Research & Evaluation

The Costs and Harms of Homelessness

A Learning Brief Examining the Costs Borne by Individuals, Communities, Systems, and Society
  |  September 25, 2023

Homelessness is both a reflection of — and driver of — some of the most irreparable harms being borne by individuals, communities, and our society at large. These consequences are both undeniable and in many ways immeasurable, spanning social, medical, behavioral, economic, and moral costs. Although discussing these costs sometimes feels like an exercise in “homelessness economics,” trying to understand the harms perpetuated by homelessness – as well as the benefits that arise from effective solutions – can help build will and urgency for the solutions that can mitigate, prevent, or even redress these harms.

This learning brief examines the multidimensional nature of the costs associated with homelessness. We synthesize a comprehensive body of research to provide readers with a deeper understanding of the wide-ranging costs and consequences of homelessness. 

In doing so, we emphasize the inherent value in ending homelessness, and that the moral imperative to address homelessness transcends any cost-benefit approach. As we noted, urgency and action are often supported by understanding what is at stake. As such, our goal is to promote informed perspectives and insights that can strengthen the case for solving homelessness. 

Costs to Individuals and Families

Homelessness can adversely affect virtually every aspect of a person’s life, from one’s sense of safety and social support to overall health and life expectancy. For children and families, homelessness can lead to devastating consequences including developmental delays, disruptions in education, and family separation. Below, we highlight some of the many harms to individuals and families caused by homelessness across domains.

Health and Wellbeing

A substantial body of research documents the dire, long-term effects of homelessness on individual health and wellbeing. Many factors contribute to these harmful health consequences, including structural barriers to quality care services (e.g., transportation, insurance, identification), difficulty obtaining and storing medication, increased exposure to risk factors (e.g., unmet subsistence needs, extreme weather, communicable diseases, violence) and avoidance of the health care system due to prior negative experiences with stigma and discrimination (Fazel et al., 2014; Corrigan et al., 2015; Thorndike et al., 2022; Fernandez et al., 2022; Reilly et al., 2022). 

Due to a combination of factors, people experiencing homelessness experience elevated rates of dangerous health conditions, injuries, violent victimization, and increased mortality, as evidenced by the following findings:

  • People experiencing homelessness have significantly higher rates of mortality and reduced life expectancies. Non-elderly adults 18-54 years old experiencing homelessness in the U.S. have a mortality rate 3.5 higher than the housed population. Even compared to housed individuals living in poverty, people experiencing homelessness face a 60% greater mortality risk (Meyer, Wyse, & Logani, 2023).  Studies and mortality reports in several cities in the U.S. also reveal devastating disparities in life expectancy, with the average age of death for adults experiencing homelessness ranging from 41 to 51 years – a life expectancy at least 26 years shorter than the national population (O’Connell, 2005; LA County Department of Public Health, 2019; Erlenbusch & Racik, 2019). 
  • The rates of several chronic conditions are significantly higher among people with a history of homelessness. These include anemia, asthma, dementia, epilepsy, cirrhosis, and chronic obstructive lung disease (ASPE, 2021).
  • Homelessness places individuals at significantly greater risk of infectious disease. For instance, tuberculosis is about 46 times more common and hepatitis C virus infections are four times more prevalent in the population experiencing homelessness in the U.S. compared to the general population (Beijer, Wolf, & Fazel, 2012).
  • Individuals experiencing homelessness are disproportionately likely to experience a traumatic brain injury in their lifetime. A comprehensive study estimated that nearly one in four people experiencing homelessness or marginal housing suffer from a moderate to severe traumatic brain injury in their lifetime, which means they are 10 times more likely to experience such an injury than the general population (Stubbs et al., 2019). Assault was the most common cause of traumatic brain injuries among people experiencing homelessness or marginal housing, which points to their heightened risk of experiencing physical violence.
  • Rates of violent victimization are alarmingly high among people experiencing homelessness. Whereas just under 1% of people nationwide reported experiencing a violent crime in 2021 (Thompson & Tapp, 2022), a study conducted in 5 U.S. cities found that nearly half – an estimated 49% – of those experiencing homelessness had been victims of violent attacks (Meinbresse et al., 2011). A large survey found that youth experiencing homelessness are at a heightened risk of exposure to gun violence: 45% of young adults experiencing homelessness had witnessed or directly experienced gun victimization, and disturbingly, over 1 in 4 young adults experiencing homelessness (27%) reported someone had intentionally fired a gun at them (Hsu et al., 2020). 
  • Experiencing homelessness dramatically increases women’s risk of sexual victimization.  Prior research estimates that women experiencing homelessness are victims of sexual violence at a rate 44 times higher than the general population (Riley et al., 2020). 
  • Drug overdose may be a leading cause of death for those experiencing homelessness. A large study of over 60,000 individuals experiencing homelessness in Boston found that drug overdose accounted for one in four deaths (Fine et al., 2022). Similar findings have been uncovered in studies conducted in New York City (Gambatese et al., 2013), San Francisco (Riley et al., 2013), and Philadelphia (Hoffman & Bissell, 2017), suggesting that people experiencing homelessness in U.S. cities are at a pronounced risk for fatal overdose.

