The American Public Health Association,
Noting that the nation has entered a second decade of mass homelessness on a scale unprecedented since the Great Depression;1 and
Being alarmed at the severity and complexity of contemporary homelessness, especially its disproportionate impact on people of color and its devastating impact on the increasing numbers of families and children in the homeless population;2 and
Noting the close connections between homelessness and ill health, namely that ill health and its financial impact can contribute to homelessness, that the exposures and stresses inherent in homelessness often result in ill health, and that the effective prevention and treatment of illnesses2,3 are compromised by a person’s homelessness; and
Recognizing that HIV disease, alcohol and other drug problems, mental illness, tuberculosis, and virtually all morbidities are prevalent among homeless people at much greater rates than are found among the general population;4 and
Noting that access of homeless people to primary health care, including nutrition services, alcohol and other drug treatment, and mental health treatment is restricted by insufficient and inappropriate services, lack of health insurance,
and barriers of finance, location, culture, and provider attitudes;2 and
Recognizing a serious deterioration of the nation’s public health infrastructure and inadequacies of the health care delivery system,5despite examples of successful system modifications through the Stewart B. McKinney Homeless Assistance Act and other programs; therefore
- Urges revision of federal, state, and local income support programs to assure the opportunity for adequate nutrition and housing that meets standard requirements;6
- Urges a dramatically increased supply of affordable supportive and independent housing units and concerted efforts to reduce reliance on emergency shelters;
- Reaffirms the Association’s call for a comprehensive national health plan that would guarantee equal access to health services for all people, including services that would address particular needs of homeless people, such as a full range of preventive and primary health care, outreach and case management, respite care, mental health services, and alcohol and other drug treatment;
- Urges, as an interim measure, extension of Medicaid to all homeless uninsured persons living at or below 100% of the federal poverty level, based on presumptive eligibility;
- Urges expansion of delivery and coverage of alcohol and substance abuse treatment for homeless people;
- Urges careful monitoring and evaluation of the impact of mandatory managed care cost containment mechanisms on homeless and other populations;
- Urges improved collaboration between the Social Security Administration and the Health Care Financing Administration on SSI outreach efforts to enable disabled homeless people to obtain Medicaid benefits; and
- Urges full funding at authorized levels for all programs of the Stewart B. McKinney Homeless Assistance Act and related homelessness relief legislation, and increases in authorizationss.
- Wright JD, Weber E. Homelessness and Health. New York: McGraw-Hill; 1987:1.
- Institute of Medicine. Homelessness, Health and Human Needs. Washington, DC: National Academy Press; 1988:11, 39,140.
- American Public Health Association Policy No. 8932(PP): Alcohol and Other Drug Problems Among the Homeless Population. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: APHA; current volume.
- Brickner PW, et al. Under the Safety Net. New York: W.W. Norton; 1990:28-29; cf. American Public Health Association Policy No. 8932(PP): Alcohol and Other Drug Problems Among the Homeless Population. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: APHA; current volume.
- Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press; 1988.
- Mood EW. Housing and Health: APHA-CDC Recommended Minimum Housing Standards. Washington, DC: American Public Health Association; 1986.
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