Homelessness and health: Integrating structural, social, and behavioral pathways

This research aims to develop a holistic understanding of the factors that drive variation in health among people without housing in the United States. People without housing endure high risks of illness and death across all categories, yet the specific pathways leading to variable health outcomes in this vulnerable population are under-investigated. This project investigates the individual, community, and structural factors that shape health for people without housing, aiming to understand the nuanced ways that factors at different levels may interact to affect specific vulnerabilities. The results of this project are disseminated broadly through scholarly publications and fact sheets produced for policymakers and the public. It includes a public education podcast project, where people without housing share their experiences with a wide audience of general listeners. It trains graduate and under-graduate students from under-represented groups. This research uses an innovative combination of methods from the health and social sciences to collect information about people’s lived experiences with houselessness and to assess their physical health and factors that contribute to health risks. It seeks to answer a range of questions surrounding: how physical structures such as shelters and forced relocation impact health; how social relationships are leveraged by people without homes to manage resource and health shortfalls; and how interventions can be implemented effectively to achieve better health and welfare outcomes. To answer these questions, we compare four distinct groups of people experiencing houselessness: those who sleep unsheltered on the street; those who live in unsanctioned encampments; those who sleep in temporary shelters; and those who have lived in permanent supportive housing arrangements. No previous study has taken this comparative and holistic approach; as such, it will provide new insights into the most important factors that shape health for people in this vulnerable population, contributing to scientific theories and applications in cultural anthropology, human biology, public health, and epidemiology. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.