Homelessness poses profound mental and emotional strains. Daily stressors, such as ensuring personal safety and finding a place to sleep, coupled with the instability and trauma of being unhoused, can increase an individual’s vulnerability to psychological conditions, distress, and substance use disorders. Moreover, homelessness puts people at greater risk of violent victimization, which has serious mental health consequences including posttraumatic stress disorder, depression, anxiety, substance abuse, and panic disorders (Kilpatrick & Acierno, 2003).

  • People experiencing homelessness are at an elevated risk of experiencing mental illness and/or substance use disorders. While under 6% of adults in the U.S. report having a serious mental illness, roughly 21% of those experiencing homelessness reported having a severe mental illness (SAMHSA, 2021; HUD, 2022). According to meta-analyses of studies conducted in several countries, bipolar disorder is over 11 times more common among the population experiencing homelessness (Ayano et al., 2020), and major depressive disorder is over 5 times more prevalent (Ayano et al., 2021). Furthermore, rates of alcohol-related disorders and drug-related disorders are about 10 times higher among adults experiencing homelessness compared to the general population (Gutwinski et al., 2021). Alarmingly high numbers of youth who experience family homelessness suffer from significant emotional distress (42%), self-injurious behaviors (29%), and suicidal ideation (21%; Barnes et al., 2018). 

While the findings above illustrate the significant mental health implications of homelessness, it’s important to note that many people experiencing homelessness do not have a mental illness or substance use disorder, and the large majority of the roughly 73 million people in the U.S. that experience either type of condition do not experience homelessness (SAMHSA, 2021).

Experiencing homelessness during the early years of a child’s life negatively impacts development in ways that can affect someone for their entire life. From heightened risk of malnutrition and stunted growth to reduced opportunities and space for play, homelessness has costly effects on all facets of childhood development, can result in child-parent separation, and limits opportunities for education. 

