8.4.2: Housing Instability
A lack of sufficient and quality housing affects health in both large cities and rural areas. Perhaps the first problem we think about with a lack of housing is homelessness, or a state of being unhoused. Although images of tent encampments on sidewalks are often what is portrayed on the news media to describe the “homelessness crisis”, the unhoused population includes more people than those visibly living on the street. Folks who have no permanent residence may be living out of their car, in hotel rooms, or “couch surfing” and staying with friends or family temporarily. They may also be living in temporary subsidized housing or staying in shelters overnight. Housing status can be dynamic and change rapidly over time, so it can be difficult for public health officials to get a true count of housing needs in a particular area. For example, the Los Angeles Homeless Services Authority (LAHSA) conducts a point-in-time count of unhoused individuals over 3 days, twice per year, which includes those in shelters, transitional housing, and hospitals, as well as a visual count conducted by volunteers across the city (Greater Los Angeles Homeless Count, 2024). This may still undercount some individuals who lack permanent housing, or are housing insecure - which can also mean being at risk for losing housing within the next couple of weeks. Housing instability is obviously a complicated problem.
Both a lack of permanent housing and housing insecurity can cause significant physical and mental stress. Those without housing are at higher risk of being assaulted, are likely to go hungry and have food insecurity, and lack access to basic hygiene facilities - which increases risks of infectious disease and malnutrition. The psychological stress of housing insecurity can be debilitating; anxiety, depression, and substance abuse are common. Yet American society adds to these hardships by stigmatizing and dismissing those who are unhoused as “lazy” or “drug addicts” (Bhattar, 2021). Local governments often take steps to remove homelessness from the sight of other residents, many times without actually providing sufficient housing for those affected. Some attempts to convert or build temporary housing facilities are met with strong opposition from local residents due to this stigma (Canadian Observatory on Homelessness, 2021). Hostile architecture like bars in public benches, or pylons under bridges are built to make it impossible for people to find shelter in those locations. Some local governments make camping on the street illegal, increasing the likelihood of hostile police interactions and incarceration for the unhoused. Assaults by private individuals and police officers on the homeless have been documented (Bhattar, 2021).
Individuals experiencing a lack of housing are not a monolith, yet homelessness does tend to affect marginalized groups at higher rates. Some are suffering from mental illness and addiction. Veterans suffering with post-traumatic stress disorder (PTSD) often lack housing and may have other disabilities as well. There are also those who have one or more jobs and their wages are insufficient to support them. Other individuals have been kicked out of a family home, or left abusive relationships. LGBTQ+ youth can be at a high risk of homelessness, and victims of domestic abuse often face homelessness while leaving an unsafe relationship. A lack of affordable housing in many areas of the U.S. exacerbates these problems (Bhattar, 2021). College students are also often among those lacking housing. For example, a CA State Assembly report found that 5% of UC students, 10% of CSU students, and 20% of community college students in CA reported experiencing some form of housing insecurity - often from a lack of affordable housing close to the campus they are attending (Burke, 2022). Lacking those basic necessities can have a significant impact on the academic performance of those students.