On the streets a feature documentary on homelessness in l a
Homelessness is the condition of people without a permanent dwelling, such as a house or apartment. People who are homeless are most often unable to acquire and maintain regular, safe, secure and adequate housing. The legal definition of homeless varies from country to country, or among different jurisdictions in the same country or region. The term homeless may also include people whose primary night-time residence is in a homeless shelter, a domestic violence shelter, long-term residence in a motel, a vehicle, squatting, cardboard boxes, a tent city, tarpaulins, shanty town structures made of discarded building materials or other ad hoc housing situations. According to the UK homelessness charity Crisis, a home is not just a physical space: it also provides roots, identity, security, a sense of belonging and a place of emotional wellbeing. American government homeless enumeration studies also include people who sleep in a public or private place not designed for use as a regular sleeping accommodation for human beings. There are a number of organizations who provide help for the homeless.
- On the streets a feature documentary on homelessness in l a
- United Nations definition
- European Typology
- Other terms
- Early history through the 1800s
- Victimization by violent crimes
- Urban homeless shelters
- Refuges and alternative accommodation
- Other housing options
- Savings from housing homeless in the US
- Health care
- Effect on life expectancy
- Statistics for developed countries
- Developing and undeveloped countries
- United States
- United Kingdom
- South Africa
- Russia and the USSR
- Popular culture
- Public awareness
In 2005, an estimated 100 million (1 in 65) people worldwide were homeless‹See TfD›, and as many as 1 billion people live as squatters, refugees or in temporary shelter, all lacking adequate housing. In Western countries, the large majority of homeless are men (75–80%), with single males particularly overrepresented.
Most countries provide a variety of services to assist homeless people. These services often provide food, shelter (beds) and clothing and may be organized and run by community organizations (often with the help of volunteers) or by government departments or agencies. These programs may be supported by the government, charities, churches and individual donors. Many cities also have street newspapers, which are publications designed to provide employment opportunity to homeless people. While some homeless have jobs, some must seek other methods to make a living. Begging or panhandling is one option, but is becoming increasingly illegal in many cities. People who are homeless may have additional conditions, such as physical or mental health issues or substance addiction; these issues make resolving homelessness a challenging policy issue.
United Nations definition
In 2004, the United Nations Department of Economic and Social Affairs defined a homeless household as those households without a shelter that would fall within the scope of living quarters. They carry their few possessions with them, sleeping in the streets, in doorways or on piers, or in another space, on a more or less random basis.
In 2009, at the United Nations Economic Commission for Europe Conference of European Statisticians (CES), held in Geneva, Switzerland, the Group of Experts on Population and Housing Censuses defined homelessness as:
In its Recommendations for the Censuses of Population and Housing, the CES identifies homeless people under two broad groups:
(a) Primary homelessness (or rooflessness). This category includes persons living in the streets without a shelter that would fall within the scope of living quarters;
(b) Secondary homelessness. This category may include persons with no place of usual residence who move frequently between various types of accommodations (including dwellings, shelters, and institutions for the homeless or other living quarters). This category includes persons living in private dwellings but reporting 'no usual address' on their census form.
The CES acknowledges that the above approach does not provide a full definition of the 'homeless'.
Article 25 of the Universal Declaration of Human Rights, adopted 10 December 1948 by the UN General Assembly, contains this text regarding housing and quality of living:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Homelessness is perceived and addressed differently according to country. The European Typology of Homelessness and Housing Exclusion (ETHOS) was developed as a means of improving understanding and measurement of homelessness in Europe, and to provide a common "language" for transnational exchanges on homelessness. The ETHOS approach confirms that homelessness is a process (rather than a static phenomenon) that affects many vulnerable households at different points in their lives.
The typology was launched in 2005 and is used for different purposes: as a framework for debate, for data collection purposes, for policy purposes, monitoring purposes, and in the media. This typology is an open exercise which makes abstraction of existing legal definitions in the EU member states. It exists in 25 language versions, the translations being provided mainly by volunteer translators.
The term unsheltered refers to that segment of a homeless community who do not have ordinary lawful access to buildings in which to sleep. Such persons frequently prefer the term houseless to the term homeless. Others may use the term street people, which does not fully encompass all unsheltered people, in that many such persons do not spend their time on urban street environments. Many shun such locales, because homeless people in urban environments may face the risk of being robbed or beaten up. Some people convert unoccupied or abandoned buildings ("squatting"), or inhabit mountainous areas or, more often, lowland meadows, creek banks and beaches. Many jurisdictions have developed programs to provide short term emergency shelter (often in churches or other institutional property, during particularly cold spells). These are referred to as warming centers, and are credited by their advocates as lifesaving.
A portion of the homeless population are generally in transit, but there is no generally accepted terminology to describe them; some nomenclature is frequently associated with derogatory connotations, and thus the professional and vernacular lingo to describe these persons is both evolving and not lacking in controversy. Much of the concern stems from the European situation, where homeless persons of Roma, Sinti and other ethnic descent have rejected the term gypsy. Other terms which some use regarding in-transit persons are: transient, vagabond, tramp or drifter. Occasionally, these terms are interchanged with terms not necessarily implying that the person is a traveler, i.e. hobo. The term bum is used for persons lacking a work ethic. The term transient is frequently used in police reports, without any precise definitions across jurisdictions.
The word unhoused refers to that segment of a homeless community who do not have ordinary lawful access to buildings in which to sleep, as referred to in the United States Department of Housing and Urban Development (HUD) definition as persons occupying "place not designed for ... sleeping accommodation for human beings. Such persons frequently prefer the term houseless to the term homeless. Recent homeless enumeration survey documentation utilizes the term unsheltered homeless. HUD requires jurisdictions which participate in Continuum of Care grant programs to count their homeless every two years. These counts have led to a variety of creative measures to avoid undercounting. Thus teams of counters, often numbering in the hundreds in logistically complex volunteer efforts, seek out the unsheltered in various nooks and crannies.