  • Homelessness can harm prenatal development and young children’s physical health. High rates of chronic and acute health problems among pregnant women experiencing homelessness, as well as a lower likelihood of accessing prenatal care (Martin et al., 2020), can impact prenatal development. Infants born during a period of unstable housing resulting in homelessness have higher rates of low birthweight, respiratory problems, and fever than infants born to housed, low-income families (Clark et al., 2019). Disparities in children’s health problems persist past infancy. Children experiencing homelessness are twice as likely to suffer from an upper respiratory infection compared to the general population (Rafferty & Shin, 1991). Compared to children in low-income families, children experiencing homelessness are twice as likely to be hospitalized (Weinreb et al., 1998), six times more likely to have stunted growth (Fierman et al., 1991), and seven times more likely to experience iron deficiencies leading to anemia (Fierman et al., 1993). 
  • Adverse childhood experiences — potentially traumatizing events that occur before the age of 17 — are more prevalent among the population experiencing homelessness. A systematic review and analysis estimated that over 89% of unhoused adults versus roughly 39% of the general population have been exposed to at least one adverse childhood experience, and over 53% of adults experiencing homelessness, versus 3-5% of the general population, have been exposed to four or more early traumatic experiences (Liu et al., 2021). As adverse childhood experiences are strongly associated with negative health and social outcomes (Hughes et al., 2017), high rates of early trauma for children experiencing homelessness can fuel a range of adversity throughout the lifecourse.
  • Repeated exposure to stressful and traumatic events at a young age causes severe emotional distress, which over time results in a high incidence of mental health challenges for children experiencing homelessness. After children experiencing homelessness reach 18 months of age, they start to demonstrate significant developmental delays that are believed to contribute to later behavioral and emotional difficulties (Hart-Shegos, 1999). A study conducted in New York City found that 34% of children experiencing homelessness between the ages of 5 and 7 experienced developmental and/or psychiatric problems (Grant et al., 2007). Another comprehensive study found that 24% to 40% of school-age children experiencing homelessness in the U.S. have mental health issues requiring clinical evaluation, which is a rate 2 to 4 times greater than that reported for low-income children of the same age (Bassuk et al., 2015).
  • Children in families experiencing homelessness are often separated from their parents. Several studies have found that housing instability and homelessness are associated with higher rates of informal child separations, as well as foster care placements (see Shinn et al., 2018). For example, a large study of families with children experiencing homelessness in emergency shelters found that nearly 40% of families had a separated child before or during their shelter stay (OPRE, 2018). 
  • Homelessness also disrupts children and youth’s schooling, from elementary school to higher education, limiting opportunities to advance their education and economic standing. Prior research conducted in New York City found that chronic absenteeism – or missing 20 days or more in a school year – is twice as common among elementary school students experiencing homelessness, placing them at greater risk of being held back and dropping out of school (ICHP, 2015). Indeed, youth and young adults experiencing homelessness are less likely to have completed a GED or high school diploma. A national survey found that young adults experiencing homelessness are over twice as likely to lack a high school diploma or GED compared to youth in the overall population (Chapin Hall & Voices of Youth Count, 2019). Decreased educational attainment in turn increases the likelihood of homelessness: youth who did not complete high school were 4.5 times more likely to experience homelessness compared to peers who completed their high school diploma or GED. Young adults who experience homelessness are also less than a third as likely to enroll in a four-year college compared to their stably housed peers. Considering the economic advantages associated with a postsecondary degree – which include increased employability, stable employment, greater lifetime earnings, and reduced risk of poverty (Baum et al., 2013; Leonhardt, 2014; Ma et al., 2019; Shierholz et al., 2014) – this series of missed educational opportunities for children and youth experiencing homelessness can perpetuate their economic hardship. 

Costs to Communities and Systems

Given the severe consequences of homelessness for individuals and families detailed above, people experiencing homelessness have comprehensive and complex needs. Without the stability of secure housing needed to appropriately address these needs, individuals experiencing homelessness use mainstream service systems — including child welfare, hospitals and emergency health care services, criminal justice, and income support — to a greater extent than stably housed community members. 

Researchers estimating the community-level costs of homelessness typically consider the financial costs associated with mainstream service usage by individuals experiencing homelessness, as well as the use of homeless programs designed to provide housing and services to those experiencing homelessness. Below, we highlight findings from some of this work, and consolidate evidence that speaks to the promise of supportive housing programs using a Housing First approach for offsetting some of these costs.  

Every year, the federal government spends about four billion dollars on homeless assistance — a figure that has doubled since 2007  (Fowler et al., 2019). Roughly half of this is used to fund emergency shelter and transitional housing beds. Nonprofit service providers in the U.S. spend an estimated $8.6 billion each year on emergency shelter and transitional housing (Culhane and An, 2021). 

  • Homeless program costs are often far greater than the cost of providing rental assistance, and providing transitional or emergency housing to individuals and families who need longer term housing support incurs very high costs. A study examining the costs of homeless and other service delivery systems serving families and individuals experiencing homelessness for the first time across six communities found that longer stays in a homeless program resulted in escalating costs that were much greater than rental subsidies based on Fair Market Rents for the same time period. On average, each additional month in a program was associated with 35% higher costs for individuals (Spellman et al., 2010).
  • Most nonprofit service providers of temporary housing spend more than double the cost of a permanent supportive housing unit on temporary housing beds for the average family. Culhane and An (2021) found that the most common cost of a temporary family shelter bed in 2015 was over $17,700. As the average family consists of over 3 people, most nonprofit providers spend over $56,000 a year providing temporary housing to a single family. This total is over twice as costly as the cost that most providers spent on a permanent supportive housing unit for a family in 2015 ($25,390).

