Chris Reynolds, a musician who was studying shipping and logistics, shows off his home in 2022 in Amani Apartments, a Los Angeles community for formerly homeless older adults.
Photo by Gary Coronado, courtesy The Los Angeles Times/Getty Images
“You can really help heal and change yourself if you're in a safe place. And the safest place is in a home, versus sleeping outside or even in a shelter.”
— Amy Turk
Life had never been easy for Los Angeles resident Jacque Plant. After spending time in the carceral system and surviving a series of abusive relationships, she moved from Florida to California seeking a fresh start.
“I came here trying to escape one lifestyle to find the exact same lifestyle, just a different scenery,” Plant told The Nation's Health.
When the partner she'd moved with was arrested, Plant was left on her own. Battling mental health and substance use issues, she spent the next three years living on the streets of Los Angeles.
Homelessness in America is an increasingly common experience. Nationwide, an estimated 770,000 people experienced homelessness at some point last year, up 18% from 2023, according to the U.S. Department of Housing and Urban Development. More than one-third had no shelter.
Homelessness puts people at increased risk for mental health conditions, substance use disorder and infectious diseases, including hepatitis C, tuberculosis, HIV and COVID-19. It can also put them at risk for violence.
But thanks to programs and organizations like Downtown Women's Center in Los Angeles — which takes a public health centered approach to homelessness — people such as Plant have found hope.
“I was matched with DWC and that's when life really started,” Plant said.
Since connecting with the organization in 2023, Plant has secured permanent housing, is receiving consistent care for her physical and mental health, and plans to celebrate three years of sobriety in October. She takes great pride in being able to care for her dogs.
Jose Medina, who formerly lived in a Denver homeless shelter, unpacks supplies in his new rented apartment in November.
Photo by Hyoung Chang, courtesy The Denver Post/Getty Images
The Los Angeles center provides unconditional permanent housing to women and gender-diverse people experiencing homelessness, along with services such as a day center for basic needs, on-site supportive housing, community housing assistance, and health and wellness programs.
“You can really help heal and change yourself if you're in a safe place,” Amy Turk, MSW, the organization's chief executive officer, told The Nation's Health. “And the safest place is in a home, versus sleeping outside or even in a shelter.”
Housing is the first step to addressing homelessness, followed by access to comprehensive care services and ongoing social support through case management, according to David Nelson, PhD, chair of APHA's Caucus on Homelessness and a professor of family medicine at the Medical College of Wisconsin.
“Overwhelmingly, the evidence points to ‘housing first' as a model that prevents a return to homelessness,” Nelson told The Nation's Health.
Housing first is an approach that provides people experiencing homelessness with permanent housing as the first step to stability. By meeting basic needs such as shelter and food, the model creates a foundation for employment, financial stability and addressing substance use and mental health issues.
Compared to ‘treatment first' programs, which are designed to get people ready for housing and often involve more conditions, housing first programs decrease homelessness by nearly 90%, according to a 2021 study in the Journal of Public Health Management and Practice.
The housing first model also supports mental health. Research shows that the interventions reduce reliance on emergency health services. After two years in the program, participants average fewer emergency department visits, more office visits for mental health needs and an increase in needed prescription medications, a 2024 study in Health Affairs found.
The housing first approach has been the federal model for addressing homelessness for over a decade. That has changed this year under the Trump administration, which is treating homelessness as a law enforcement issue.
In July, the White House issued an executive order directing HUD and the Department of Health and Human Services to roll back support for housing first policies. The order also promotes expanded use of involuntary civil commitment and instructs agencies to give funding priority to jurisdictions that enforce bans on urban camping, loitering and squatting.
A man pushes his belongings past trucks during a sweep of a homeless encampment in Van Nuys, California, in July. Abruptly displacing residents can be harmful to their physical and mental health.
Photo by David Pasha, courtesy Middle East Images/Getty Images
The move has drawn condemnation from public health experts who warn that civil commitment violates civil and human rights and will overwhelm hospitals and emergency departments.
“Make no mistake: Trump's actions are not at all about helping unhoused people,” Mary Turner, RN, president of National Nurses United, said in a news release. “They are about criminalizing people for being poor or sick.”
The administration's attack on people experiencing homelessness reached the nation's capital in August, when federal officials assumed control over the Metropolitan Police Department of the District of Columbia. President Trump demanded on social media that people living together in encampments leave the city immediately. More than 40 encampments across the city were cleared out in August, the White House said.
Such sweeps can harm health by removing personal survival resources, forcing people into unsafe areas, limiting access to health care, increasing harmful interactions with law enforcement and discouraging use of support services, a 2022 study in SSM–Qualitative Research in Health found.
Rather than sweeping people aside, public health experts are calling for more affordable housing solutions. But without federal resources — which are being cut by the Trump administration — states and cities are struggling to find solutions, Sarah Gillespie, MPA, associate vice president for the Housing and Communities Division at the Urban Institute, told The Nation's Health.
“If we could wave a magic wand and scale housing first to the size of the problem, we could end homelessness,” Gillespie said. “But we have nowhere near the amount of housing as the number of people experiencing homelessness.”
America's high housing costs are a key contributor to homelessness. Nearly half of American renters spend over 30% of their income on housing, according to the U.S. Census Bureau. Black renters are disproportionately burdened by rental costs compared to other racial groups.
With cuts to food assistance, rental assistance and Medicaid coverage on their way thanks to the Republican-led Congress and the Trump administration, more Americans will be forced to make difficult trade-offs that jeopardize their housing stability.
“I would expect that to contribute to the trend of rising homelessness that we've seen in recent years,” Anna Bailey, MSW, JD, senior policy analyst at the Center for Budget and Policy Priorities, told The Nation's Health.
Previous federal investments in housing assistance have proven effective. In 2021, in response to the COVID-19 pandemic, Congress approved over $46 billion in emergency rental assistance programs, helping prevent millions of evictions — primarily among low-income renters and people of color.
Another pandemic-era policy expanded the child tax credit, leading to a 30% reduction in childhood poverty. The child tax credit also improved financial stability and narrowed economic disparities.
Unfortunately, those policies were eliminated at the end of the federal pandemic emergency. But the issue of homelessness and housing insecurity persists.
“We are the wealthiest nation in the world...we do indeed have the resources needed to make sure that people have a safe place to live, that people can have access to health care and have food on the table,” Bailey said. “The real challenge is that we haven't decided that we are committed to making sure that's going to happen.”
For more on the housing first strategy, visit www.endhomelessness.org.
- Copyright The Nation’s Health, American Public Health Association
