20. Homeless Assistance, US Department of Housing and Urban Development. Available at: http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/homeless
A. Lowrey, “Homeless Rates in the U.S. Held Level Amid Recession, Study Says, but Big Gains Are Elusive,” New York Times, Dec 10, 2012. Available at: http://www.nytimes.com/2012/12/10/us/homeless-rates-steady-despite-recession-hud-says.html?_r=0
21. However, for many such programs, to qualify, people had to be sober, which meant that the highest-risk groups—the heaviest drinkers, the crack and the heroin users—weren’t eligible.
One “Housing First” program in Seattle launched in December 2005 sought to help an estimated 500 chronically publicly inebriated persons in downtown Seattle. The program came to be known as 1811 Eastlake, the street address where seventy-five units of residential housing were built. The researchers tried to assess what might happen if these high-risk groups were included, even allowing participants to drink in their rooms. Needless to say, 1811 Eastlake was overrun with homeless applicants wishing to take part.
The situation created a unique opportunity for researchers to conduct a natural experiment. The researchers were able to compare people who participated in Seattle’s Housing First program for chronically homeless persons with severe alcohol problems against people who were on a wait-list for the program.
Participants in the program were estimated to cost society $4,066 per person per month in hospital, jail, and housing bills. Once provided with permanent housing, their total costs dropped to $1,492 after six months, and to $958 by the end of the year. The benefits had largely come from participants drinking less than those who remained homeless.
Finding housing helped avoid health hazards, but the ultimate health effect depended on the quality of the neighborhood. A 2011 study published in The New England Journal of Medicine randomly assigned 4,498 women with children living in public housing in high-poverty urban areas to one of three groups: 1,788 received housing vouchers, which could be redeemed only if they moved to a low-poverty area (where less than 10 percent of residents are poor); 1,312 received unrestricted, traditional vouchers; and 1,398 placed into a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up study, researchers measured data on their health outcomes. They found that simply moving from a neighborhood with a high level of poverty to a community with a lower level of poverty was associated with significant reductions in the obesity and diabetes. These remarkable benefits appeared to happen because wealthier neighborhoods offered their residents better access to healthier food, along with more green space that made it easier and more desirable to walk without the fear of crime and gang-related violence.
22. Fairmount Ventures Inc. Evaluation of Pathways to Housing Philadelphia, 2011. Available at: https://www.pathwaystohousing.org/uploads/PTHPA-ProgramEvaluation
Finding housing helped avoid health hazards, but the ultimate health effect depended on the quality of the neighborhood. A 2011 study published in The New England Journal of Medicine randomly assigned 4,498 women with children living in public housing in high-poverty urban areas to one of three groups: 1,788 received housing vouchers, which could be redeemed only if they moved to a low-poverty area (where less than 10 percent of residents are poor); 1,312 received unrestricted, traditional vouchers; and 1,398 placed into a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up study, researchers measured data on their health outcomes. They found that simply moving from a neighborhood with a high level of poverty to a community with a lower level of poverty was associated with significant reductions in the obesity and diabetes. These remarkable benefits appeared to happen because wealthier neighborhoods offered their residents better access to healthier food, along with more green space that made it easier and more desirable to walk without the fear of crime and gang-related violence.
23. J. Eng, “Homeless Numbers Down, but Risks Rise,” NBC News, Jan 18, 2012. Available at: http://usnews.nbcnews.com/_news/2012/01/18/10177017-homeless-numbers-down-but-risks-rise?lite
The number of beds of permanent supportive housing rose from 195,724 in 2008 to 274,786 in 2012, with significant financing from the HPRP program. Available at: https://www.onecpd.info/resources/documents/2012AHAR_PITestimates.pdf
24. V. Busch-Geertsema and S. Fitzpatrick. 2009. “Effective Homelessness Prevention? Explaining Reductions in Homelessness in Germany and En gland,” European Journal of Homelessness v2:69–96. UK Housing benefit fact sheet. Available at: https://www.gov.uk/housing-benefit/what-youll-get; where this was not enough to meet rent payments, it was also possible to apply for “discretionary housing payments” to help make up the difference.
Housing has long been a key target of public health intervention. The founder of the Yale School of Public Health, C. E. A. Winslow, gave a famous speech to the American Public Health Association in 1937. “Housing as a public health problem,” he argued, was a fundamental goal in public health. “We call you today to a new contest even harder than the old ones—the fight for decent hygienic housing for the American peoples.” He pointed to the example of Britain, noting, “No British health officer publishes an annual report without a section on housing in the positive sense, and the same inevitable laws of social progress are pressing on us in this country that have operated there.”