Early history through the 1800s
Following the Peasants' Revolt, English constables were authorised under 1383 English Poor Laws statute to collar vagabonds and force them to show support; if they could not, the penalty was gaol. Vagabonds could be sentenced to the stocks for three days and nights; in 1530, whipping was added. The presumption was that vagabonds were unlicensed beggars. In 1547, a bill was passed that subjected vagrants to some of the more extreme provisions of the criminal law, namely two years servitude and branding with a "V" as the penalty for the first offense and death for the second. Large numbers of vagabonds were among the convicts transported to the American colonies in the 18th century. During the 16th century in England, the state first tried to give housing to vagrants instead of punishing them, by introducing bridewells to take vagrants and train them for a profession. In the 17th and 18th centuries, these were replaced by workhouses but these were intended to discourage too much reliance on state help.
The growing movement toward social concern sparked the development of rescue missions, such as America's first rescue mission, the New York City Rescue Mission, founded in 1872 by Jerry and Maria McAuley. In smaller towns, there were hobos, who temporarily lived near train tracks and hopped onto trains to various destinations. Especially following the American Civil War, a large number of homeless men formed part of a counterculture known as "hobohemia" all over America. This phenomenon re-surged in the 1930s during and after the Great Depression.
How the Other Half Lives and Jack London's The People of the Abyss (1903) discussed homelessness, and raised public awareness, which caused some changes in building codes and some social conditions. In England, dormitory housing called "spikes" was provided by local boroughs. By the 1930s in England, there were 30,000 people living in these facilities. In 1933, George Orwell wrote about poverty in London and Paris, in his book Down and Out in Paris and London. In general, in most countries, many towns and cities had an area which contained the poor, transients, and afflicted, such as a "skid row". In New York City, for example, there was an area known as "Bowery", traditionally, where alcoholics were to be found sleeping on the streets, bottle in hand.
The Great Depression of the 1930s caused a devastating epidemic of poverty, hunger, and homelessness. There were two million homeless people migrating across the United States. Many lived in shantytowns they called "Hoovervilles". In the 1960s, the nature and growing problem of homelessness changed in England as public concern grew. The number of people living "rough" in the streets had increased dramatically. However, beginning with the Conservative administration's Rough Sleeper Initiative, the number of people sleeping rough in London fell dramatically. This initiative was supported further by the incoming Labour administration from 2009 onwards with the publication of the 'Coming in from the Cold' strategy published by the Rough Sleepers Unit, which proposed and delivered a massive increase in the number of hostel bed spaces in the capital and an increase in funding for street outreach teams, who work with rough sleepers to enable them to access services.
Modern homelessness started as a result of economic stresses in society and reductions in the availability of affordable housing such as single room occupancies (SROs) for poorer people. In the United States, in the 1970s, the deinstitutionalisation of patients from state psychiatric hospitals was a precipitating factor that seeded the homeless population, especially in large cities like New York City. This theory is vigorously disputed by clinical psychologist Seth Farber who points out that "the emptying of the state mental hospitals took place almost entirely in the 1960s and 1970s," a decade or more before the steep rise in homelessness which began in the late 1980s. Some feel that Ronald Reagan's signing (as governor of California in 1967) of the Lanterman–Petris–Short Act greatly exacerbated homelessness among the mentally ill. This law lowered the standards for involuntary commitment in civil courtrooms and was followed by significant de-funding of 1700 hospitals caring for mental patients [unclear why lowering standards would cause less committals].
The Community Mental Health Act of 1963 was a predisposing factor in setting the stage for homelessness in the United States. Long term psychiatric patients were released from state hospitals into SROs and supposed to be sent to community mental health centers for treatment and follow-up. It never quite worked out properly, the community mental health centers mostly did not materialize, and this population largely was found living in the streets soon thereafter with no sustainable support system.
Also, as real estate prices and neighborhood pressure increased to move these people out of their areas, the SROs diminished in number, putting most of their residents in the streets. Other populations were mixed in later, such as people losing their homes for economic reasons, and those with addictions, the elderly, and others. Trends in homelessness are closely tied to neighborhood conditions according to a report by the Edna McConnell Clark Foundation in 1990.
In 2002, research showed that children and families were the largest growing segment of the homeless population in the United States, and this has presented new challenges, especially in services, to agencies. Some trends involving the plight of homeless people have provoked some thought, reflection and debate. One such phenomenon is paid physical advertising, colloquially known as "sandwich board men".
Another trend is the side-effect of unpaid free advertising of companies and organizations on shirts, clothing, and bags, to be worn by homeless and poor people, given out and donated by companies to homeless shelters and charitable organizations for otherwise altruistic purposes. These trends are reminiscent of the "sandwich board signs" carried by poor people in the time of Charles Dickens in the Victorian 19th century in England and later during the Great Depression in the United States in the 1930s.
In the USA, the government asked many major cities to come up with a ten-year plan to end homelessness. One of the results of this was a "Housing first" solution, rather than to have a homeless person remain in an emergency homeless shelter it was thought to be better to quickly get the person permanent housing of some sort and the necessary support services to sustain a new home. But there are many complications of this kind of program and these must be dealt with to make such an initiative work successfully in the middle to long term. Some formerly homeless people, who were finally able to obtain housing and other assets which helped to return to a normal lifestyle, have donated money and volunteer services to the organizations that provided aid to them during their homelessness. Alternatively, some social service entities that help homeless people now employ formerly homeless individuals to assist in the care process.
