Ungoverned and Out of Sight Public Health and the Political Crisis of Homelessness in the United States

If health policy truly seeks to improve population health and reduce health disparities, addressing homelessness must be a priority

Homelessness is a public health problem. Nearly a decade after the great recession of 2008, homelessness rates are once again rising across the United States, with the number of persons experiencing homelessness surpassing the number of individuals suffering from opioid use disorders annually. Homelessness presents serious adverse consequences for physical and mental health, and ultimately worsens health disparities for already at-risk low-income and minority populations. While some state-level policies have been implemented to address homelessness, these services are often not designed to target chronic homelessness and subsequently fail in policy implementation by engendering barriers to local homeless policy solutions.

In the face of this crisis, Ungoverned and Out of Sight seeks to understand the political processes influencing adoption of best-practice solutions to reduce chronic homelessness in US municipalities. Drawing on unique research from three exemplar municipal case studies in San Francisco, CA, Atlanta, GA, and Shreveport, LA, this volume explores conflicting policy solutions in the highly decentralized homeless policy space and provides recommendations to improve homeless governance systems and deliver policies that will successfully diminish chronic homelessness. Until issues of authority and fragmentation across competing or misaligned policy spaces are addressed through improved coordination and oversight, local and national policies intended to reduce homelessness may not succeed.

Charley Willison, PhD, MPH, MA, is a National Institutes of Mental Health Postdoctoral Fellow at the Harvard University Department of Health Care Policy. Her work focuses on health policies that are designed and/or delivered at the local level, including homelessness, housing, behavioral health policies and disaster responses.

Table of Contents

Acknowledgements

Chapter 1: America's Homelessness Crisis

Chapter 2: Homeless Politics in the United States: Theories of the Ungoverned and Unwanted

Chapter 3: Seeking Deeper Explanations: Case Selection and Qualitative Analysis

Chapter 4: Measuring Municipal Participation in Homeless Governance: A National Perspective

Chapter 5: The Integrated State: San Francisco and Challenges for Policy Implementation

Chapter 6: The Fragmented State: Atlanta and the Challenges of Coordination

Chapter 7: The Delegated State: Shreveport and Challenges of Authority and Capacity

Chapter 8: A Way Forward

Appendix A: Dataset Overview and Codebook
Appendix B: fsQCA Deduction Procedure
Appendix C: Interviewee Demographics by Cases
Appendix D: Qualitative Interview Consent Protocol
Appendix E: Qualitative Interview Questionnaire
Appendix F: Codebook for Qualitative Interviews
Appendix G: Process Tracing Analytic Approach and for Archival Documents

Notes
References
Index