25. R. Ramesh, “Warning on Benefit Cuts amid Rise in Homelessness,” The Guardian, Dec 4, 2012. Available at: http://www.guardian.co.uk/society/2012/dec/04/benefit-cuts-rise-homelessness
The total austerity figure was later slightly revised down to reach total spending cut of £81 billion by 2014–15 as set out in the June budget. This included 11 billion in welfare reform savings and 3.3 billion from a two year freeze in public-sector pay. HM Treasury Spending Review 2010. Cm 7942. UK Trea sury, Oct 2010.
R. Bury, “Social Housing to Be Hit With £8bn Cuts,” Inside Housing, 2010. Available at: http://www.insidehousing.co.uk/social-housing-%E2%80%98to-be-hit-with-%C2%A38bn-cuts%E2%80%99/6512119.article
“Housing Benefit Cuts,” Crisis UK, 2012. Available at: http://www.crisis.org.uk/data/files/publications/Crisis%20Briefing%20-%20Housing%20Benefit%20cuts.pdf. The Scottish government followed suit, cutting its own affordable housing budget by 31 percent.
“Social Housing budget ‘To Be Cut In Half’,” BBC, Oct 19, 2010. Available at: http://www.bbc.co.uk/news/uk-politics-11570923
26. US Department of Housing and Urban Development, Point-in-Time Estimates of Homelessness: Volume I of the 2012 Annual Homeless Assessment Report (AHAR), 2012. Available at: https://www.onecpd.info/resource/2753/2012-pit-estimates-of-homelessness-volume-1-2012-ahar/; UK Government, “Live Tables on Homelessness.” Available at: https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness. Homelessness rose in London from 9,700 households to 11,680 households between 2010 and 2011 (Department for Communities data). In the city of London, the number of people sleeping on the streets rose by 8 percent; youth were particularly negatively affect, as among those aged under twenty-five, homelessness rates rose by a third.
27. SSAC (November 2010) Report on S.I. No 2010/2835 and S.I. No. 2010/2836. Cited on p. 19 in http://www.crisis.org.uk/data/files/publications/Crisis%20Briefing%20-%20Housing%20Benefit%20cuts.pdf
28. “Homelessness: A Silent Killer,” Crisis UK, 2011. Available at: http://www.crisis.org.uk/data/files/publications/Homelessness%20-%20a%20silent%20killer.pdf The epidemiological study tried to disentangle homelessness from pre-existing health problems by evaluating people’s health over time. These researchers identified and followed 6,323 homeless adults over five years and compared them with 12,451 people of the same age and gender in the general population. The homeless people, they discovered, were 4.4 times more likely to die than those with homes. But more interestingly, even when the researchers adjusted for the risks linked to past hospitalizations and current disabilities
, it was found that not having a house posed a significantly greater risk of dying prematurely. In other words, the homeless who started out being healthy ultimately ended up being sicker.
A Department of Health report in 2010 estimated the healthcare costs alone of UK homelessness at about £2,115 per person per year. Department of Health. March 2010. Healthcare for single homeless people. March 2010. Based on 10,000 persons made homeless, this would result in a cost of an additional £20 million per annum. Unison Briefing on the Coalition Government’s Housing Policies, Unison, London. Available at: http://www.unison.org.uk/acrobat/B5199.pdf
S. Salman, “How Have the Cuts Affected Housing?” The Guardian, Mar 30, 2011. Available at: http://www.guardian.co.uk/society/2011/mar/30/cuts-housing
29. “Tuberculosis Rises 8% in London—HPA Figures,” BBC News, 2012. Available at: http://www.bbc.co.uk/news/uk-england-london-17485728
A. Gerlin, “Ancient Killer Bug Thrives in Shadow of London’s Canary Wharf,” Bloomberg, Feb 23, 2012. Available at: http://www.bloomberg.com/news/2012-02-23/ancient-killer-bug-thrives-in-shadow-of-london-s-canary-wharf-skyscrapers.html
30. “Homeless Crisis as 400 Youths a Day Face Life on the Streets of Britain,” Mirror, 2011. Available at: http://www.mirror.co.uk/news/uk-news/homeless-crisis-as-400-youths-a-day-95173
L. Moran, “Is Greece Becoming a Third World Country? HIV, Malaria, and TB Rates Soar as Health Services Are Slashed by Savage Cuts,” The Mail, 2012. Available at: http://www.dailymail.co.uk/news/article-2115992/Is-Greece-world-country-HIV-Malaria-TB-rates-soar-health-services-slashed-savage-cuts.html
31. ECDC, “West Nile Virus Infection Outbreak in Humans in Central Macedonia, Greece,” ECDC Mission Report, July–August 2010. Available at: http://www.ecdc.europa.eu/en/publications/publications/1001_mir_west_nile_virus_ infection_outbreak_humans_central_macedonia_greece.pdf
32. Greece estimates that the homeless population rose to 20,000 in 2011, a rise of 25 percent between 2009 and 2011. Ireland’s number of households increased from 1,394 in 2008 to 2,348 in 2011. See “Major Increase in Homelessness,” Irish Times, Dec 19, 2012. Available at: http://www.irishtimes.com/newspaper/breaking/2012/1219/breaking53.html. See also “On the Way Home?” FEANTA Monitoring report on homelessness and homeless policies in Europe. The European Federation of National Organisations Working with the Homeless, 2012. Available at: http://www.feantsa.org/IMG/pdf/on_the_way_home.pdf
