Few coroners are likely to put “homelessness” as the cause of death. It is too bad, because we could use that level of honesty.
The omnibus appropriations bill that Congress passed last month to fund federal government operations and programs through the rest of the 2015 fiscal year (through September 2015) largely left out the Obama Administration’s proposed $300 million increase to the Department of Housing and Urban Development for permanent supportive housing units, part of the government’s effort to end chronic homelessness. The funding would have provided 37,000 new units of supportive housing by the end of 2016 (p. 2). Congress opted for a $30 million increase instead (fiscal year 2014 funding for these homeless assistance grants was $2.105 billion; the omnibus provided $2.135 billion), which is essentially only enough to keep up with inflation.
This omission will cost lives. Homeless people in the United States have a life expectancy 15 years shorter than the rest of us, 64 years compared to the U.S. average of 79. A study several years ago of Los Angeles’s homeless population had even more dire findings. The 2,815 members of this population who died from 2000 through 2007 had a collective life expectancy of 75 years (based on gender and ethnicity) – yet died, on average, when they were 48 years old. Latina women lived barely half their normal life expectancies. Such massive differences mirror findings in other studies.
How different this reality from the noble calls of the UN Secretary-General. The United Nations is approaching the homestretch in defining the Sustainable Development Goals (SDGs), the successors to the Millennium Development Goals (MDGs), which are due up this year. Last month, Ban Ki-moon issued his long anticipated synthesis report, bringing together the findings from a range of different consultation processes, meetings, and reports on the SDGs to feed into state negotiations, with the new goals expected to be finalized in September.
In his report (page 15), the Secretary-General insists that the new sustainable development agenda “must…address inequalities in all areas, agreeing that no goal or target be considered met unless met for all social and economic groups.”
What a remarkable change that would be, a concern about the worth of all of us, standing in sharp contrast to the politically expedient decision to sacrifice the homeless in the omnibus appropriations bill. Would the Secretary-General’s proposal mean an end to homelessness?
The most prominent proposal for the SDGs come from the UN Open Working Group on Sustainable Development Goals (OWG), which last year proposed 17 goals with 169 targets among them. The proposed OWG health targets include universal health coverage, yet how many homeless people are able to secure quality health coverage, rather than relying on the limits of sporadic emergency room care? With cardiovascular disease the leading cause of death among homeless populations in the Los Angeles study (and the second leading cause in a review of deaths among homeless people in Colorado in 2012), we must similarly ask, can a proposed one-third reduction in premature mortality from non-communicable diseases by 2030 be accomplished without vastly reducing the number of people who are homeless? And what of ending preventable newborn and child deaths, another proposed target? If children are born into and begin their lives in homelessness, are not some preventable deaths virtually inevitable, given the heightened levels of malnutrition, low birth weight, and exposure to environmental toxins that they experience?
(Also worth noting in this context is the proposed target of reducing substance abuse. This would importantly benefit homeless populations. Substance abuse was the leading direct cause of death in the Colorado review and second in Los Angeles study, and is often a factor in people becoming homeless.)
Beyond the health sector, as long as there are homeless people, can all people have access “to safe, nutritious and sufficient food all year round,” part of the OWG’s proposed target on ending hunger? Access to adequate sanitation facilities?
These are only targets directly related to health. Goals universal in scope on employment, education, and ending violence against women would powerfully affect the homeless (or would-be homeless) as well — and continued homelessness would seriously impede achieving them.
And then there is this target: By 2030, ensure access for all to adequate, safe and affordable housing and basic services, and upgrade slums.
If this goal is interpreted robustly (e.g., meaningful access, “all” indeed meaning “all”) and achieved, that would mean an end to homelessness.
One of the fundamental shifts from the MDGs to the SDGs is the focus on equity, and not only reducing extreme poverty – a task that remains vitally important (and the elimination of extreme poverty is in the Open Working Group’s proposal). Being true to this concern for equity would be transformative. Ensuring that countries commit to meeting goals and targets not only in the aggregate but for each of their marginalized populations is one way to advance this global mission.
Will states agree that no goal can be considered achieved unless it is achieved for every sub-population? And if they do, will they then act on this commitment? Or, having made the noble commitment, will they do enough – will we do enough – to counter the prejudices, interests, power dynamics, and other forces that have perpetuated the inequitable status quo, that have kept the marginalized marginalized, the neglected neglected, the disadvantaged disadvantaged?
In 2002, the Bush Administration set a goal of ending chronic homelessness in the United States in ten years. The Obama Administration set the same ten-year goal eight years after that. And still much work remains – even as there has been progress, with the number of chronically homeless people falling from 156,000 in 2006 to just below 100,000 in 2012. Meanwhile, looking at homelessness overall, despite a longer term downward trend, a new report of homelessness in 25 cities from the U.S. Conference of Mayors found a 1% increase in overall homelessness those cities over the past year (page 24), with 73% of the cities having had to turn families away from shelter due to lack of bed space (page 27). Lack of affordable hosing was the number one factor in homelessness (page 2). (Click here for a summary of findings.)
Goals are goals, not realities. Getting into the Sustainable Development Goals the Secretary-General’s proposal that no goal or target be considered met unless it is met for all groups will be a start, but only a start. The stinginess of the omnibus appropriations bill on housing for the homeless is a stark reminder that bold commitments are nearer the first step than the last. We will need to remain vigilant, active, and committed.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.