Introduction

In the mid nineteenth century, English social reformer Edwin Chadwick established an association between appalling living conditions and poor health. Soon thereafter, Rudolph Virchow, the founder of both modern pathology and the field of social medicine, recognized the link between rising rates of infectious disease and crowded, poorly maintained housing. In the absence of diagnostic tools and effective treatments for rampant infectious diseases, many of the advances in health of the 19th and early 20th century resulted from improvements in housing, sanitation, and water quality. The Great Depression and the post-World War II era brought increased interest in housing because of the massive influx of people moving to cities in search of jobs.

The United States is a signatory to the 1948 Universal Declaration of Human Rights, which states: "Everyone has the right to … food, clothing, housing and medical care and necessary social services.” The explicit nature of the nation's societal contract to meet the housing needs of its citizens is spelled out in the Housing Act of 1949, which stipulates “the realization as soon as feasible of the goal of a decent home … for every American family." In 1968, The Fair Housing Act made discrimination on the basis of race in the housing market illegal. Regrettably, neither the Universal Declaration nor these landmark laws have solved the problem of homelessness, substandard housing, and racial profiling by sellers and realtors.

In the late 1970s, de-institutionalization of the mentally ill (unaccompanied by promised outpatient psychiatric and social services), along with a massive disinvestment in developing affordable housing, led to a large increase in the homeless, mentally ill population. The number of homeless grew in the 1980s, as housing and social service cuts increased. This was in part a consequence of the transfer of federal dollars to a huge military buildup (including the spectacularly wasteful and unsuccessful "Star Wars" strategic missile defense initiative) and consequent large budget deficits.

Fortunately, public compassion soared, and in 1986, 5 million Americans joined hands across the country to raise money for homeless programs. In 1987, the McKinney-Vento Homelessness Act authorized millions of dollars for housing and hunger relief, yet despite reauthorizations, its implementation has not been uniform or consistent across all 50 states.

Two decades later, many families lost their homes and/or went bankrupt during the financial meltdown of 2008, which was caused by a proliferation of sub-prime mortgages and the de-regulation of banks, insurance companies, and financial services companies, consequent to repeal of Glass-Steagall Act, but really, at its root, greed. Huge government bailouts were allotted mostly to financial institutions, which have recovered and indeed profited handsomely, rather than to homeowners or the newly homeless.

Despite legislative efforts to address housing inequities, a shortage of affordable housing persists, as does the problem of homelessness. Over 7 percent of persons living in the United States have been homeless at some point in their lives. An estimated 3 million people experience homelessness each year. Nationally, in 2017, there were 553,742 counted as experiencing homelessness on just one night in January, although such counts can miss large numbers of homeless people.

Nationally, 1 in 4 people experiencing homelessness is a veteran. More than 50% of all homeless women and children become homeless as a direct result of fleeing domestic violence. The availability of domestic violence shelter beds in the US is poor, and funding inadequate; most women and children are turned away on any given night.  

The homeless suffer disproportionately from numerous medical and psychiatric disorders. which will be the subject of a future program. Homeless adults face higher overall and disease-specific mortality, as well as higher medical costs. They often lack adequate health insurance, and all suffer from the pressure to fulfill competing nonfinancial needs, such food, clothing, and temporary shelter, while facing misconceptions and prejudices from many of their fellow human beings. In 2016, 80 people died on the streets of Multnomah County, here in Portland, Oregon, and another 311 in 2017 on the streets of New York City. Deaths among the homeless have been increasing, fueled by the opioid epidemic and the government’s tepid, uncoordinated response.

Affordable housing shortages and discriminatory housing practices plague many American communities. Low-income housing is frequently substandard, does not meet city inspection requirements, and is characterized by conditions that contribute to poor indoor air quality and adverse health. Such substandard accommodations are disproportionately concentrated in lower-income communities and communities of color. Segregation by income and race limit one’s access to grocery stores, neighborhood parks, and quality schools. Polluting industries are more frequently located in and around poor communities and communities of color, a phenomenon known as environmental injustice or environmental racism. Due to excessive exposure to air and water pollution, such communities bear a higher burden of many diseases. 

