Honolulu’s failure to assist the homeless is an issue of both public health and social injustice

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The multitude of social and health problems that homeless people endure reflects a variety of social injustice issues. The homeless condition itself represents the convergence of multiple factors, including poverty, high housing costs, and a shortage of subsidized public housing units. The exposure to substandard environmental conditions that affects the health of homeless people is related to urban development failures. (, Barry S. Levy, Victor W. Sidel, Ed., Oxford University Press, 2006
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by Larry Geller

Yes, in part, the growing number of people living in the streets in Honolulu is related to urban development failures. Honolulu’s development philosophy? Whatever developers want, they get. In a nutshell, that’s it.

Rents remain uncontrolled, so families and individuals find themselves thrown out. Meanwhile, unaffordable housing gets swift approval for Kakaako.

Evidence-based solutions such as Housing First exist only as plans. That accomplishes… nothing.

If one must resort to economic arguments (what else will move an uncaring City Council?), they should know that they may be paying for their tightfistedness anyway:

In the United States and Canada, about 24 percent of the homeless are hospitalized each year. About 75 percent of hospitalized homeless persons are hospitalized for conditions that are often preventable, such as substance abuse, mental illness, trauma, respiratory disorders, skin disorders, and infectious diseases except AIDS—a rate 15 times that in the general population.  Following hospital discharge, 40 percent of homeless persons are readmitted to the hospital within 14 months, usually with the same diagnosis.

[Social Injustice and Public Health, p. 181] [see original for references]

Add to healthcare costs the high costs of repeated raids and sweeps. Someone on the City Council should dust off their abacus and disclose what continued neglect has cost taxpayers. And it’s reported that the number of homeless people living on the streets increases each year. Hint: do something to keep people in their homes. Face up to your responsibilities.

The cities that have a regime of rent control or rent stabilization generally put those laws in place in reaction to the Great Depression. Honolulu could do worse than to enact appropriate laws to prevent rent gouging here.

I think it was Rev. Al Sharpton who said something like, Sure, if you see someone drowning in a river, you have to extend a hand to pull them out. But you also have to take a walk up the river and see who is throwing them in.

Homelessness in Honolulu is both a public health issue and a social injustice issue. Newspaper letter writers and many undemocratic Democrats among our lawmakers assert that those living at the edge of the sidewalks are exercising some kind of rational choice. Accordingly, they become undeserving of public assistance. This is similar to the rational that congressional Republicans use as they attack the Affordable Care Act which, despite its many flaws, is an effort to improve the health of every individual as a right. Certainly, the high cost of health insurance (which is different from health care) is a factor everywhere in this country that helps create poverty. Poverty, and in the extreme, homelessness, is not a rational choice issue.

It is hard to provide healthcare to those without a home, one very good reason to push the Housing First model as rapidly as possible.

Health care, however, is only one of many complex factors that explain health disparities among the homeless. Social and environmental factors also play an important role. As seen in our studies, disparities in health behaviors, such as cigarette use, obesity, and communicable disease, are also shaped by social and physical environments where homeless persons live.

Again, these issues can be better worked on when a person or family is safe in an adequate apartment or home of some sort than if they are on the streets.

What will it take? The book cited here is just one of many. Our city council and mayor would do well to curl up in their comfy offices with any one of them, and come to understand that a solution will …

…ultimately require redirecting resources, significant government investment, and collective efficacy (the capacity of neighborhood members to improve social and structural development according to collective principles and desires).

For our part, those who care might help nudge the “collective efficacy” needle up a bit from zero. Complaining about the condition of the streets won’t help a bit. Destroying someone’s  property with a sledgehammer ought to be a crime, but seems not to be, and doesn’t help a bit. Pushing our city government to take action will help.

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