Homelessness has migrated toward rural and suburban areas. The number of homeless people has not changed dramatically but the number of homeless families has increased according to a report of HUD. The United States Congress appropriated $25 million in the McKinney-Vento Homeless Assistance Grants for 2008 to show the effectiveness of Rapid Re-housing programs in reducing family homelessness. In February 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, part of which addressed homelessness prevention, allocating $1.5 billion for a Homeless Prevention Fund. Emergency Shelter Grant (ESG) program's name was changed to Emergency Solution Grant (ESG) program, and funds were re-allocated to assist with homeless prevention and rapid re-housing for families and individuals.
On May 20, 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act into Public Law (Public Law 111-22 or "PL 111-22"), reauthorizing HUD's Homeless Assistance programs. It was part of the Helping Families Save Their Homes Act of 2009. The HEARTH act allows for the prevention of homelessness, rapid re-housing, consolidation of housing programs, and new homeless categories. In the eighteen months after the bill's signing, HUD must make regulations implementing this new McKinney program.
The HEARTH Act also codifies in law the Continuum of Care planning process, long a part of HUD's application process to assist homeless persons by providing greater coordination in responding to their needs. This final rule integrates the regulation of the definition of homeless, and the corresponding recordkeeping requirements, for the Shelter Plus Care program, and the Supportive Housing Program. This final rule also establishes the regulation for the definition developmental disability and the definition and recordkeeping requirements for homeless individual with a disability for the Shelter Plus Care program and the Supportive Housing Program.
In late 2009, some homeless advocacy organizations, such as the National Coalition for the Homeless, reported and published perceived problems with the HEARTH Act of 2009 as an HUD McKinney-Vento Reauthorization bill, especially with regard to privacy, definitional ineligibility, community roles, and restrictions on eligible activities.
Major reasons and causes for homelessness as documented by many reports and studies include:
A substantial percentage of the U.S. homeless population are individuals who are chronically unemployed or have difficulty managing their lives effectively due to prolonged and severe drug and/or alcohol abuse. Substance abuse can cause homelessness from behavioral patterns associated with addiction that alienate an addicted individual's family and friends who could otherwise provide support during difficult economic times. Increased wealth disparity and income inequality causes distortions in the housing market that push rent burdens higher, making housing unaffordable. Dr. Paul Koegel of RAND Corporation, a seminal researcher in first generation homelessness studies and beyond, divided the causes of homelessness into structural aspects and then individual vulnerabilities.
The basic problem of homelessness is the need for personal shelter, warmth, and safety. Other difficulties include:
Homeless people face many problems beyond the lack of a safe and suitable home. They are often faced with many social disadvantages also, reduced access to private and public services, gaps in their personal infrastructures, and reduced access to vital necessities:
There is sometimes corruption and theft by the employees of a shelter as evidenced by a 2011 investigative report by FOX 25 TV in Boston wherein a number of Boston public shelter employees were found stealing large amounts of food over a period of time from the shelter's kitchen for their private use and catering. The homeless are often obliged to adopt various strategies of self-presentation in order to maintain a sense of dignity, which constrains their interaction with passers-by and leads to suspicion and stigmatization by the mainstream public.
Homelessness is also a risk factor for depression caused by prejudice (i.e. "deprejudice"). When someone is prejudiced against people who are homeless and then becomes homeless themselves, their anti-homelessness prejudice turns inward, causing depression. "Mental disorders, physical disability, homelessness, and having a sexually transmitted infection are all stigmatized statuses someone can gain despite having negative stereotypes about those groups." Difficulties can compound exponentially. For example, a homeless man in New Jersey found that he could not get food from some volunteer organizations if he did not have a legally-recognized address; after being mugged, he lost valuable identification documents and contact information so he could not contact his daughter; since his hips and knee had been broken because of the attack, it was harder for him after recovering in the hospital to walk to those places which did offer free food; in numerous instances, problems seemed to exacerbate other problems in a downward cycle. A study found that in the city of Hong Kong over half of the homeless population in the city (56%) suffered from some degree of mental illness. Only 13% of the 56% were receiving treatment for their condition leaving a huge portion of homeless untreated for their mental illness.
Victimization by violent crimes
The homeless are often the victims of violent crime. A 2007 study found that the rate of violent crimes against the homeless in the United States is increasing. In the United States in 2013 there were 109 reported attacks on homeless people, an increase of 24 per cent on the previous year, according to the National Coalition for the Homeless. Eighteen of those attacked died as a result. In July 2014 three boys 15, 16 and 18, were arrested and charged with beating to death two homeless men with bricks and a metal pole in Albuquerque. The 18-year-old was subsequently found guilty of second-degree murder and other felony charges and sentenced to 67 years in prison, the 16-year old was sentenced to 26 years in prison.
Rent Control and Homelessness
Rent controlled apartments contribute to shelter and street populations (around .04%). Apartments that are rent controlled encourage people to not move out or pass apartments along between families, this leads to the price of apartments being higher for new renters and, consequently, it is harder for people to afford their rents. About 10% of housing in the United States is under the control of price control laws. Most laws were enacted to deal with the high inflation rates experienced during the 1970s and 80s. These laws can motivate apartment owners to convert the property to a more profitable enterprise, which can reduce the amount of housing available to potential tenants. A black market can also develop, with tenants leasing rent controlled premises at prices above the legal maximum. This can price out low income individuals and families.
Stigma attached to the term homelessness
Prior to 1983, the term homeless implied that economic conditions caused homelessness. However, after 1983 more associations were made with the term. Alcoholism and mental illness became associated with the term in the media. Claims were often backed up with testimony made by high-ranking officials. For example, Ronald Reagan was quoted as saying “one problem that we’ve had, even in the best of times, is the people who are sleeping on the grates, the homeless who are homeless, you might say, by choice.” This claim made the homelessness problem one of personal choice and mental condition, not of the neoliberal reforms sweeping through the economic system. This made homelessness something that would exist even under the best economic conditions, and therefore economic reforms would be unnecessary.
