Barb Anderson, director of Haven House in Jeffersonville, Indiana, works with homeless people to place them into housing. It’s a job that has shown her firsthand the severe health issues facing unhoused people in southern Indiana, where many people live in tents in the woods and under bridges.

She is currently working with an older couple with limited options. The woman, 69, has two felonies for producing and selling methamphetamine; crimes, Anderson said, she committed about 20 years ago that prevent her from accessing housing. Anderson said she is working with them on getting that conviction expunged, but it is going to cost thousands of dollars.

“As a homeless woman, she has lost a leg due to diabetes because before she got to us, they were living in tents,” Anderson said. “How much more does she have to go through before somebody decides it’s OK for her to live in a regular home?”

Non-elderly unhoused people have 3.5 times higher mortality than housed people, according to University of Chicago researchers, who say their work is the first national calculation of mortality for unhoused people in the United States. The findings come as housing advocates say it’s as urgent as ever for policymakers to address homelessness, as more pandemic-era protections end and funding for programs benefiting vulnerable groups start to dry up.

An unhoused person who is 40 years old has a similar mortality risk to a 60-year-old with housing or a 50-year-old poor person with housing. More than a half a million people in the U.S. were unhoused in January 2020. Thirty-nine percent of unhoused people and 50% of unhoused families with children are Black.

The research, released in a March paper, uses a sample of 140,000 people who were homeless during the 2010 U.S. Census as well as Social Security Administration data on mortality from 2010 to 2022 to come to an estimate on the health disparities of unhoused people.

“The housing affordability situation just continues to get worse and worse and worse,” said Steve Berg, chief policy officer at the National Alliance to End Homelessness. “Even though the homeless programs are doing a better job than ever, they’re underfunded and then for every homeless person who gets moved into housing, another person or two people or three people lose their housing and fall into homelessness.”

The researchers also noticed a big change in mortality from the onset of the pandemic to March 2022. Homeless people’s mortality shot up by 33%. They said that although the rise was similar in proportion to the increase for housed people, the increase “affected a much larger share of the homeless population due to their substantially elevated baseline mortality rate.”

The paper doesn’t have information on their cause of death. One of the researchers, Angela Wyse, a Ph.D. student at the University of Chicago, told States Newsroom that other work in this research area has reasoned that in addition to COVID-19, people may have struggled to access emergency services because of an overcrowded and overburdened health care system, and that drug overdoses could be a factor as well. The pandemic also may have made it more difficult for unhoused people with substance use issues to access help.

Backlash against homeless increasing

Advocates for groups serving unhoused people and fighting for affordable housing say that policymakers need to address a long list of barriers to housing, including the criminalization of unhoused people and situations where people with criminal histories are denied housing. They also say the Department of Housing and Urban Development needs more federal funding to help prevent people from becoming homeless. The end of pandemic-era programs and services that benefited people who were unhoused or at risk of eviction also concerns advocates.

“As we’re seeing unsheltered homelessness increase in many communities, we’re at the same time seeing more of a backlash against people who are experiencing homelessness themselves, but also against proven solutions to homelessness,” said Sarah Saadian, senior vice president of public policy and field organizing, at the National Low Income Housing Coalition.

Saadian pointed to Missouri legislation that uses state and federal funds for short-term housing, mostly state-approved encampments, and other services, instead of permanent housing, and also outlaws people living and sleeping on state-owned land. The bill was signed into law in June 2022 by Republican Gov. Mike Parson. Similar bills have popped up in several states, which are close in language to model legislation from the Cicero Institute, a Texas think tank. It was founded by Joe Lonsdale, the co-founder of a surveillance tech company, who also advocates for “a competitive, market-based rewards system for private prisons,” Vice reported. Kansas lawmakers introduced a similar bill this session.

Donald Whitehead Jr., executive director of the National Coalition for the Homeless, said that when cities force unhoused people to move out of encampments, they’re putting their health at risk.

“When they come in with the bulldozers and they’re moving people out of these encampments, they’re taking medication. … They are taking Narcan from people in these places,” he said.

Advocates envision universal housing assistance

Saadian said President Joe Biden’s budget proposal, which calls for universal rental assistance for youth aging out of foster care and veterans at risk of homelessness is something she would love to see become a reality. But she isn’t optimistic that it will go anywhere in Congress.

“That sort of universal coverage for rental assistance is incredibly important. We would love to see that extend to all populations, not just those ones, but the fact that the president is pointing to this and calling for it shows that it would be bringing us one step closer to that vision of universal housing assistance for everyone who needs it,” she said.

She added that the proposal to expand rental assistance to another 180,000 households through the Housing Choice Voucher program is one of the best ways to prevent people from becoming homeless.

“Every year the cost to serve the same number of households goes up because most of HUD’s budget goes to rental assistance and when rents go up in your community because of inflation or other reasons, you know, the cost of providing that rental assistance also goes up. Even level funding is really a cut because you can’t serve the same number of people,” she said.

Some Republicans in Congress have proposed cuts in rental assistance, which House Democrats have pushed back against. Rep. Rosa DeLauro (D-CT) released letters from agency heads showing that hundreds of thousands of families could stop receiving rental assistance and be evicted from Section 8 housing as a result of the  proposed changes.

Housing advocates said that they’d like to see more of the federal resources states received as pandemic-related assistance, such as American Rescue Plan Act funds, distributed in a way that serves the most vulnerable people. They said they’d also like to see states and localities do their best to retain at least part of the services and funding they expanded early in the pandemic that serve unhoused people and people at risk of eviction.

Whitehead said that the Housing is a Human Right Act, introduced in March by Democratic Reps. Pramila Jayapal of Washington and Grace Meng of New York, would also take several important steps to help keep people housed. The bill would invest $300 billion in housing infrastructure, $27 billion for homelessness services, and $200 billion for affordable housing and support services.

“Experiencing homelessness is not a failure of individuals,” Jayapal said in March, “but a structural failure of a country that has refused to make safe and affordable housing a priority.”