With higher rates of chronic and acute health issues, people experiencing homelessness have an inherently greater need for health care services. Yet structural barriers and competing priorities make it challenging for those experiencing homelessness to access primary or preventive health care services, resulting in delayed treatment, unmet care needs, deteriorating health status, and reliance on more costly forms of health care delivery such as Emergency Departments and inpatient hospitals. 

  • People experiencing homelessness visit Emergency Departments at higher rates than the overall population. Compared to stably housed individuals, people experiencing homelessness have roughly three times as many visits to Emergency Departments each year (Coe et al., 2015). Even among patients who frequently visit Emergency Departments, those experiencing homelessness average 1.6 more visits annually than frequent visitors with secure housing (Ku et al., 2014). In addition, patients experiencing homelessness are also significantly more likely to get to the Emergency Department via ambulance (Coe et al., 2015).
  • Individuals experiencing homelessness also have longer average hospital stays. One analysis conducted in Harris County, Texas found that the total length of hospital stays per year was nearly three times higher among patients experiencing homelessness compared to housed patients (Buck et al., 2012). Similar findings emerge for infants born during periods of housing instability that result in homelessness, who experience longer neonatal intensive care unit stays and more emergency department visits, resulting in higher health care spending (Clark et al., 2019).
  • High levels of Emergency Department utilization among individuals experiencing homelessness result in steep health care costs. A 2006 study found that the average annual cost for a frequent Emergency Department visitor experiencing homelessness exceeded $64,000 (Ku et al., 2014). The study calculated the total costs of visits by 74 patients experiencing homelessness, who visited the Emergency Department an average of 11.4 times throughout the year. In total, these visits amounted to nearly $5 million in hospital charges at a single institution. While this study also found that the median visit cost was significantly higher for frequent Emergency Department users who were not experiencing homelessness compared to users who were ($2125 versus $1478), so was the median reimbursement rate per visit ($348 versus $272).
  • Research consistently shows that patients experiencing homelessness also have higher hospital readmission rates than those with stable housing. A large analysis of all inpatient hospitalizations in three states found that patients who were identified as experiencing homelessness at the time of discharge had significantly higher readmission rates compared to those who were housed (Khatana et al., 2020). Another study estimated that veterans experiencing homelessness had a 43% higher risk of readmission within 30 days after surgery (Titan et al., 2018). Lastly, among patients visiting an urban Emergency Department who presented with mental health conditions, homelessness was associated with a 28% increased likelihood of hospital readmission (Lam et al., 2016).

Involvement with the criminal legal system increases a person’s likelihood of experiencing homelessness. In turn, experiencing homelessness can result in more frequent interactions with police and disproportionate rates of arrest and incarceration. This revolving door of risk traps people in a cycle between homelessness and jail by creating further barriers to jobs, social services, and housing opportunities. In addition to being ineffective, punitive responses to homelessness are costly. 

  • Laws that criminalize homelessness are highly costly. For example, over the course of 2016 and 2017, Boulder, Colorado spent at least $1.8 million annually enforcing anti-homeless ordinances (Bishop et al., 2018). In LA, the police department spent anywhere from $53.6 million to $87.3 million – out of a total budget of roughly $100 million – in one year on interactions with people experiencing homelessness, not including costs incurred from patrol officers’ time (Office of the Administrative Officer, 2015). 
  • Incarcerating individuals experiencing homelessness is expensive. A study conducted by the Central Florida Commission on Homelessness found that the costs of arresting, booking, incarcerating, and providing mental health care in jail for 37 individuals experiencing homelessness in Osceola County amounted to over $6 million dollars over a ten-year period. 

Rising rates of unsheltered homelessness over the past several years are correlated with an increase in the number of reported encampments. Encampments are associated with steep costs to municipal governments across the U.S. Various municipal entities participate in responding to encampments, even those not traditionally involved in homeless response efforts such as city departments of sanitation, solid waste, or environmental services who lead regular cleanings.

Unfortunately, cities often respond to encampments by clearing and closing them, which involves removing individuals’ structures and belongings and requiring people to leave the encampment area. This further displaces individuals experiencing unsheltered homelessness, leads to harmful health consequences, and creates greater challenges for pursuing the more humane, and cost-effective strategy: moving people into shelters or permanent housing (Change et al., 2022; Dunton et al., 2020). As highlighted below, responding to encampments in this way is also resource-intensive for local governments.