There are many community organizations and social movements around the world which are taking action to reduce homelessness. They have sought to counteract the causes and reduce the consequences by starting initiatives that help homeless people to transition to self-sufficiency. Social movements and initiatives tend to follow a grassroots, community-based model of organization. This form of movement is generally characterized by a loose, informal and decentralized structure, with an emphasis on radical protest politics. An interest group gives more of an emphasis on influencing government policies and relies on more of a formal organization structure. These different groups share a common element: they are both made up of and run by a mix of allies of the homeless population and former or current members of the homeless population. Both grassroots groups and interest groups aim to break stereotyped images of the homeless as being weak, criminals, drug addicts and excluded and to ensure that the voice of homeless people and their representatives is clearly heard by policymakers.
Urban homeless shelters
Homeless shelters, which generally are night shelters, make people leave in the morning to whatever they could manage and return in the evening when the beds in the shelters opened up again for sleeping. There are some daytime shelters where people could go, instead of being stranded on the streets, and they could be helped, get counseling, avail themselves of resources, meals, and otherwise spend their day until returning to their overnight sleeping arrangements. An example of such a day center shelter model is Saint Francis House in Boston, Massachusetts, founded in the early 1980s, which opens for homeless people all year long during the daytime hours and was originally based on the settlement house model.
Many homeless people keep all their possessions with them because they have no access to storage. There was also the reality of the "bag" people, the shopping cart people, and the soda can collectors (known as binners or dumpster divers) who sort through garbage to find items to sell, trade and eat. These people carry around all of their possessions with them all the time because they have no place to store them. If they had no access to or capability to get to a shelter and possible bathing, or access to toilets and laundry facilities, their hygiene was lacking. This again creates social tensions in public places.
These conditions created an upsurge in tuberculosis and other diseases in urban areas. In 1974, Kip Tiernan founded Rosie's Place in Boston, the first drop-in and emergency shelter for women in the United States, in response to the increasing numbers of needy women throughout the country.
Refuges and alternative accommodation
There are many places where a homeless person might seek refuge.
Other housing options
Transitional housing provides temporary housing for the certain segments of the homeless population, including working homeless, and is set up to transition their residents into permanent, affordable housing. It's not in an emergency homeless shelter but usually a room or apartment in a residence with support services. The transitional time can be short, for example, one or two years, and in that time the person must file for and get permanent housing and usually some gainful employment or income, even if Social Security or assistance. Sometimes, the transitional housing residence program charges a room and board fee, maybe 30% of an individual's income, which is sometimes partially or fully refunded after the person procures a permanent place to live in. In the USA, federal funding for transitional housing programs was originally allocated in the McKinney–Vento Homeless Assistance Act of 1986.
Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives. Supportive housing works well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance abuse, addiction or alcoholism, mental illness, HIV/AIDS, or other serious challenges to a successful life.
In 2007 urban designer and social theorist Michael E. Arth proposed a controversial national solution for homelessness that would involve building nearly carfree "Pedestrian Villages" in place of what he terms "the current band-aid approach to the problem." A prototype, Tiger Bay Village, was proposed for near Daytona Beach, FL. He claims that this would be superior for treating the psychological as well as psychiatric needs of both temporarily and permanently homeless adults, and would cost less than the current approach. It would also provide a lower cost alternative to jail, and provide a half-way station for those getting out of prison. Work opportunities, including construction and maintenance of the villages, as well as the creation of work force agencies would help make the villages financially and socially viable.
In South Australia, the State Government of Premier Mike Rann (2002 to 2011) committed substantial funding to a series of initiatives designed to combat homelessness. Advised by Social Inclusion Commissioner David Cappo and the founder of New York's Common Ground program, Rosanne Haggerty, the Rann Government established Common Ground Adelaide building high quality inner city apartments (combined with intensive support) for "rough sleeping" homeless people. The government also funded the Street to Home program and a hospital liaison service designed to assist homeless people who are admitted to the Emergency Departments of Adelaide's major public hospitals. Rather than being released back into homelessness, patients identified as rough sleepers are found accommodation backed by professional support. Common Ground and Street to Home now operate across Australia in other States.
Savings from housing homeless in the U.S.
In 2013, a Central Florida Commission on Homelessness study indicated that the region spends $31,000 a year per homeless person to cover "salaries of law-enforcement officers to arrest and transport homeless individuals — largely for nonviolent offenses such as trespassing, public intoxication or sleeping in parks — as well as the cost of jail stays, emergency-room visits and hospitalization for medical and psychiatric issues. This did not include "money spent by nonprofit agencies to feed, clothe and sometimes shelter these individuals". In contrast, the report estimated the cost of permanent supportive housing at "$10,051 per person per year" and concluded that "[h]ousing even half of the region's chronically homeless population would save taxpayers $149 million over the next decade — even allowing for 10 percent to end up back on the streets again." This particular study followed 107 long-term-homeless residents living in Orange, Osceola or Seminole Counties. There are similar studies showing large financial savings in Charlotte and Southeastern Colorado from focusing on simply housing the homeless."
Health care for homeless people is a major public health challenge. Homeless people are more likely to suffer injuries and medical problems from their lifestyle on the street, which includes poor nutrition, exposure to the severe elements of weather, and a higher exposure to violence (robberies, beatings, and so on). Yet at the same time, they have little access to public medical services or clinics, in part because they often lack identification or registration for public health care services. There are significant challenges in treating homeless people who have psychiatric disorders because clinical appointments may not be kept, their continuing whereabouts are unknown, their medicines may not be taken as prescribed and monitored, medical and psychiatric histories are not accurate, and for other reasons. Because many homeless people have mental illnesses, this has presented a crisis in care.