Quality housing is an important social determinant of health not only because it provides safe shelter from the outdoor environment and from crime victimization, but also because Americans spend much of their time indoors. For some, the quality of indoor air that they breathe may exert a greater influence on their health than the quality of the air outdoors. The elderly, pregnant women, fetuses, young children, and the chronically ill are most vulnerable to poor indoor air quality and to toxic substances in the home. Poor heating or cooling systems, inadequate ventilation, overcrowding, and poor construction can cause and/or exacerbate many health and safety problems. Lead poisoning from old pipes and paint can cause neurological damage, which may result in lower intelligence, disabilities, worsened job prospects later in life, and higher rates of criminal activity. Finally, poor housing quality adversely affects mental health, leading to increased rates of depression and stress.

The Center for Housing Policy and many other groups have found a clear impact of housing on health, education and economic development. By investing in affordable housing, cities and communities can move toward a more equitable society. Achieving equality in housing access, cost, and neighborhood conditions (such as educational opportunities and good community-law enforcement relationships) will help to create a more just and healthier America. Affordable housing frees up resources for food and health care, reduces stress and stress-related health problems, alleviates over-crowding, and allows access to neighborhood resources. Stable, affordable housing can be lifesaving for victims of domestic violence. It improves the health of seniors and those with disabilities, permitting more effective and consistent methods of delivering home care and other services. Sadly, only one in four people nationally who are eligible for rental assistance receive it.

Conclusions:

According to the Universal Declaration of Human Rights, “everyone has the right to a standard of living adequate for health…including…housing.”  Despite our government’s promise, through the Housing Act of 1949, to create the conditions to house every American family, the high numbers of homeless and those living in substandard, even dangerous, housing is a national disgrace. This is especially noteworthy, given the health consequences and high socioeconomic and quality of life costs we all share when so many of our citizens lack basic necessities. It is also both galling and embarrassing, since we are the wealthiest country on the planet.

There is much that can be done at the local, state, and federal levels to ameliorate the lack of safe and affordable housing and to provide assistance to those who, whether through physical or mental illness, interpersonal violence, disability, military service, poverty and substandard wages, or other socioeconomic barriers are unable to afford a place to stay. For many Americans, homelessness is one paycheck, medical crisis, military deployment, or domestic assault away.

Holocaust survivor and author Primo Levi wrote, “A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.” If we are to become a more civilized society, then we must heed his advice and work together to confront social injustices through voting, changes in legislation, and activism.

Bio: Martin Donohoe, MD, FACP practices internal medicine and is the author of Public Health and Social Justice (Jossey Bass/Wiley) and the host of the cable television program “Prescription for Justice.” See http://publichealthandsocialjustice.org or http://www.phsj.org for further information.

Attack on St. Louis Homeless Foreshadows Things to Come

by Don Fitz 

The sub-freezing temperature was dropping.  As the snow began to fall, many felt their hands were too cold to hold signs during the December 17 action.  Two dozen had answered the Green Party call to picket the mayor of St. Louis for his efforts to close down New Life Evangelistic Center, the city's homeless “shelter-of-last-resort.”  They knew things would be much worse for those forced to sleep in the cold if the shelter were shut down.  The action was one in a series of efforts to draw attention to the city government's ruthless attack on those with no place to go. 

The roots of homelessness are much deeper than cold blooded insensitivity of Republicans.  It reflects a bi-partisan attack on the poorest of the poor.  Efforts to shut down New Life are spearheaded by Francis Slay, the Democratic Party mayor who has championed charter schools over public ones, stymied efforts to create a meaningful Civilian Oversight Board for police violence, and always finds millions upon millions of dollars for sports stadiums while funding for homeless shelters are never adequate.  

Over 40 years ago Rev. Larry Rice began New Life in a part of downtown St. Louis where real estate was cheap.  He expanded the number of homeless he could house to over 200 per night and became somewhat of a folk legend.  But in recent years, buildings near New Life gentrified.  In flocked yuppies and others who sneered at homeless people as beneath them.  Even though the shelter was there first and newcomers were quite aware of who their neighbors would be, many of them acted as if the loft owners had assured them that they could get rid of the unwanted.  

