Housing, Health, and Homelessness: Evaluating the Evidence

Type: Consensus Study
Topics: Health Services, Coverage, and Access, Public Health, Select Populations and Health Equity
Board: Board on Population Health and Public Health Practice

Activity Description

A committee, under the auspices of the Science and Technology for Sustainability (STS) Program and the Board on Population and Public Health Practice, will evaluate interventions and policy options for addressing urban homelessness, particularly permanent supportive housing programs.[1] Specifically, the study will address the fundamental question, to what extent have permanent supportive housing programs improved health outcomes and affected health care costs in people experiencing homelessness? To address this question, the committee will take into consideration any variation in outcomes for different subsets of homeless populations, including people experiencing chronic homelessness and people identified as high-utilizers of health care services, as well as the variation in outcomes related to different housing configurations and approaches to services delivery and financing associated with permanent supportive housing.

The committee will focus on the following questions:

  • What is the evidence that permanent supportive housing improves health-related utilization and outcomes in homeless persons with serious, chronic or disabling conditions (e.g., substance use disorders, serious mental illness, physical disabilities, diabetes, etc.)? How cost effective is permanent supportive housing for addressing homelessness and health outcomes compared with usual care and alternative interventions? 
  • What are individual and other characteristics that may be associated with the health related outcomes and costs of permanent supportive housing (e.g., age, health conditions, other demographics)?
  • What characteristics of permanent supportive housing programs, if any, result in improved health outcomes and evidence of cost effectiveness? 
  • How generalizable are the findings from studies evaluating outcomes associated with the use of permanent supportive housing in the chronically homeless to other homeless populations (families with children, disabled persons, etc.)?
  • Are the outcomes associated with the use of permanent supportive housing translatable to other populations or systems (e.g., what are common characteristics that might translate to an institutionalized population)? 
  • What are the key policy barriers and research gaps associated with developing programs to address the housing and health needs of homeless populations?
The committee will produce a consensus report with findings and recommendations. 

[1] Permanent supportive housing is defined as decent, safe, and affordable community-based housing that provides residents the rights of tenancy under state and local landlord-tenant laws.

As of March 2016, the Health and Medicine Division continues the consensus studies and convening activities previously undertaken by the Institute of Medicine (IOM).


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