A Cup of Coffee – Where We’ve Been, and Where We’re Going

Welcome back! Last week, we talked about air conditioning and how it affects our bodies. If you missed that blog and would like to catch up, click HERE.

A campsite near the Springwater Corridor pedestrian walkway in Southeast Portland in May 2016. (Photo by portgrimes/iStock)

It is impossible to ignore our housing situation in the United States. Many of us feel this is the worst it’s ever been, given our scope of understanding. I decided to do some research on our current situation and look back over time to see if anything compares. I was also interested in learning what has worked in the past so that maybe we can use this knowledge in the future.

I may have found a couple of things that will surprise you and move us forward in the right direction. Let’s look, shall we?

First, let’s look at our past

Fewer than 7 percent of Americans lived in cities prior to the 1820s (Kim and Margo, 2003). Growing industrialization in the 19th century brought a steady migration to urban centers such as Boston, New York, and Philadelphia, and vagrancy records suggest a rise in the numbers of those in search of work in these cities. The Industrial Revolution ushered in a shift from the individual living and surviving on farms or working in skilled trades to the wage-earning worker dependent upon wealthy employers. By the 1850s, lodging rooms for vagrants located in police stations served as the major shelter system, and most major cities reported increasing numbers of traveling homeless (Kusmer, 2002).

After declining briefly after the Civil War, homelessness first became a national issue in the 1870s. Facilitated by the construction of the national railroad system, urbanization, industrialization, and mobility led to the emergence of “tramps riding the rails” in search of jobs.

The Great Depression

During the Great Depression, Herbert Hoover was President, and there were 2 million homeless people in the United States with a population of 123,202,624 (1.6%). Compare that statistic to today, where the number of houseless people in the US is estimated at 552,830. This is actually a small percentage compared to our current population of 327.2 million or 0.2%.

The New Deal

At the depth of the Great Depression, President Theodore Roosevelt was elected and reminded us that the only thing to fear was fear itself. He promised us a New Deal. FDR declared a “banking holiday” to end the runs on the banks and created new federal programs administered by so-called “alphabet agencies”.

For example, the AAA (Agricultural Adjustment Administration) stabilized farm prices and thus saved farms.

The CCC (Civilian Conservation Corps) provided jobs to unemployed youths while improving the environment.

The TVA (Tennessee Valley Authority) provided jobs and brought electricity to rural areas for the first time.

The FERA (Federal Emergency Relief Administration) and

The WPA (Works Progress Administration) provided jobs to thousands of unemployed Americans in construction and arts projects across the country.

The NRA (National Recovery Administration) sought to stabilize consumer goods prices through a series of codes. Through employment and price stabilization and by making the government an active partner with the American people, the New Deal jump-started the economy towards recovery.

Consequent to the Great Depression of the 1930s, there was a significant increase in the number of persons experiencing homelessness in America and a greater need to address poverty and improve the quality and affordability of housing. In response, a number of federal policies and pieces of legislation were enacted to improve the overall quantity and affordability of housing.

For example, The Emergency Relief and Construction Act of 1932 authorized the Reconstruction Finance Corporation to lend public funds to corporations to build housing for low-income families (Congressional Research Service, 2004).

Another relevant federal legislative act from this era included the National Industrial Recovery Act of 1933, which allowed the Public Works Administration (a government-sponsored work program) to use federal funds for slum clearance, the construction of low-cost housing, and subsistence homesteads; close to 40,000 housing units were produced that year.


World War II put the nation to work. Over the next three decades, the typical individual experiencing homelessness were disproportionately white males but became increasingly older (usually over 50 years old), disabled, dependent on welfare or social security, and resided in cheap hotels, flophouses, and in single-room occupancy hotels (SROs) located in the poorest neighborhoods of urban America (Rossi, 1989).

The people living in SROs and rooming houses during this period would be considered “housed” under HUD’s current definition of homelessness. This is why it’s been difficult to define and study homelessness throughout U.S. history.

Post War Distress

Years of economic downturns were followed by 5 years of World War II and this resulted in a severe housing shortage which pushed the federal government to lay the cornerstones for today’s “affordable housing system”.

Congress passed the Housing Act of 1949. and Its goal was to offer “a decent home and a suitable living environment for every American family” (HUD, nd, p. 3). Unfortunately, the urban renewal programs it authorized often destroyed more housing than was created (Lipsitz, 2008).

