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WARNING: Homelessness Is Hazardous to Your Health

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The Surgeon General should issue a warning that homelessness is hazardous to your health.

It is no surprise that being homeless, especially living on the street for long periods of time, has negative effects on physical and mental health. A person lacking shelter experiences indescribable stress just to survive, and is unlikely to have regular access to much of anything in the way of services, let alone adequate health care. That is why homelessness is increasingly being viewed as a health crisis.

Dr. Kelly Doran, an emergency room physician, sums it up pointedly: "chronically ill, chronically homeless patients who we see so frequently...are likely to be dead within a few years if we do not do something to change their situations."

There is growing recognition among health care professionals and policymakers that in order to improve the population's health and availability to health care while reducing costs, we must take a broader approach to health care delivery by including certain social services and supports.

This new vision seeks to maximize attention and dollars to systematically address the social determinants of health that collectively have a greater impact on the health of a community than does access to or quality of care. Social determinants of health are the economic and social conditions that affect health outcomes and are the underlying, contributing factors of health inequities. Examples include lack of housing, poor educational attainment, limited employment and an unstable environment.

Access to safe, quality, affordable housing -- and the supports necessary to maintain that housing -- constitute one of the most basic and powerful social determinants of health for individuals and families trapped in a cycle of crisis and housing instability due to extreme poverty, trauma, violence, mental illness, addiction or other chronic conditions.

For these populations, stable housing is a necessary precursor of health. Supportive Housing, an evidence-based practice that combines affordable housing with comprehensive and flexible support services, is increasingly recognized as a cost-effective health intervention for homeless and other extremely vulnerable populations.

People with long histories of housing instability and multiple chronic physical and behavioral health conditions need more than medical care; they need support in mastering and sustaining habits and behaviors that lead to effective disease management and health-promoting lifestyles. Programs and services in supportive housing are designed to be person-centered, reduce or mitigate the impact of risky/unhealthy behaviors, help tenants establish healthy personal relationships, leisure activities, and employment, and foster self-care behaviors that lead to wellness and recovery.

Two decades of research on supportive housing and our practical experience have taught us that a comprehensive view of health care must include housing and other social factors. Increasingly, evidence tells us that for particularly vulnerable populations, lack of housing and instability more than determine health, they dictate health.

At the national level, the Affordable Care Act is an important step forward in aligning our health care financing and delivery systems with this vision. It provides a unique window of opportunity to maximize supportive housing as a health care solution for the most complex and costly patients. With this framework in place, the next step is to work with states, communities and local housing systems to build the capacity, resources and political will to achieve the full promise of a reformed health care system that helps everyone.

Housing is the Best Medicine: Supportive Housing and the Social Determinants of Health at