  • Fire departments are increasingly called to encampments to respond to homeless-related fires that spread out of control, putting individuals in harm’s way and necessitating substantial time and resources from local fire departments and other first responders. As examples, Portland Fire and Rescue reported more than 4,300 homeless-related fires, and the San Francisco Fire Department reported over 3,500 in 2021 alone. Homeless-related fires increased by about 150% in Los Angeles over the course of three years, from about 3,700 in 2019 to over 9,000 in 2021, according to the Los Angeles Fire Department (Verzoni, 2023).
  • Cleaning up encampments can strain city budgets. In 2015, the administrative officer for the city of Los Angeles reported that the Bureau of Sanitation spent at least $547,000 on homeless encampment cleanups in the past year. A 2019 study conducted by Abt Associates found that responding to homeless encampments cost Houston, TX $3,393,000 and San Jose, CA $8,557,000 in a single year. Chicago spent $3,572,000, and Tacoma spent $3,905,000 during the same period (Dunton et al., 2020). As this study could not include the large costs of encampment responses by fire departments and emergency medical services because of issues with data quality and availability, these figures underestimate the costs associated with cities’ responses to encampments. 

There’s considerable evidence that supportive housing — especially when provided using a Housing First approach — shows promise for offsetting the costs associated with homelessness incurred by emergency shelters, hospitals, and other local systems. Supportive housing combines permanent, affordable housing through rental assistance with wraparound services tailored to an individual’s specific needs and preferences. When supportive housing is offered using a Housing First approach, people are able to access permanent supportive housing without needing to meet any prerequisites, such as achieving sobriety or committing to ongoing service participation requirements. 

Simply comparing the costs of supportive housing to those associated with emergency shelter, incarceration, and hospitalization makes the case for the cost-effectiveness of permanent supportive housing. For example, a recent report released by the NYC Comptroller’s Office in 2023 lists that the following daily costs per person in each location:

  • Supportive housing: $68
  • Shelter: $136
  • Incarceration at Rikers Island: $1,414
  • Hospitalization: $3,609

In addition to baseline cost differences, numerous studies have found significant cost offsets resulting from permanent supportive housing interventions. 

  • Supportive housing programs that use a Housing First approach may help break the homelessness-jail cycle and reduce associated public costs. An evaluation of the five-year Denver Supportive Housing Social Impact Bond Initiative (Denver SIB) provides compelling evidence (Cunningham et al., 2021). Launched in 2016, the Denver SIB provided supportive housing to individuals who experienced long-term homelessness and had frequent interactions with the criminal legal and emergency health systems. The evaluation study demonstrated that compared to a randomized control group, annual per-person costs for local services (i.e., jail, courts, shelter, police, and emergency medical services) were $6,876 lower for individuals that participated in Denver SIB (Gillespie et al., 2021). Other studies have found that permanent supportive housing programs can reduce time spent incarcerated by up to 84%, which amounts to savings up to over $1,700 per person each year (Culhane, Metraux, & Hadley; 2002New York City Department of Health and Mental Hygiene, 2013). These savings do not include the costs of arrests, booking, probation, or parole.
  • The Housing First Supportive Housing approach can also reduce costs to medical and behavioral health care systems. For instance, a Housing First pilot program in Seattle found participants significantly decreased their use of high-cost emergency medical, sobering center, and medical respite services relative to a comparison group. This led to cost reductions of $36,579 per person, far surpassing the program’s per person operating cost of $18,600 (Srebnik et al., 2013). Similarly, another study conducted in Portland, Oregon found that moving into supportive housing was associated with significant health care cost savings. Medicaid-covered residents experienced an $8,724 reduction in annual Medicaid expenditures one year after housing placement, with additional decreases observed the second year after move-in (Wright et al., 2016). Lastly, a randomized control trial in Chicago for adults with chronic medical illness experiencing homelessness found that individuals who participated in a housing and case management program saw a 29% reduction in hospital stays and a 24% reduction in and emergency department visits compared to a usual care control group (Sadowski et al., 2009). While some studies find that enrollment in permanent supportive housing is not associated with total annual health care costs, and some even show increases in costs for program participants, these findings often point to the role of stable, affordable housing in providing greater access to needed and appropriate health care, such as outpatient and mental health services (Brennan et al., 2020; Raven et al., 2020; Williams et al., 2023) Such findings emphasize the potential preventative effects of supportive housing, which may lead to a sustainable, overall reduction in healthcare utilization and costs.
  • Permanent supportive housing can result in measurable, cross-system cost offsets that save taxpayers money.  A large analysis examining service utilization and costs associated with the Housing for Health’s Permanent Supportive Housing program in LA County found that people who were experiencing homelessness with two or more admissions for inpatient hospitalization and/or emergency-based services in the prior year cost an average of $38,146 per year in county services, including health, corrections, and general relief. A year after housing was provided, this average cost decreased to $15,358 per person (Hunter et al., 2017).
  • A Domestic Violence Housing First Model can offset some of the severe, costly harms experienced by survivors of intimate partner violence, who are at a heightened risk of housing instability and homelessness (Pavao et al., 2007; Jasinski et al., 2005). Domestic Violence Housing First (DVHF) adapts the Housing First model for IPV survivors (Sullivan & Olsen, 2016) by centering safety, trauma-informed practice, and social and emotional well-being and providing housing-focused advocacy and flexible funding. One longitudinal study examining the impact of receiving DVHF services found that compared to IPV survivors who received services as usual from domestic violence victim service agencies (i.e., support groups, counseling, safety planning, shelter, or other forms of advocacy not related to housing stability), survivors who received DVHF reported higher housing stability both 6 months and one year after approaching an agency for help. Moreover, survivors receiving DVHF services reported significantly less physical, emotional, and economic abuse at the one-year follow-up (Sullivan et al., 2023). 

