February 15, 2024

Rates of people experiencing homelessness plummeted when pandemic-era housing safety net programs and policies were in effect but – after those phased out – rates of people experiencing homelessness rose to record levels. This was the most striking finding in analysis conducted by the Dornsife School of Public Health, Urban Health Collaborative using point-in-time homelessness counts for 2023 compared to prior years, in 35 of the biggest cities in the U.S. who are members of the Big Cities Health Coalition (BCHC).

Counts of Homelessness and What We Found

Each year at the end of January, in cities across the U.S., tens of thousands of volunteers alongside social service agency staff conduct a one-night census of people experiencing homelessness (PEH). The U.S. Department of Housing and Urban Development (HUD) mandates point-in-time counts from all homeless assistance programs that receive federal dollars.

We identified the ten BCHC cities with the highest rates of PEH in 2023 and compared them with the rest of the BCHC cities across a number of housing- and health-related metrics (see Supplement Table for details).

In aggregate across the BCHC cities in 2023, approximately 300,000 people experienced homelessness – the highest point-in-time count recorded by the cities’ homeless assistance programs.

In cities with the highest rates of PEH, rent costs were approximately 40% higher than in other cities and the rental supply was approximately 80% lower (proxied by the number of rental vacancies relative to homeless population). In cities with the highest rates of PEH, income inequality was higher and the proportion of city neighborhoods that had experienced extreme gentrification was higher.

Additionally, cities with the highest rates of homelessness had higher underlying rates of some communicable diseases – which can disproportionately affect PEH. PEH generally have less access to health care and often live in environments that increase risk for acquiring communicable diseases. In BCHC cities with the highest PEH vs. other cities, prevalence of HIV/AIDS was 55% higher, and there were slightly higher rates of tuberculosis incidence and syphilis prevalence.

Implications

Our results align with existing research that high rates of homelessness are a consequence of a housing crisis. The crisis is perpetuated by the continued tightening of the rental housing market, and scarcity of affordable housing particularly in higher-income cities where income inequality is extreme. The crisis is rooted in long-standing structural inequities – including federal and local policies – that severely disadvantaged people living in poverty and systematically excluded communities of color from attaining housing security.

Advocates for people experiencing homelessness ask that the public health community amplify the message that homelessness is not primarily an addiction and mental health problem. Health vulnerabilities may increase the risk of housing insecurity but are not the root causes of homelessness. In fact, they can be consequences of housing instability. For example, research by the Urban Health Collaborative's Dr. Gabriel L. Schwartz has documented how the trauma of housing insecurity can lead to long-term mental distress and other problems among children and adults.

The massive drop in homelessness observed during the COVID-19 pandemic shows it is possible to significantly reduce homelessness with large-scale federal investment and housing guarantees.¹ Cost-effectiveness analyses have demonstrated massive and wide-ranging societal costs when cities have large numbers of people experiencing homelessness. These studies show that large subsidies for permanent housing support are either cost-neutral or cost-saving and confer long-term dividends in part due to their role in breaking intergenerational poverty. 

¹In 2020-2021 pandemic-era legislation, such as The American Rescue Plan, made funds available for emergency rental assistance, assistance for homeowners behind on their mortgage payments, emergency housing vouchers for individuals and families who are experiencing homelessness or at risk of homelessness, infusion of dollars into the Fair Housing Initiatives Program to investigate fair housing complaints, strengthen enforcement, and assist those who believe they have been victims of housing discrimination. Added to that, the CDC issued a national moratorium on evictions for nonpayment of rent.

In partnership with the Big Cities Health Coalition (BCHC), the Drexel Urban Health Collaborative maintains the Big Cities Health Inventory, an open-source platform providing health metrics for the 35 large U.S. cities that comprise the BCHC. Much of the data described here are available on the data platform. To stay up-to-date on the Big Cities Health Inventory please make sure to follow both the Drexel Urban Health Collaborative (@DrexelUHC) and BCHC (@BigCitiesHealth) on Twitter or subscribe to our newsletter.

The Big Cities Health Inventory data platform is primarily funded by the U.S. Centers for Disease Control and Prevention through a cooperative agreement with the National Association of County and City Health Officials. The views expressed on the data platform do not necessarily represent the views of the funders.

Suggested citation: Amy Auchincloss and Saima Niamatullah. (2024) Homelessness soars after pandemic-era safety net programs end: a summary of data from big cities. Drexel University, Urban Health Collaborative. Philadelphia, PA.