Mayor Slay became their knight in shining armor as he initiated efforts to drive the homeless from the streets of downtown.  Driving people away from where they live due to the increased value of land is a recurring theme in the history of this hemisphere.  For centuries, indigenous peoples have suffered the “extraction curse” when their home are discovered to be located atop gold, silver, tin, lead or adjacent to a potential hydroelectric dam.

This was not lost on several St. Louisans who recently returned from opposing the Dakota Access Pipleline (DAPL).  Corporate executives are eager to sacrifice sacred lands and clean water so they can transport fossil fuel across the US for sale to distant countries.  The Mississippi Standing Action Group joined the Green Party picket because of the painful similarity between dehumanizing native peoples and demonizing the homeless.  

As temperatures plummeted, the mayor's campaign of harassment against New Life swung into full gear.  “It's obscene for Francis Slay to interfere with people trying to bring donations in the cold of winter,” observes Green Party spokeswoman Barbara Chicherio.  “Slay has ordered parking meters to be removed from the entire block in front of New Life.  I have witnessed police telling people that they can no longer stop their cars to bring food and blankets inside.  They have even used taxpayer money to put up signs in front of New Life telling people to take their donations somewhere else.”

For months, Slay has been working to pull corporate media under his umbrella.  Stories of good work done by New Life have almost disappeared from TV and the St. Louis Post-Dispatch as they are replaced by reports confirming what the Democratic Party Mayor wants the public to believe.  The newspeak includes charges that New Life …

1. has to be shut down because it does not comply with codes for building permits;
2. is responsible for a wave of overdoses by those smoking K-2 (synthetic marijuana) in front of it; and,
3. can easily be eliminated because other area shelters can handle those who come there. 

There are a few wee problems with each of these allegations.  As the New Life attorney notes, building codes and ordinances “are so vague and ambiguous that it is impossible to comply.”  The Board of Public Services, which revoked New Life's occupancy permit had no jurisdiction because New Life is not a hotel as it claimed.  Additionally, requiring New Life to obtain signatures of approval by those living nearby is discriminatory in the extreme, since shelters favored by the city are not required to do so.

The charge that New Life is somehow responsible for K-2 overdoses is absurd.  City police refused to respond to 911 calls made by New Life that dealers and thugs were distributing K-2 near the shelter, raising the question of whether city government itself was behind the overdoses.  Checking the public record of 911 calls to respond to K-2 overdoses reveals that they were made all over the downtown area and were definitely not limited to New Life.

Many homeless shelters in St. Louis are doing great work.  City Hall may claim that other shelters can absorb people going to New Life; but the reality for those who suddenly find themselves without a home on a frigid night is quite different.  When people call another shelter, they are likely to find …

• that shelter has restrictions which exclude them; or
• that shelter has a waiting period before they can get a bed; or
• they need a diagnosis before coming in; or
• they can only leave a phone number for an agency which never calls them back; 
• the shelter decided that the cold is not “excessive” because it is not 15 degrees or lower; or
• they are told that the only shelter which can meet their emergency needs is New Life.

Green Party mayoral hopeful Johnathan McFarland believes that “New Life must be kept open because it is the only shelter in St. Louis which takes in homeless people in truly desperate situations.  It is obviously needed because so many people come there.”

While Trump and the Republicans are more blatant in their rhetoric, the slick wordsmithing of Democratic Party politicians like Francis Slay has equally brutal effects.  As capitalism sinks into a feeding frenzy to extract profits from every acre of native land and urban real estate, it uses whatever technique it finds most useful.  In St. Louis and Standing Rock, its focus is on those who have the least power to resist.  It is clearly the time for the left to unite in their defense.  If we do not, the 1% will intensify their efforts to throw environmentalists, trade unionists and social justice activists under the rug. 

Don Fitz is on the Editorial Board of Green Social Thought, which is sent to members of The Greens/Green Party USA.  He produces the show Green Time in conjunction with KNLC-TV in the City of St. Louis and is editor of the Compost-Dispatch newsletter, published for the Green Party of St. Louis.