Problem-solving courts are another promising intervention to reduce the harms and costs of homelessness by diverting individuals from the criminal justice system and connecting them with services and supports. Problem-solving courts bring together criminal justice and community partners to respond to crime in a manner that not only holds defendants accountable, but also addresses underlying needs and community concerns. Problem-solving courts typically focus on a distinct population (e.g., veteran’s courts, homeless courts), type of offense (drug courts, domestic violence courts), and/or geographic area (e.g., community courts). 

Across various models, problem-solving courts divert individuals away from criminal convictions and their extensive collateral consequences, which put people at greater risk of future homelessness and criminal justice system involvement. Moreover, participants can get connected to a wide array of services based on individual needs, including housing assistance, mental health services, employment programs, and more. This approach to justice can reduce homelessness directly via housing placements. For example,  36% of new participants who entered San Francisco’s Community Justice Center collaborative courts in 2017 were experiencing homelessness at the time of entry. By the time they left, 88% had housing (Judicial Council of California, 2020). Moreover, problem-solving courts can also reduce homelessness indirectly by preventing eviction, reoffending, and other outcomes associated with increased risks for homelessness (Center for Justice Innovation, 2016). 

Available analyses of community courts also suggest that this is an effective model that can reduce costs across systems. For instance, an evaluation of the Red Hook Community Justice Center in Brooklyn found that the community court resulted in a net savings of $6.8 million, mostly due to avoided crime and criminal justice system costs (Lee et al., 2013). Although there is a need for more rigorous cost analyses, available evidence indicates that problem-solving courts can be a powerful intervention for breaking the cycle between incarceration and homelessness, connecting individuals experiencing homelessness with housing support and other services, and reducing wasteful spending of limited public resources. 

Costs to Society

The harms of homelessness result in profound costs to society at both national and global scales. Persistent and increasing homelessness provides a stark reflection of systemic socioeconomic inequality in the United States – one of the richest countries in the world, yet where income and wealth inequality is greater than almost any other developed nation. The extreme concentration of wealth among the richest .1 percent of households has coincided with a widening racial gap in wealth, stemming from an intricate interplay of income inequality, structural racism, and ableism, homelessness stands at a juncture where entrenched disparities converge. 

A robust analysis of changes in community-level income inequality, homelessness, renter cost burden, and home values over time found that an increase in income inequality within a community generates higher rates of homelessness (Byrne et al., 2021). Considering the racial dimensions of economic inequality, and the fact that widening racial wealth gaps contribute to rising inequality (Aladangady & Forde, 2021), it is important to center racism in discussions about the causes, and consequences, of homelessness. 