Homeless people often find it difficult to document their date of birth or their address. Because homeless people usually have no place to store possessions, they often lose their belongings, including their identification and other documents, or find them destroyed by police or others. Without a photo ID, homeless persons cannot get a job or access many social services, including health care and clinic access. They can be denied access to even the most basic assistance: clothing closets, food pantries, certain public benefits, and in some cases, emergency shelters. Obtaining replacement identification is difficult. Without an address, birth certificates cannot be mailed. Fees may be cost-prohibitive for impoverished persons. And some states will not issue birth certificates unless the person has photo identification, creating a Catch-22. This problem is far less acute in countries which provide free-at-use health care, such as the UK, where hospitals are open-access day and night and make no charges for treatment. In the US, free-care clinics, for homeless and other people, do exist in major cities, but they often attract more demand than they can meet.
The conditions affecting homeless people are somewhat specialized and have opened a new area of medicine tailored to this population. Skin conditions, including scabies, are common because homeless people are exposed to extreme cold in the winter and they have little access to bathing facilities. They have problems caring for their feet and have more severe dental problems than the general population. Diabetes, especially untreated, is widespread in the homeless population. Specialized medical textbooks have been written to address this for providers.
There are many organizations providing free care to homeless people in countries which do not offer free medical treatment organized by the state, but the services are in great demand given the limited number of medical practitioners. For example, it might take months to get a minimal dental appointment in a free-care clinic. Communicable diseases are of great concern, especially tuberculosis, which spreads more easily in crowded homeless shelters in high-density urban settings. There has been an ongoing concern and studies about the health and wellness of the older homeless population, typically ages fifty to sixty-four years of age, and even older, as to whether they are significantly more sickly than their younger counterparts and if they are under-served.
In 1985, the Boston Health Care for the Homeless Program was founded to assist the growing numbers of homeless living on the streets and in shelters in Boston and who were suffering from lack of effective medical services. In 2004, Boston Health Care for the Homeless in conjunction with the National Health Care for the Homeless Council published a medical manual called "The Health Care of Homeless Persons", edited by James J. O'Connell, M.D., specifically for the treatment of the homeless population. In June 2008, in Boston, Massachusetts, the Jean Yawkey Place, a four-story, 77,653-square-foot (7,214.2 m2) building, was opened by the Boston Health Care for the Homeless Program. It is an entire full-service building on the Boston Medical Center campus dedicated to providing health care for homeless people. It also contains a long-term care facility, the Barbara McInnis House, which expanded to 104 beds, and is the first and largest medical respite program for homeless people in the United States.
A 2011 study led by Dr. Rebecca T. Brown in Boston, Massachusetts conducted by the Institute for Aging Research (an affiliate of Harvard Medical School), Beth Israel Deaconess Medical Center, and the Boston Health Care for the Homeless Program found the elderly homeless population had "higher rates of geriatric syndromes, including functional decline, falls, frailty and depression than seniors in the general population and that many of these conditions may be easily treated if detected". The report was published in the Journal of Geriatric Internal Medicine. There are government avenues which provide resources for the development of healthcare for the homeless. In the United States, the Bureau of Primary Health Care has a health care for the homeless program which provides grants to fund the delivery of healthcare to the homeless. According to 2011 UDS data community health centers were able to provide service to 1,087,431 homeless individuals. Furthermore, there are many nonprofit and religious organizations which provide healthcare services to the homeless. These organizations also contribute to the large need which exists for expanding healthcare for the homeless.
The passage of the Patient Protection and Affordable Care Act in 2010 may also provide new healthcare options for the homeless in the United States, particularly through the optional expansion of Medicaid. A 2013 Yale study showed that a substantial proportion of the chronically homeless population in America will be able to obtain Medicaid coverage if states expand Medicaid under the Affordable Care Act, although efforts will be needed to help the homeless enroll in Medicaid.
There has been a significant number of unsheltered persons dying of hypothermia, adding impetus to the trend of establishing warming centers as well as extending the enumeration surveys with vulnerability indexes.
Effect on life expectancy
In 1999, Dr. Susan Barrow of the Columbia University Center for Homelessness Prevention Studies reported in a study that the "age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City". A report commissioned by homeless charity Crisis in 2011 found that on average homeless people in the UK have a life expectancy of 47 years, 30 years younger than the rest of the population.
In western countries such as the United States, the typical homeless person is male and single, with the Netherlands reporting 80% of homeless people aged 18–65 to be men. Some cities have particularly high percentages of males in homeless populations, with men comprising eighty-five percent of the homeless in Dublin. Non-white people are also overrepresented in homeless populations, with such groups two and half times more likely to be homeless in the U.S. The median age of homeless people is approximately thirty-five.
