift in US policy toward using PSH rather than shelters and transitional housing.
Despite recognizing that individuals transitioning from homelessness to PSH experience a high burden of disease and health disparities, public health research has not considered whether and how PSH improves physical health outcomes.
Based on diverse areas of research, we argue that in addition to improved access to quality health care, social determinants of health (including housing itself, neighborhood characteristics, and built environment) affect health outcomes. We identify implications for practice and research, and conclude that federal and local efforts to end long-term homelessness can interact with concurrent efforts to build healthy communities. (Am J Public Health. 2013;103:S188-S192. dol:10. 2105/AJPH.2013.301490)
LONG-TERM HOMELESSNESS is a significant determinant of poor health. Lengthy exposure to weather, infections, drugs, and vi- olence, coupled with limited ac- cess to ongoing health care, is associated with a high incidence of acute and chronic health problems and premature mortality.1,2 Launched in 1985 through pilot programs funded by the Robert Wood Johnson Foundation and the Pew Charitable Trust, Health Care for the Homeless programs now exist in cities throughout the United States and are designed to address the significant disease burden of this vulnerable popula- tion.3,4 In addition, efforts to ad- dress the rise of homelessness during the past four decades have resulted in the recognition that housing is an important part of health care service delivery for persons who have experienced homelessness5 and is cost effec- tive6"8 and consistent with basic human rights.9 These factors have contributed to a remarkable shift in US policy toward addressing long-term homelessness through permanent supportive housing (PSH) rather than relying on shel- ters and transitional housing.10
PSH denotes programs that provide access to affordable community-based housing along with flexible support services intended to meet a broad array of health and psychosocial needs.11 Typically, housing can be a con- gregate residence with services provided on site (i.e., single-site model)12 or an apartment rented from a private landlord with services provided by mobile community treatment teams (i.e., scatter site).13 Today, there are nearly 240000 PSH units across the country, a figure that has increased by an average of 12...