Historic and ongoing barriers to economic security and progress – including land theft, segregation, redlining, and present-day institutional practices –  have led to an unjust overrepresentation of Black, Indigenous, and Latinx people among the population living in poverty and those experiencing homelessness. (HUD, 2022; Shrider et al., 2021; U.S. Census Bureau, 2022). Moreover, racial disparities in family homelessness further exacerbate and entrench intergenerational inequalities. In 2022, 50% of people experiencing homelessness as members of families with children identified as black or African American, and nearly 3 in 10 were Hispanic and/or Latinx (HUD, 2022). 

On average, workers with disabilities are paid 74 cents for every dollar paid to nondisabled workers. The poverty rate is over twice as high for working-age adults with disabilities in the U.S., with nearly 18% living in poverty in 2020 compared to 8% of the nondisabled population (Fox & Burns, 2021). Systemic socioeconomic disadvantages result in people with disabilities being overrepresented in the population experiencing homelessness. In 2021, 57% of adults living in shelters reported a disability, although individuals with disabilities comprise 13% of the civilian noninstitutionalized population (HUD, 2023; U.S. Census Bureau, 2021)

This is evidenced by racial disparities in poverty rates, as well as the size of the disability wage gap. One in four Black adults with a disability lived in poverty in 2020 with similar rates for Hispanic individuals, while roughly one in seven White adults with a disability faced poverty. The wage gap is even greater for Black and Hispanic workers with disabilities, who earn 68 and 67 cents, respectively, on the dollar compared with nondisabled workers (Vallas et al., 2022).

The disproportionate rates of homelessness experienced by people of color and individuals with disabilities in the U.S. have led scholars to consider homelessness as a prominent pathway through which structural racism and ableism drives disparities in other system outcomes such as health care, criminal justice, and education. However, it’s also important to recognize that disproportionate rates of homelessness among people of color and people with disabilities are a symptom of inequitable systems. 

Every year, homelessness contributes to countless premature deaths, indicating a failure to protect the most basic right to life. In addition to undermining the principles of inherent dignity, homelessness also infringes upon several fundamental human rights standards enshrined in the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights:
• The right to adequate food, clothing and housing, and to the continuous improvement of living conditions.
• The right to the highest attainable standard of physical and mental health.
• The protection of human rights without discrimination of any kind.

In light of these infringements, the United Nations now recognizes homelessness as a global human rights violation and has published Guidelines for the Implementation on the Right to Adequate Housing, which underscore the obligation of States to put an end homelessness as swiftly as possible and to end the criminalization of people experiencing homelessness.


A key lesson that emerges from this literature is that the costs of homelessness are multifaceted, resulting in whole-of-society impacts that cannot be ignored. Evidence demonstrating that effective solutions to homelessness can lead to substantial savings across sectors such as healthcare, criminal justice, and emergency systems underscores the need for an integrated, intergovernmental approach to ending homelessness. This research further reminds us that while government departments and local systems often operate within isolated silos, addressing homelessness is not the sole responsibility of any single agency. It necessitates community-wide systems change and data-driven investments. 

The stories of communities embracing effective approaches, particularly those grounded in the Housing First model, showcase that addressing homelessness can be achieved through proactive investment in holistic interventions. Rather than perpetuating a cycle of costly consequences, communities are channeling their efforts towards comprehensive solutions with wide-ranging benefits. By placing stable, affordable housing above all else, and providing a continuum of supportive, medical, and social services, permanent supportive housing programs with a Housing First approach can not only improve the livelihoods and wellbeing of individuals and families, but also to alleviate strains on public budgets over the long term.

The costs and consequences of homelessness are profound and far-reaching, exacting a heavy toll upon individuals, communities, and society at large. Although much of the research reviewed above focuses on individual-level outcomes or economic measures of costs that are more easily quantified, we cannot understate the burdens of homelessness that are more challenging to measure — including immeasurable losses in people’s lives and infringements on human rights — or the immense benefits that arise from solutions, which extend far beyond financial figures and include qualitative improvements in family relationships and progress towards social justice. The call to end homelessness is not merely a matter of mitigating costs. It is a moral imperative to uphold the principles of equity, justice, and compassion.