33. See “On the Way Home?”
34. Markee, “Unfathomable Cuts in Housing Aid.”
35. “Stampede Chaos as Thousands of Dallas Residents Apply for Housing Vouchers,” Above Top Secret, July 16, 2011. Available at: http://www.abovetopsecret.com/forum/thread729362/pg1
“Oakland Opens Waiting List for Section 8 Vouchers,” SFGate, Jan 26, 2011. Available at: http://www.sfgate.com/bayarea/article/Oakland-opens-waiting-list-for-Section-8-vouchers-2478260.php
“City’s Homeless Count Tops 40,000,” Wall Street Journal, Nov 9, 2011. Available at: http://online.wsj.com/article/SB10001424052970204190704577026511791881118.html?mod=googlenews_wsj
36. RealtyTrac, January 2013 Foreclosure Rate Heat Map, 2013. Available at: http://www.realtytrac.com/trendcenter/default.aspx?address=Duval%20county%2C%20FL&parsed=1&cn=duval%20county&stc=fl
Council on Homelessness. 2011 Report. Submitted June 2011 to Governor Rick Scott, p. E-2. Available at: https://docs.google.com/viewer?a=v&q=cache:lQVqDby8TywJ: www.dcf.state.fl.us/programs/homelessness/docs/2011CouncilReport.pdf+&hl=en&gl=uk&pid=bl&srcid=ADGEESjrwRb_ph_ xCzTBGQ4vRvnrVQvXIAnreSVi3MrT6xlXE6f_5aJ9k_iJW1ZegjE0Wt3IxIbP2ENvqMUzgI-HD0CdbLwcge14wysl9dDI6FAp_lHqqjTxoSGwOyc3jkZf9dsuR6b5&sig= AHIEtbTSHKozwOFJZyewSqHKbsh-xJFoIA
37. As the CDC reported, “This outbreak represents one of the most extensive TB outbreaks that the CDC has been invited to assist with since the early 1990s, both in terms of its size and rapid growth.”
While some commentators in Florida were quick to blame the immigrant population for importing the disease, the CDC found that all but three of the ninety-nine cases were among US citizens.
38. K. Q. Seelye, “Public Health Departments Shrinking, Survey Finds,” New York Times, March 1, 2010. Available at: http://prescriptions.blogs.nytimes.com/2010/03/01/public-health-departments-shrinking-survey-finds/
Conclusion
1. Merriam Webster Collegiate Dictionary.
2. Naomi Klein, The Shock Doctrine (New York, 2007).
3. Source for Figure C.1: EuroStat 2013 Statistics. Gross domestic product is per capita, purchasing-power-parity adjusted and constant 2005 dollars. Estonia, Latvia, Lithuania, and Hungary are calculated as peak-to-trough austerity in 2008–10 to reflect earlier initiation of austerity. The association of budgetary changes with changes in gross domestic product is consistent and statistically significant even after adjusting for the depth of prior recession.
4. Laura Tiehan, Dean Jolliffe, Craig Gundersen, “Alleviating Poverty in the United States: The Critical Role of SNAP Benefits,” US Department of Agriculture, ERR-132, April 2012. Available at: http://www.ers.usda.gov/publications/err-economic-research-report/err132.aspx; Parke E. Wilde, “Measuring the Effect of Food Stamps on Food Insecurity and Hunger: Research and Policy Considerations,” Journal of Nutrition, Feb 2007. Available at: http://jn.nutrition.org/content/137/2/307.full
5. Health Impact Assessments were used for selected policies by the UK’s Labour government before the Tories came into power in 2010. We are grateful to Klim McPherson for the suggestion to institute an Office of Health Responsibility.