Its use of public housing to serve the displaced households, who were generally minorities, and the creation of a Federal Housing Administration (FHA) mortgage program to finance suburban housing available only to whites helped to entrench poverty and segregation in America’s cities, particularly for people of color.

The Housing Act of 1954 continued and broadened slum clearance and urban redevelopment in inner cities. It was not until the Housing Act of 1956 (P.L. 84-1020) that relocation payments were authorized to those individuals and families who were displaced by the process of urban renewal (HUD, 2014).

The Housing and Urban Renewal Act

The Housing and Urban Renewal Act of 1965 (P.L. 89-117) was enacted as a rent supplement for low-income, disabled, and elderly individuals. Legislation in 1965 also formally created the Department of Housing and Urban Development.

Fair Housing Act

Title VIII of the Civil Rights Act of 1968, the Fair Housing Act, established fair housing provisions to prohibit discrimination in access to housing. This act covers discrimination based on disability status or family status.

Discrimination based on age was added in 1995 through the Housing for Older Persons Act. Enforcement of Title VIII is vested with HUD’s Office of the Assistant Secretary for Fair Housing and Equal Opportunity (HUD, 2007b). The HUD Rule on Affirmatively Furthering Fair Housing, authorized in 1968, was not published until 2016.

It took 50 years to issue the rule, and enforcement of its provisions has been inconsistent at best.

The Housing and Community Development Act

The Housing and Community Development Act of 1974 (P.L. 97-35) merged several urban development programs into the broader Community Development Block Grant (CDBG) program. This legislation also created the Housing Choice Voucher program, also known as the Section 8 program, to provide low-income housing through rental subsidies paid to the private sector.

The “tenant-based” form of these rent subsidies, whereby families with a voucher choose and lease safe, decent, and affordable privately owned rental housing, is the mainstay of today’s federal housing assistance programs for homeless and low-income individuals and families. The program serves more than 2.1 million households (Congressional Budget Office, 2015).

Stewart B. McKinney Homeless Assistance Act

The first federal legislation enacted to explicitly address homelessness was the 1977 Stewart B. McKinney Homeless Assistance Act (PL 100-77).

In addition to defining homelessness (see Box B-1), which is important for allocating federal resources, it also made provisions for using federal money to support shelters for persons experiencing homelessness.

The McKinney Act also created a targeted Health Care for the Homeless (HCH) primary care funding stream, with a distinct broad definition of homelessness, which now exists within the Federally Qualified Health Center (FQHC) program.

The 1980s

The early 1980s marked the emergence of what now may be considered the modern era of homelessness.

Major forces that changed the complexion of homelessness in the modern era include:

1. gentrification of the inner city,

2. deinstitutionalization of the mentally ill,

3. high unemployment rate,

4. the emergence of HIV/AIDS,

5. an inadequate supply of affordable housing options, and

6. deep budget cuts to the U.S. Department of Housing and Urban Development (HUD) and social service agencies in response to what was then the country’s worst recession since the Great Depression (Jones, 2015).

In some cities, property values increased dramatically in the areas near downtown, and “Skid Row” areas disappeared as the SROs and rooming houses that were home to thousands of houseless Americans were razed or converted into apartments and condominiums.

The rent goes up, the wages stay the same

Since the 1980s, rents in metro areas across the country have been increasing while wages have stayed the same (Katz, 2006). Recent research indicates that families experiencing homelessness are more likely to continue to face poverty and homelessness in the future (Desmond, 2016). Not a good prospect.

How hard was HUD hit?

The recession of the 1980s resulted in deep cuts to the HUD budget, which decreased from approximately $29 billion in 1976 to approximately $17 billion in 1990, and led directly to reductions in the budget authority for housing assistance (from almost $19 billion in 1976 to about $11 billion in 1990) and in subsidized housing for poor Americans (OMB, 2001). Two changes in policy particularly contributed to the rise in homelessness during that period.


  1. Cuts in Supplemental Security Income (SSI) in the late 1980s,
  2. accompanied by a tightening of the disability eligibility process (Social Security Act of 1980). This especially affected mentally ill persons living in rooming houses. The subsequent loss of personal income contributed to homelessness for many of these individuals (Collin and Barry, 1987).