Statistics for developed countries
In 2005, an estimated 100 million people worldwide were homeless. The following statistics indicate the approximate average number of homeless people at any one time. Each country has a different approach to counting homeless people, and estimates of homelessness made by different organizations vary wildly, so comparisons should be made with caution.European Union: 3,000,000 (UN-HABITAT 2004) United Kingdom: 10,459 rough sleepers, 98,750 households in temporary accommodation (Department for Communities and Local Government 2005) Canada: 300,000. Australia: On census night in 2006 there were 105,000 people homeless across Australia, an increase from the 99,900 Australians who were counted as homeless in the 2001 census United States: According to HUD's July 2010 5th Homeless Assessment Report to Congress, in a single night in January 2010, single point analysis reported to HUD showed there were 649,917 people experiencing homelessness. This number has increased from January 2009's 643,067. The unsheltered count increased by 2.8 percent while the sheltered count remained the same. Also, HUD reported the number of chronically homeless people (persons with severe disabilities and long homeless histories) decreased one percent between 2009 and 2010, from 110,917 to 109,812. Since 2007 this number has decreased by eleven percent. This is mostly due to the expansion of permanent supportive housing programs. The change in the numbers has happened due to the prevalence of homelessness in local communities rather than other changes. According to HUD's July 2010 Homeless Assessment Report to Congress, more than 1.59 million people spent at least one night in an emergency shelter or transitional housing program during 2010 reporting period, this is a 2.2 percent increase from 2009. Most users of homeless shelters used only emergency shelter, while 17 percent used only transitional housing and less than 5 percent used both during the reporting period. Since 2007 the annual number of those using homeless shelters in cities has decreased from 1.22 million to 1.02 million. That is a 17 percent decrease. The number of those using homeless shelters in suburban and rural areas has increased 57 percent from 367,000 to 576,000 In the USA, the federal government's HUD agency has required federally funded organizations to use a computer tracking system for homeless people and their statistics, called HMIS (Homeless Management Information System). There has been some opposition to this kind of tracking by privacy advocacy groups, such as EPIC. However, HUD considers its reporting techniques to be reasonably accurate for homeless in shelters and programs in its Annual Homeless Assessment Report to Congress. Actually determining and counting the number of homeless is very difficult in general due to their lifestyle habits. There are so-called "hidden homeless" out of sight of the normal population and perhaps staying on private property. Various countries, states, and cities have come up with differing means and techniques to calculate an approximate count. For example, a one night "homeless census count", called a point-in-time (PIT) count, usually held in the early Winter, for the year, is a technique used by a number of American cities, especially Boston, Massachusetts. Los Angeles, California uses a mixed set of techniques for counting, including the PIT street count. In 2003, The United States Department of Housing and Urban Development (HUD) had begun requiring a PIT count in all "Continuum of Care" communities which required them to report the count of people, housing status, and geographic locations of individuals counted. Some communities will give sub-population information to the PIT, such as information on veterans, youth, and elderly individuals as done in Boston. Japan: 20,000–100,000 (some figures put it at 200,000–400,000) Reports show that homelessness is on the rise in Japan since the mid-1990s. There are more homeless men than homeless women in Japan because it is usually easier for women to get a job and they are less isolated than men. Also Japanese families usually provide more support for women than they do for men.
Developing and undeveloped countries
The number of homeless people worldwide has grown steadily in recent years. In some developing countries such as Nigeria, and South Africa, homelessness is rampant, with millions of children living and working on the streets. Homelessness has become a problem in the countries of China, India, Thailand, Indonesia, and the Philippines despite their growing prosperity, mainly due to migrant workers who have trouble finding permanent homes.
Determining the true number of homeless people worldwide varies between 100 million and 1 billion people based on the exact definition used. Refugees, asylum-seekers, and internally displaced persons (ITDs) can also be considered homeless in that they too experience "marginalization, minority status, socio-economic disadvantage, poor physical health, collapse of social supports, psychological distress, and difficulty adapting to host cultures" like the domestic homeless. In the past twenty years, scholars like Tipple and Speak have begun to refer to homelessness as the "antithesis or absence of home" rather than rooflessness or the "lack of physical shelter." This complication in the homelessness debate further delineates the idea that home actually consists of an adequate shelter, an experienced and dynamic place that serves as a "base" for nurturing human relationships and the "free development of individuals" and their identity. Thus, the home is perceived to be an extension of one's self and identity. In contrast, the homeless experience, according to Moore, constitutes more as a "lack of belonging" and a loss of identity that leads to individuals or communities feeling "out of place" once they can no longer call a place of their own home
This new perspective on homelessness sheds light on the plight of refugees, a population of stateless people who are not normally included in the mainstream definition of homelessness. It has also created problems for researchers because the nature of "counting" homeless people across the globe relies heavily on who is considered a homeless person. Homeless individuals, and by extension refugees, can be seen as lacking lack the "crucible of our modern society" and lacking a way of actively belonging to and engaging with their respective communities or cultures As Casavant demonstrates, a spectrum of definitions for homelessness, called the "continuum of homelessness," should refer to refugees as homeless individuals because they not only lose their home, but they are also afflicted with a myriad of problems that parallel those affecting the domestic homeless, such as "[a lack of] stable, safe and healthy housing, an extremely low income, adverse discrimination in access to services, with problems of mental health, alcohol, and drug abuse or social disorganization" Refugees, like the domestic homeless, lose their source of identity and way of connecting with their culture for an indefinite period of time. Thus, the current definition of homelessness unfortunately allows people to simplistically assume that homeless people, including refugees, are merely "without a place to live" when that is not the case. As numerous studies show, forced migration and displacement brings with it another host of problems including socioeconomic instability, "increased stress, isolation, and new responsibilities" in a completely new environment
For people in Russia, especially the youth, alcoholism and substance abuse is a major cause and reason for becoming and continuing to be homeless. The United Nations, United Nations Centre for Human Settlements (UN-Habitat) wrote in its Global Report on Human Settlements in 1995: "Homelessness is a problem in developed as well as in developing countries. In London, for example, life expectancy among homeless people is more than 25 years lower than the national average.
Poor urban housing conditions are a global problem, but conditions are worst in developing countries. Habitat says that today 600 million people live in life- and health-threatening homes in Asia, Africa, and Latin America. For example, more than three in four young people had insufficient means of shelter and sanitation in some African countries like Malawi. The threat of mass homelessness is greatest in those regions because that is where population is growing fastest. By 2015, the 10 largest cities in the world will be in Asia, Latin America, and Africa. Nine of them will be in developing countries: Mumbai, India – 27.4 million; Lagos, Nigeria – 24.4; Shanghai, China – 23.4; Jakarta, Indonesia – 21.2; São Paulo, Brazil – 20.8; Karachi, Pakistan – 20.6; Beijing, China – 19.4; Dhaka, Bangladesh – 19; Mexico City, Mexico – 18.8. The only city in a developed country that will be in the top ten is Tokyo, Japan – 28.7 million."