6. A. Reeves, S. Basu, M. Mckee, C. Meissner, D. Stuckler. “Does Investment in the Health Sector Promote or Inhibit Economic Growth?” Health Policy, forthcoming.
RESEARCH PUBLICATIONS
B. Barr, D. Taylor-Robinson, A. Scott-Samuel, M. McKee, D. Stuckler. “Suicides associated with the 2008–2010 recession in the UK: a time-trend analysis.” British Medical Journal. August 2012, v345: e5142.
A. Bessudnov, M. McKee, and D. Stuckler. “Inequalities in male mortality by occupational class, perceived social status, and education in Russia, 1994–2006.” European Journal of Public Health. June 2012, v22(3): 332–37.
J. Bor, S. Basu, A. Coutts, M. McKee, D. Stuckler. “Alcohol use during the Great Recession of 2008–2009.” Alcohol and Alcoholism. January 2013. In press.
M. Bordo, C. Meissner, and D. Stuckler. “Foreign currency debt, financial crises and economic growth: A long run view.” Journal of International Money and Finance. May 2010, v29: 642–65.
R. De Vogli, M. Marmot, and D. Stuckler. “Excess suicides and attempted suicides in Italy attributable to the Great Recession.” Journal of Epidemiology and Community Health. August 2012. In press.
R. De Vogli, M. Marmot, and D. Stuckler. “Strong evidence that the economic crisis caused a rise in suicides in Europe: the need for social protection.” Journal of Epidemiology and Community Health. January 2013. In press.
M. Gili, M. Roca, S. Basu, M. McKee, D. Stuckler. “The mental health risks of unemployment, housing payment difficulties, and evictions in Spain: evidence from primary care centres, 2006 and 2010.” European Journal of Public Health. February 2013, v23(1): 103–8.
P. Hamm, L. King, and D. Stuckler. “Mass privatization, state capacity, and economic growth in post-communist countries: firm- and country-level evidence.” American Sociological Review. April 2012, v77(2): 295–324.
M. Karanikolos, P. Mladovsky, J. Cylus, S. Thomson, S. Basu, D. Stuckler, J. P. Mackenbach, M. McKee. “Financial crisis, austerity, and health in Europe.” The Lancet. In press.
A. Kentikelenis, M. Karanikolos, I. Papanicolas, S. Basu, M. McKee, D. Stuckler. “Effects of Greek economic crisis on health are real.” British Medical Journal. December 2012, v345: e8602.
A. Kentikelenis, M. Karanikolos, I. Papanicolas, S. Basu, M. McKee, D. Stuckler. “Health effects of financial crisis: omens of a Greek tragedy.” The Lancet. October 2011, v378(9801): 1457–58.
A. Kentikelenis, M. Karanikolos, I
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L. King, P. Hamm, and D. Stuckler. “Rapid large-scale privatization and death rates in ex-communist countries: an analysis of stress-related and health system mechanisms.” International Journal of Health Services. July 2009, 39(3): 461–89.
M. McKee and D. Stuckler. “The assault on universalism: How to destroy the welfare state.” British Medical Journal. December 2011, v343: d7973.
M. McKee and D. Stuckler. “The consequences for health and health care of the financial crisis: a new Dark Age?” In Finnish. Sosiaalilääketieteellinen Aikakauslehti. March 2012, v49: 69–74.
M. McKee and D. Stuckler. “Older people in the United Kingdom: under attack from all directions.” Age and Ageing. January 2013, v42(1): 11–13.
M. McKee, S. Basu, and D. Stuckler. “Health systems, health and wealth: the argument for investment applies now more than ever.” Social Science & Medicine. March 2012, v74(5): 684–87.
M. McKee, M. Karanikolos, P. Belcher, D. Stuckler. “Austerity: a failed experiment on the people of Europe.” Clinical Medicine. August 2012, v12(4): 346–50.
M. McKee, D. Stuckler, J. M. Martin-Moreno. “Protecting health in hard times.” British Medical Journal. September 2010. v341: c5308.
C. Quercioli, G. Messina, S. Basu, M. McKee, N. Nante, D. Stuckler. “The effect of health care delivery privatization on avoidable mortality: longitudinal cross-regional results from Italy, 1993–2003.” Journal of Epidemiology & Community Health. 2013, v67(2): 132–38.
B. Rechel, M. Suhrcke, S. Tsolova, J. Suk, M. Desai, M. McKee, D. Stuckler, I. Abubakar, P. Hunter, M. Senek, J. Semenza. “Economic crisis and communicable disease control in Europe: A scoping study among national experts.” Health Policy. December 2011, v103(2–3): 168–75.
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