The Social Security Disability Benefits Reform Act

The Social Security Disability Benefits Reform Act of 1984 was later enacted to pull back on some of the aspects of the 1980 Social Security Act, which held back the efforts of some individuals experiencing illness and homelessness to pursue benefits.

Also, public inebriation was decriminalized in many cities, and those once jailed for public drunkenness now avoided arrest and often entered shelters or remained on the streets (McCarty et al., 1991).

U.S. Interagency Council on Homelessness (USICH)

The 1997 Stewart B. McKinney Act also authorized the creation of the U.S. Interagency Council on Homelessness (USICH). USICH is an independent executive branch body established to better coordinate homelessness programs across government agencies.

The USICH includes representative membership from all major federal agencies whose mission touches upon homelessness, including, among others, HHS, HUD, the Department of Veterans Affairs (VA), and the Federal Emergency Management Agency (FEMA).

The council is charged with assessing the effectiveness of federal activities and programs for people experiencing homelessness and apprise state and local governments, public agencies, and private organizations about the availability of relevant federal programs and funding opportunities (USICH, 2016).

Chronic Homelessness Initiative

In 2002, the USICH spearheaded the Chronic Homelessness Initiative, asking states and local jurisdictions to create 10-year plans to end chronic homelessness.

Another change in federal policy occurred in 2003, bringing a focus on “ending chronic homelessness” through low-threshold and permanent supportive housing programs (HUD, 2007a).

At that time, through a collaborative process overseen by the USICH, the federal government formally defined chronic homelessness as “an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more or has had at least four episodes of homelessness in the past three years” (HUD, 2007a, p. 3).


The next reauthorization of the McKinney-Vento Act, called the HEARTH Act, was signed into law in 2009. The reauthorization consolidated several existing programs for individuals experiencing homelessness, created a federal goal that individuals and families experiencing homelessness be permanently housed within 30 days, and codified the planning processes used by communities to organize into Continuums of Care in order to apply for homeless assistance funding through HUD.

New definitions of “homeless,” “homeless person,” and “homeless individual” were expanded. These changes were based on Congress identifying

(1) a lack of affordable housing and limited housing assistance programs, and

(2) an assertion that homelessness is an issue that affects every community.


In 2010, under President Obama’s administration, a federal strategic plan to end homelessness was released (USICH, 2017). Begun under the Bush administration, Obama used programs such as the HUD/VASH, combining HUD housing vouchers issued through local housing authorities with ongoing support from VA physical and mental health programs.

The federal strategic plan established four key goals:

(1) Prevent and end homelessness among Veterans in 5 years;

(2) Finish the job of ending chronic homelessness in 7 years;

(3) Prevent and end homelessness for families, youth, and children in 10 years; and

(4) Set a path to ending all types of homelessness.

More than 78,000 vouchers were issued nationally through September 2015.

2010 – 2016

From 2010 to 2016 the nation saw double-digit drops in homeless families (23 percent), individuals experiencing chronic homelessness (27 percent), and veteran homelessness (47 percent).

While some states, such as New York, saw increases in homelessness over this time period—especially during the period of 2015/16—nationwide, the number of people experiencing homelessness on a single night in 2016 fell 14 percent since 2010.

The Census

Between 2007 and 2016, the number of people living on the streets, in encampments, or otherwise outside the shelter system, plunged dramatically—a drop-off of 31 percent. (Point-in-time counts do miss homeless people, as any census does. But because they employ the same methodology year over year, they are considered important and reliable trackers for how homelessness affects a community.)

Housing First and Rapid Re-Housing

The most important figures fall in the 2010–2016 range since that span serves as a measure of the federal government’s homelessness strategy.

The feds can’t take all the credit, of course: Housing First and Rapid Re-Housing are policy concepts that started at the city and community level before the Obama administration adopted them as federal law. The work to fight homelessness is first and foremost the work of local government.

But federal support from the U.S. Interagency Council on Homelessness, an agency comprising senior leaders of 19 federal agencies, has helped more communities adopt and expand housing-first strategies. For Opening Doors, the Interagency Council considered the causes of homelessness for several groups—veterans, families, youth, and the chronically homeless—and tailored solutions for each category.