In 2008, Dr. Anna Tibaijuka, Executive Director of UN-HABITAT, referring to the recent report "State of the World's Cities Report 2008/2009", said that the world economic crisis we are in should be viewed as a "housing finance crisis" in which the poorest of poor were left to fend for themselves.
In Australia the Supported Accommodation Assistance Program (SAAP) is a joint Commonwealth and state government program which provides funding for more than 1,200 organisations which are aimed to assist homeless people or those in danger of becoming homeless, as well as women and children escaping domestic violence. They provide accommodation such as refuges, shelters, and half-way houses, and offer a range of supported services. The Commonwealth has assigned over $800 million between 2000 and 2005 for the continuation of SAAP. The current program, governed by the Supported Assistance Act 1994, specifies that "the overall aim of SAAP is to provide transitional supported accommodation and related support services, in order to help people who are homeless to achieve the maximum possible degree of self-reliance and independence. This legislation has been established to help the homeless people of the nation and help rebuild the lives of those in need. The cooperation of the states also helps enhance the meaning of the legislation and demonstrates their desire to improve the nation as best they can. In 2011, the Specialist Homelessness Services (SHS) program replaced the SAAP program.
In the United States, the number of homeless people grew in the 1980s, as welfare cuts increased.
Housing First is an initiative to help homeless people reintegrate into society, and out of homeless shelters. It was initiated by the federal government's Interagency Council on Homelessness. It asks cities to come up with a plan to end chronic homelessness. In this direction, there is the belief that if homeless people are given independent housing to start, with some proper social supports, then there would be no need for emergency homeless shelters, which it considers a good outcome. However this is a controversial position. Miami, Florida's Community Partnership for Homeless launched a national outreach program in 2008 to help other communities throughout the United States address homelessness. Since its inception in 1993, CPH has served nearly 76,000 residents with a successful outplacement rate of nearly 62 percent in Miami-Dade County, Florida. The number of homeless people in the county has declined by 83 percent. The national program shares CPH's model of Homeless Assistance Centers, job training programs, on-site childcare, housing assistance and more. The organization also provides background on its unique funding structure and partnerships within the community.
Carrfour Supportive Housing, a nonprofit organization established in 1993 by the Homeless Committee of the Greater Miami Chamber of Commerce – develops, operates and manages innovative housing communities for individuals and families in need through a unique approach combining affordable housing with comprehensive, on-site supportive services. As the leading not-for-profit provider of supportive housing in Florida, Carrfour has supplied homes for more than 10,000 formerly homeless men, women and children since its founding. In Philadelphia, Pennsylvania, in 2007, a novel non-profit organization named Back on My Feet was created by runner Anne Mahlum as a running club for homeless men and women in the area, to help overcome homelessness through a multi-step self-help program centered on running three days a week, plus sponsored running events. Participants, drawn from local homeless shelters partnered with the organization, are assigned to different teams within each chapter and monitored by a nonresident member, and are required to commit to punctuality, endurance, self-optimism, team spirit, and sobriety. The members earn incentives through continued participation and progress, culminating in educational scholarships and assistance in finding permanent housing and employment. Back on My Feet counted a total of 400 homeless runners in nine cities after five years, and by the beginning of 2013 counted 10 different city chapters in the United States, with four more chapters planned by the end of the year.
In Boston, Massachusetts, in September 2007, an outreach to homeless people was established in the Boston Common, after some arrests and shootings, and in anticipation of the cold winter ahead. This outreach targets homeless people who would normally spend their sleeping time on the Boston Common, and tries to get them into housing, trying to skip the step of an emergency shelter. Applications for Boston Housing Authority were being handed out and filled out and submitted. This is an attempt to enact by outreach the Housing First initiative, federally mandated. Boston's Mayor, Thomas Menino, was quoted as saying "The solution to homelessness is permanent housing". Still, this is a very controversial strategy, especially if the people are not able to sustain a house with a proper community, health, substance counseling, and mental health supportive programs. In October 2009, as part of the city's Leading the Way initiative, Mayor Thomas M. Menino of Boston dedicated and opened the Weintraub Day Center which is the first city-operated day center for chronically homeless persons. It is a multi-service center, providing shelter, counseling, healthcare, housing assistance, and other support services. It is a 3,400-square-foot (320 m2) facility located in the Woods Mullen Shelter. It is also meant to reduce the strain on the city's hospital emergency rooms by providing services and identifying health problems before they escalate into emergencies. It was funded by $3 million in grants from the American Recovery and Reinvestment Act of 2009, Massachusetts Department of Housing and Community Development (DHCD), the Massachusetts Medical Society and Alliance Charitable Foundation, and the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA).
In 2010 in New York City, where there were over 36,000 homeless people in 2009, there was a mobile video exhibit in the streets showing a homeless person on a screen and asking onlookers and passersby to text with their cellphones a message for him, and they also could donate money by cellphones to the organization Pathways to Housing. In September 2010, it was reported that the Housing First Initiative had significantly reduced the chronic homeless single person population in Boston, Massachusetts, although homeless families were still increasing in number. Some shelters were reducing the number of beds due to lowered numbers of homeless, and some emergency shelter facilities were closing, especially the emergency Boston Night Center. In 2011, the Department of Veterans Affairs Supportive Services for Veterans Families Initiative, SSVF, began funding private non-profit organizations and consumer cooperatives to provide supportive services to very low-income Veteran families living in or transitioning to permanent housing. Supportive Services for Veteran Families
Enhanced data collection and evaluation Homeless enumeration counts are mandated by HUD for all jurisdictions participating in HUD Continuum of Care grant programs. These occur as frequently as every two years. More recently, organizations such as Common Ground have compiled Vulnerability Indexes which prioritize homeless persons. The factors include the existence of late stage terminal disease, HIV-AIDS, kidney or liver disease, frequent hospitalizations and frequent emergency room visits. The data which is compiled which exceeds the BUD mandate is retained and held confidential by Common Ground. Advocates of the system claim high rates of success in placing the most vulnerable persons, but skeptics remain concerned with confidentiality and security issues.
