America’s Homelessness Crisis

Homelessness is a public health problem. From rising housing costs to discriminatory lending and leasing, natural disasters, and mental illness, homelessness has many different causes and many similar effects: serious adverse consequences for physical and mental health across the life course. This chapter makes the case for homelessness as a public health problem, with chronic homelessness as scope of focus for this book. This chapter then introduces the main question of the book: If municipalities are the site of the U.S. homeless epidemic, what are municipal governments doing to address homelessness, and why? This chapter then outlines the role of governance structures in shaping municipal approaches to chronic homelessness, describes the governance system responsible for designing and delivering solutions to homelessness and chronic homelessness in the United States, and the history of homeless policy in America. Finally, this chapter lays the roadmap for the book and subsequent chapters.

Measuring Municipal Participation in Homeless Governance

Chapter 4 examines national variation in municipal responses to chronic homelessness, identifying the prevalence of municipal-level supportive housing policies among municipalities affected by homelessness in the United States and identifying and examining factors associated with the presence of a municipal-level supportive housing policy. The presence of municipal-level supportive housing policies is an indication of evidence-based policy adoption to address chronic homelessness effectively in urban areas. To date, there has been almost no research on the political predictors of the adoption of these evidence-based policies. Results demonstrate that most municipalities facing homelessness challenges do not have supportive housing policies. Of the municipalities in the data set, only 40% had a municipal-level supportive housing policy. These municipalities tend to be: more liberal; sanctuary cities; have fewer but better funded nonprofit health organizations; lower rates of municipal governmental fragmentation; and located in states without Medicaid expansion.

The Fragmented State

Atlanta represents municipalities with a supportive housing policy in municipalities that are majority Black and in states that have not expanded Medicaid. Atlanta’s Continuum of Care is integrated into municipal government. Atlanta’s move to integrate the Continuum of Care into local government occurred when the Continuum of Care restructured, moving from a trijurisdictional arrangement to separate city and county institutions. The restructuring was prefaced by an investment in homelessness and chronic homelessness prevention and services by the city of Atlanta. Subsequently, the city adopted a supportive housing policy and implemented pilot programs to reduce policing of persons experiencing chronic homelessness. Despite positive changes, Atlanta still suffers from barriers to policy implementation resulting from: histories of race and segregation, including separate policy efforts mobilizing police to move persons experiencing chronic homelessness to other jurisdictions; limited governmental funding and reliance on nongovernmental actors as providers and funders; and metropolitan fragmentation inhibiting policy coordination.

The Integrated State

San Francisco represents municipalities with a local supportive housing policy. San Francisco highlights the significance of policy implementation as a critical process that cannot be overlooked when examining policy success. San Francisco should seemingly be very well positioned to successfully tackle chronic homelessness compared to other cities across the United States with a centralized municipal Continuum of Care, strong local tax base, and historical investment in social and health services for at-risk groups. Yet, many efforts have stagnated at the implementation phase. San Francisco is a city with a very visible homelessness epidemic. The problem will not be solved until implementation problems can be overcome by improving participatory equity in political decision-making to include minorities and at-risk groups, limiting elected officials’ ability to interfere with bureaucrats’ duties to carry out supportive housing regulation, and improving state level coordination with municipal goals to reduce administrative burden and align funding mechanisms.

A Way Forward

Overcoming challenges associated with decentralization and policy conflict across policy interests to address chronic homelessness in municipalities across the United States will be a big hurdle requiring substantial changes. Primary recommendations for reform include, first, aligning Continuums of Care with municipal government to ensure Continuums have access to necessary resources and governmental authority to design and implement policy across the variety of policy spaces including housing, healthcare, behavioral health, policing, and incarceration. Second, improving participatory equity in homeless policy decision-making to include minority groups and persons who are currently or formerly homeless will improve policy design and implementation to ensure policies targeting persons experiencing homelessness work to their intended goals and protect policy processes from bias toward economic elite stakeholders in pluralistic settings. Lastly, steps are recommended to align tangential state-level policies providing services for persons experiencing chronic homelessness but, by virtue of not being designed to target chronic homelessness, fail in implementation.

Seeking Deeper Explanations

Chapter 3 describes the rationale for conducting a mixed methods, explanatory sequential design, or the use of quantitative data, to first explore trends in an understudied subject, followed by in-depth qualitative analyses to explain the mechanisms behind the broader trends. Chapter 3 outlines the quantitative data, sample selection, and methodological approaches. A novel national data set was built to identify political characteristics associated with the presence of a municipal-level supportive housing policy. The sample includes municipalities receiving federal funding to address homelessness. This chapter subsequently discusses the case selection strategy stemming from the results from the national analysis and the qualitative methods and data. Three municipal cases were selected from the national data set to provide in-depth explanations of the mechanisms behind local choices to adopt supportive housing policy or not. The three cases are San Francisco, CA; Atlanta, GA; and Shreveport, LA.

The Delegated State

Shreveport serves as the representative case for municipalities without a local government level supportive housing policy. Shreveport is a case where the Continuum of Care, municipal policy goals, decision-making, and implementation remain very separate. The separation is evident in policy decision-making and implementation, where the municipal government has little to no involvement in homeless policy aside from coordinating pass-through federal funding. Limited involvement by Shreveport’s municipal government presents direct barriers to supportive housing policy design and implementation by restricting authority and resources available to the Continuum of Care to coordinate policy activities. Policy activities constrained by the limited municipal authority for the Continuum of Care include challenges reducing policing of persons experiencing chronic homelessness and severe mental illness and limited ability to participate in municipal decision-making, which disadvantaged the Continuum of Care in debates over new shelter or low-income housing constructions compared to economic elites in the Downtown Development Authority.

Homeless Politics in the United States

Public health studies issues and policies implemented and often governed by local-level public health departments. Yet public health policy research emphasizes state and federal relations. Obscuring the role of local politics and in designing and implementing public health policies inaccurately portrays the functioning of public health systems and may lead to incomplete assumptions about the effects of health politics on public health. Homelessness is no exception, with a long history of expanded governing authority for communities and local governments. To understand homeless policy governance, we must draw from theories of urban politics and intergovernmental relations that have been developed to explain social policy. Chapter 2 develops the main theoretical argument of the book: limited coordination between policy interests governing homeless policy and trends of decentralization in homeless policy governance contribute to fewer publicly funded policy alternatives for solutions to chronic homelessness and increases the policy alternatives for private actors.