According to an article in Street Roots, out of Portland Oregon, prior to 2016, homelessness on a national level was actually decreasing. HUD started tracking homelessness with Point-in-Time counts in 2007, and by 2015, the number of people counted each year had declined by nearly 100,000 people, to 578,000. By 2016, the count was below 550,000.

So where does this leave us?

This is the point where I remind you that at the beginning of this blog, we looked at the number of homeless people today, in real-time: “Compare that statistic to today, where the number of houseless people in the US is estimated at 552,830”.

This means that between 2016 when we were at our lowest numbers and 2022 when we think we are so much worse off than we’ve ever been, the difference is actually 2,830 people.

Now, please don’t misunderstand. Even one person living on the street is not ok in the United States of America, and I also realize that these numbers may be underreported, but they are the only numbers we have.

The bottom line is, how do we learn from the past and fix this moving forward?

What causes people to become houseless?

Causes of homelessness, according to The National Law Center on Homelessness and Poverty:

1. Insufficient income and lack of affordable housing are the leading causes of homelessness.

2. After paying their rent and utilities, 75% of households end up with less than half of their
income left to pay for necessities such as food, medicine, transportation, or childcare.

3. The foreclosure crisis also played, and continues to play, a significant role in homelessness:
In 2008, state and local homeless groups reported a 61% rise in homelessness since the
foreclosure crisis began.

4. Approximately 40% of families facing eviction due to foreclosure are renters; the problem
may continue to worsen as renters represent a rising segment of the U.S. population.

5. For women, in particular, domestic violence is a leading cause of homelessness.

6. According to the most recent annual survey by the U.S. Conference of Mayors, major cities across
the country reported that the top causes of homelessness among families were: (1) lack of affordable
housing, (2) unemployment, (3) poverty, and (4) low wages, in that order. The same report found
that the top four causes of homelessness among unaccompanied individuals were (1) lack of
affordable housing, (2) unemployment, (3) poverty, (4) mental illness and the lack of needed
services, and (5) substance abuse and the lack of needed services.

Most of these causes are hard to address if you aren’t housed

Of all the programs we’ve looked at today, the “Housing FIrst” approach works. Just ask Houston Texas, which used this approach to cut its homeless population in half.

Housing First was a revolutionary idea when it was introduced in the 1990s because it didn’t require homeless people to fix their problems before getting permanent housing. Instead, its premise — since confirmed by years of research — was that people are better able to address their individual problems when basic needs, such as food and a place to live, are met.

In an article written on the success that Houston has had, they interviewed one of its participants.

What could Houston do better?

Mindy Johnson, who is a survivor of sex trafficking, hasn’t had stable housing for nearly two decades. She arrived in Houston in 2003 and since then has moved in and out of temporary shelters.

In October, Johnson got a place to live and supportive services from Houston’s homeless system. She said she still struggles with alcohol addiction but sees a therapist and caseworker on a regular basis.

What could Houston do better? “They can’t,” said Johnson, 41. “Houston has helped me more than anybody in this world. It brings me to tears.”

The article continued,

In 2011, the Houston area had one of the highest homeless populations in the country, with more than 8,400 people without stable housing. By January 2020 that number had decreased by about 55% to around 3,800, according to the latest government homeless census. The city had earlier ended its U.S. veteran homelessness by combining local, state, and federal resources to house 3,650 veterans over a three-year period, according to government data.

Experts attribute the success to a systemwide effort to coordinate homelessness responses across the Houston area, following the Housing First principles of providing housing and services for people without mandatory prerequisites.

So there you have it

We now know what works, or at least have a blueprint to start the process of solving our homeless problem in this country. Now we just need to have the leadership to make it happen. It only takes one person to stand up in any city and say, “this is the answer – let’s do it”.


That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.

Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!


  1. David,
    Your review of this topic is excellent. Thank you.
    Although so much deserves to be done locally, FEDERAL funding–not defunding of HUD or HHS–can be the only answer, to help local govt., given that even poor people have mobility in this country…
    Health and Human Services should increase funding to address substance abuse, given its presence in our communities.
    Thank you for being a part of NWOMF.
    S. Leifheit, DO 8/5/22
    p.s.: Yes, FDR (but not Theodore) provided leadership by federal government to address the Great Depression, while Republicans were ready to just stand by–things that haven’t changed in…100 years!

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