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An Introduction To Health Care For The Homeless

Serious personal health problems and flaws in health care systems are major contributors to contemporary homelessness. Some health problems—addiction, serious mental illness, and physical disabilities—are distressingly obvious, particularly in persons living in public spaces. Other problems are less visible but equally insidious, undermining capacity to maintain stable housing and function independently. In far too many cases, a fragmented health care delivery system has not responded adequately to the multiple needs of homeless persons, who are indigent and typically uninsured.

Soon after the dramatic increase of homelessness in the 1980’s, health care professionals, shelter providers, advocates, government agencies and homeless people themselves recognized that a concerted health care response was required. A successful 4-year Health Care for the Homeless demonstration program, operated in 19 cities with financial support from the Robert Wood Johnson Foundation and the Pew Charitable Trust, was replicated in the Stewart B. McKinney Homeless Assistance Act of 1987. The Health Resources and Services Administration, which administers the federal Health Care for the Homeless (HCH) Program authorized by this legislation, began funding homeless health projects in 1988.

By 2001, HCH projects existed in every State, the District of Columbia, and Puerto Rico. HCH projects are created and operated by the communities they serve, are widely heralded as a smart and effective approach to homelessness, and continue to emerge in additional communities as the Consolidated Health Center Program of which they are part continues to expand.