It is estimated that over half a million people in the United States are homeless, with 70% consisting of individual adults or adults living with other adults.2 However, the remaining 30% consists of families with children—an estimated 171,000 people.2 In addition, there are over 35,000 unaccompanied youth without housing.2 While this demographic includes individuals up to the age of 25, there is still a significant portion of children counted in this number. The health issues experienced by this particular subset of the homeless are unique. Children’s bodies and minds are still developing, and the stress of homelessness affects them in complex and far-reaching ways.
Any period of homelessness can result in negative health outcomes for children of all ages and even fetuses. Both prenatal homelessness and postnatal homelessness are separately associated with poor health outcomes for children.1 Prenatal homelessness is associated with higher risks of developmental delays such as learning disabilities or behavioral problems.3 Even if mothers gain housing after giving birth, children whose mothers were unhoused while pregnant are more likely to be hospitalized and in poor health during infancy and childhood. The stress of homelessness can increase the likelihood of chronic diseases as well as unhealthy lifestyle choices. It can also increase the risk of a child being overweight.1
Although any duration of homelessness is harmful for children, the longer the duration of homelessness, the more severe the consequences. For example, infants and children who are unhoused for more than six months are at a greater risk for developmental delay, poor health outcomes, hospitalization, and being overweight than children who were never homeless or homeless for less than six months.1 In addition to young children, homeless adolescents experience health issues of their own. Rates of sexually transmitted diseases, teen pregnancy, and violence are much higher among homeless youth than housed youth. Mental health problems are also common among homeless adolescents as well as high levels of suicide and drug use.4 Due to the wealth of evidence showing how devastating homelessness is on children of all ages, it is clear that we need solutions.
As any firefighter will note, the best way to put out a fire is to prevent it. In the same way, focusing on preventing homelessness for children and their families is the best way to reduce the negative outcomes associated with childhood homelessness. For example, rapidly rehousing women and children decreases returns to homelessness and prevents some of the negative health impacts of long-term homelessness. Multiple federal housing programs support rapid rehousing initiatives like the Housing Choice Voucher and Emergency Shelter Grant.1 In addition, case management, which involves coordinating multiple services for a particular individual or family, can also help families take advantage of the benefits of housing. Services can further include financial literacy classes, counseling, and addiction treatment.1 Although services like these have been shown to benefit formerly unhoused people, they are most effective when participation is voluntary. For example, the Housing First approach is an evidenced based model that focuses on providing housing regardless of sobriety, participation in programs, or criminal history unrelated to their tenancy.5
The California legislature has adopted the Housing First model in all state programs funding housing for homeless people and those at risk of homelessness. While not specifically focused on child homelessness, the program benefits all unhoused people, including families with children. On the issue of homeless youth, California passed AB1235, which established new guidelines for youth shelters. Instead of limiting stays to only 21 consecutive days, the new guidelines extend the number of days to 90 as well as expanding eligibility to youth at risk of homelessness.6, 7
The initiatives mentioned above are steps in the right direction. However, there is still work to be done. Even if one ignores the moral problem of unhoused children and families, the fact is that no society can survive if its children are neglected. For children experiencing homelessness, the consequences can be debilitating and permanent. Increasing the health and well-being of all children is not just a moral obligation; it is an essential component of an equal, fair, and compassionate country.
Shannon Toole is a second-year medical student at Loma Linda University School of Medicine. She attended Oakwood University in Huntsville, Alabama, and graduated with a degree in Biochemistry. Her interests include health disparities, health care access, and health policy. When not working, she can be found playing tennis and/or pickleball.