Harm Reduction in a Pandemic: Opportunities and Challenges for Homeless Policy (Pre-Recorded)

• In Event: Beyond COVID-19: The Influence of Infectious Diseases on Public Health Policy (Pre-Recorded)

Abstract

Homelessness is inexorably linked to adverse health outcomes and high mortality. The number of persons experiencing homelessness in the United States exceeds the number of persons suffering from opioid substance use disorders. During the COVID-19 pandemic, the rate of homelessness increased significantly, and is expected to eclipse rates of homelessness during the Great Recession.

Despite the prevalence of homelessness in the U.S., policies to mitigate homelessness are underfunded, and governance is primarily directed by locally organized, fragmented systems of non-governmental actors. Most municipal governments do not participate in homeless policy governance, constraining actors’ ability to design, deliver, and fund policy tasks to ameliorate homelessness.

Persons experiencing homelessness are at a high risk of communicable diseases as a result of congregate living circumstances and limited access to hygiene facilities. In response to COVID-19, homeless policy governance systems faced critical challenges to reforming service delivery and continuing to provide necessary services to an already high-risk population. We conducted a unique, national survey of homeless policy governance systems across the U.S. in 2020, to understand the influence of the COVID-19 pandemic on homeless policy governance in the context of this fragmented, delegated state environment. Our results demonstrate that while homeless policy systems overall faced many insurmountable challenges, exacerbated by COVID-19, nearly half of all homeless governance systems simultaneously experienced increased engagement from municipal governments for the first time ever in response to increased salience of homelessness during the pandemic. While governance systems received additional resources as a result of this increased coordination, pre-existing challenges arising from limited authority, fragmentation, and political opposition to homeless solutions continued to stymie policy implementation.

Authors

• Charley Ellen Willison, Cornell University

• Kasia Klasa, University of Michigan

• Scott L. Greer, University of Michigan

• Julia A Wolfson, Johns Hopkins Bloomberg School of Public Health