Since the late 1990s, housing policy has been a devolved matter, and state support for the homeless, together with legal rights in housing, have therefore diverged to a certain degree. A national service, called Streetlink, was established in 2012 to help members of the public obtain near-immediate assistance for specific rough sleepers, with the support of the Government (as housing is a devolved matter, the service currently only extends to England). Currently, the service does not operate on a statutory basis, and the involvement of local authorities is merely due to political pressure from the government and charities, with funding being provided by the government (and others) on an ad-hoc basis. A member of the public who is concerned that someone is sleeping on the streets can report the individual's details via the Street Link website or by calling the referral line number on 0300 500 0914. Someone who finds themselves sleeping on the streets can also report their situation using the same methods. It is important to note that the Streetlink service is for those who are genuinely sleeping on the streets, and not those who may merely be begging, or ostensibly living their life on the streets despite a place to sleep elsewhere (such as a hostel or supported accommodation).
The annual number of homeless households in England peaked in 2003–04 at 135,420 before falling to a low of 40,020 in 2009–10. In 2014–15, there were 54,430 homeless households, which was 60 per cent below the 2003–04 peak. The UK has more than 80,000 children in temporary accommodation, a number which increases every year. The official figures for England are that an average of 498 people sleeps rough each night, with 248 of those in London. It is important to note that many individuals may spend only a few days or weeks sleeping rough, and so this number hides the total number of people actually affected in any one year.
In South Africa, there are an estimated 200,000 homeless people from a diverse range of backgrounds. Most South African municipalities preimarily view homelessness as a social dependency issue, responding with social interventions.
In Sweden, homelessness should not exist, since the municipalities are required to provide a home to any citizen who does not have one. However, the landlords and lessors have the right to select guests among applicants. Owners (including municipality owned) avoid homeless people, unemployed people or people with a bad credit score. People who cannot pay their rent will be evicted, including families with small children. In 2009, 618 children were evicted. In cities with a lack of housing, the only options for homeless are usually shelters; usually privately owned, often of bad quality, for which municipalities pay.
In Finland the municipalities are required by law to offer apartments or shelters to every Finnish citizen who does not have a residence. In 2007 the centre-right government of Matti Vanhanen began a special program of four wise men modeled after a US-originated Housing First policy to eliminate homelessness in Finland by 2015.
Russia and the USSR
After the abolition of serfdom in Russia in 1861, major cities experienced a large influx of former peasants who sought jobs as industrial workers in rapidly developing Russian industry. These people often lived in harsh conditions, sometimes renting a room, shared between several families. There also was a large number of shelterless homeless. Immediately after the October Revolution a special program of "compression" ("уплотнение") was enabled: people who had no shelter were settled in flats of those who had large (4, 5 or 6 room) flats with only one room left to previous owners. The flat was declared state property. This led to a large number of shared flats where several families lived simultaneously. Nevertheless, the problem of complete homelessness was mostly solved as anybody could apply for a room or a place in dormitory (the number of shared flats steadily decreased after large-scale residential building program was implemented starting in the 1960s). By 1922 there were at least 7 million homeless children in Russia as a result of nearly a decade of devastation from World War I and the Russian Civil War. This led to the creation of a large number of orphanages. By the 1930s the USSR declared the abolition of homelessness and any citizen was obliged to have a propiska – a place of permanent residency. Nobody could be stripped of propiska without substitution or refuse it without a confirmed permission (called "order") to register in another place. If someone wanted to move to another city or expand their living area, he had to find a partner who wanted to mutually exchange the flats. The right for shelter was secured in the Soviet constitution. Not having permanent residency was legally considered a crime.
After the breakup of the USSR, the problem of homelessness sharpened dramatically, partially because of the legal vacuum of the early 1990s with some laws contradicting each other and partially because of a high rate of frauds in the realty market. In 1991 articles 198 and 209 of Russian criminal code which instituted a criminal penalty for not having permanent residence were abolished. In Moscow, the first overnight shelter for homeless was opened in 1992. In the late 1990s, certain amendments in law were implemented to reduce the rise in homelessness, such as the prohibition of selling last flat with registered children.
Nevertheless, the state is still obliged to give permanent shelter for free to anybody who needs better living conditions or has no permanent registration, because the right to shelter is still included in the constitution. Several projects of special cheap 'social' flats for those who failed to repay mortgages were proposed to facilitate mortgage market.
Homelessness in popular culture is depicted in various works. The issue is frequently described as an invisible problem, despite its prevalence. Writers and other artists play a role in bringing the issue to public attention. Homelessness is the central theme of many works; in other works homelessness is secondary, added to advance the story or contribute to dramatic effect.
Advocates for the homeless have developed various events, commemorations, and projects to raise awareness of the issue of homelessness.
In 1987, the United Nations established a International Year of Shelter for the Homeless.
In England, advocates founded an annual event named Homelessness Action Week.
In Australia, NGOs have founded two main annual events: Homeless Persons' Week, and Youth Homelessness Matters Day.
Some have taken to social media to raise awareness with projects such as I Have A Name.