Student Name
Capella University
NHS-FPX 6008 Economics and Decision Making in Health Care
Prof. Name
Date
Needs Analysis for Change
Homelessness in California poses significant economic and public health challenges. The growing population of people experiencing homelessness (PEH) places immense pressure on healthcare systems, driving up costs and contributing to disparities in access and outcomes. Limited availability of preventive and routine healthcare services results in higher rates of emergency department visits and hospitalizations, creating a feedback loop of increased strain on healthcare providers. Vulnerable populations—particularly those with chronic medical conditions or mental health issues—are disproportionately affected. Addressing these issues requires immediate and comprehensive interventions, including investment in affordable housing, integrated healthcare services, and targeted policy reforms to promote equity and improve overall outcomes.
Summary of Homelessness as Economic Issue
Homelessness represents a critical economic concern in California, with both direct and indirect costs affecting healthcare systems, communities, and individual providers. In 2023, California reported 337,735 homeless individuals, of whom 73.4% were unsheltered, 55% were men, and 45% were women (CHCF, 2024). People experiencing homelessness encounter significant barriers to care, which contributes to higher prevalence of chronic illnesses such as hypertension (30.1%), diabetes (11.1%), heart disease (15.1%), and pulmonary disorders (25.2%) (Statista, 2024). These conditions increase the likelihood of hospital admissions, emergency visits (37.2%), and readmissions (27.4%) (Miyawaki et al., 2020), amplifying both economic and operational pressures on healthcare systems.
The financial impact extends to housing and shelter services, with estimated costs averaging $208,000 per bed and $278,000 per unit (Hoover Institution, 2023). For healthcare professionals, homelessness increases patient complexity and requires more care coordination. Hospitals experience strain due to frequent readmissions and uncompensated care, while communities face higher public health risks, widening disparities, and increased economic pressure.
Key Statistics of Health and Economic Burden
| Indicator | Percentage / Cost | Source |
|---|---|---|
| Unsheltered PEH | 73.4% | CHCF, 2024 |
| Hypertension prevalence | 30.1% | Statista, 2024 |
| Diabetes prevalence | 11.1% | Statista, 2024 |
| Heart disease prevalence | 15.1% | Statista, 2024 |
| Pulmonary illness prevalence | 25.2% | Statista, 2024 |
| Emergency visits | 37.2% | Miyawaki et al., 2020 |
| Readmissions | 27.4% | Miyawaki et al., 2020 |
| Shelter cost per bed | $208,000 | Hoover Institution, 2023 |
| Shelter cost per unit | $278,000 | Hoover Institution, 2023 |
The rationale for addressing homelessness is reinforced by its widespread impact on healthcare access, cost, and equity. In 2020, PEH represented 3.4% of hospital admissions and 2.8% of emergency visits in California (CHCF, 2024). Unhoused individuals face a mortality risk 2.7 times higher than the general population (Liu et al., 2020). The core gaps involve insufficient integrated healthcare, limited affordable housing, and inadequate social support networks. Policy reforms, expanded healthcare access, and housing-focused interventions are essential to mitigate these disparities.
Socioeconomic or Diversity Disparities
Homelessness disproportionately affects minority populations in California, revealing systemic inequities. Black, American Indian, and Pacific Islander communities experience disproportionately higher rates of housing instability. For example, Black Californians constitute only 5.3% of the state population but represent 26.6% of unhoused individuals receiving assistance. American Indian/Alaska Native individuals account for 1.2% of the unhoused population despite comprising just 0.03% of the state’s total population (Davalos & Kimberlin, 2023).
These disparities reflect historical and structural barriers, including discriminatory housing policies, economic instability, and limited access to high-wage employment. Effective interventions must include expanded affordable housing, economic support programs, and policy measures that dismantle structural inequities affecting marginalized groups.
Evidence-Based Sources for Combating Homelessness
Research underscores the importance of evidence-based interventions in reducing homelessness and addressing systemic disparities. Housing-first programs, which prioritize stable housing before addressing other social or health needs, have demonstrated significant improvements in long-term housing stability for marginalized populations (Sandu et al., 2021).
The shortage of affordable housing disproportionately impacts renters of color. According to the National Low Income Housing Coalition (2023), 19% of Black households, 17% of American Indian or Alaska Native households, and 14% of Latino households have extremely low incomes, compared with 6% of White non-Latino households. Expanding rental assistance and permanent supportive housing can reduce homelessness among Black and Latinx populations (Olivet et al., 2021). Integrating job training and workforce development further promotes long-term financial independence and economic stability, bridging the racial gap in housing security (Aubry et al., 2020).
Opportunities and Predicted Outcomes
Expanding housing-first initiatives and rental assistance programs in California offers significant economic and social benefits. Stable housing reduces healthcare utilization, particularly emergency visits and hospitalizations, which are disproportionately high among PEH (Olivet et al., 2021). Additionally, permanent supportive housing programs lower interactions with the criminal justice system, mitigating public expenditures (Aubry et al., 2020).
Targeted interventions—such as workforce training and rental subsidies—enhance economic mobility for marginalized populations, reducing dependence on public assistance and emergency shelters (Sandu et al., 2021). Over time, these measures contribute to improved health outcomes, equity, and a more resilient local economy.
Conclusion
Addressing homelessness in California requires a holistic, evidence-based approach that integrates housing-first models, rental assistance, and workforce development initiatives. Tackling systemic disparities while expanding access to affordable housing and healthcare can alleviate economic burdens on hospitals, reduce recidivism, and improve stability for vulnerable populations. Through community-driven, policy-supported interventions, California can promote health equity, economic empowerment, and long-term social sustainability.
References
Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. The Lancet Public Health, 5(6), 342–360. https://doi.org/10.1016/s2468-2667(20)30055-4
NHS FPX 6008 Assessment 2 Needs Analysis for Change
CHCF. (2024). People experiencing homelessness in California Almanac. California Health Care Foundation. https://www.chcf.org/publication/people-experiencing-homelessness-in-california-almanac/#related-links-and-downloads
Davalos, M., & Kimberlin, S. (2023, March). Who is experiencing homelessness in California? California Budget and Policy Center. https://calbudgetcenter.org/resources/who-is-experiencing-homelessness-in-california/
Hoover Institution. (2023). Sheltering California’s homeless is insanely expensive. It doesn’t have to be. Hoover Institution. https://www.hoover.org/research/sheltering-californias-homeless-insanely-expensive-it-doesnt-have-be
Liu, C. Y., Chai, S. J., & Watt, J. P. (2020). Communicable disease among people experiencing homelessness in California. Epidemiology and Infection, 148. https://doi.org/10.1017/s0950268820000722
Miyawaki, A., Hasegawa, K., Figueroa, J. F., & Tsugawa, Y. (2020). Hospital readmission and emergency department revisits of homeless patients treated at homeless-serving hospitals in the USA: Observational study. Journal of General Internal Medicine, 35(9), 2560–2568. https://doi.org/10.1007/s11606-020-06029-0
NHS FPX 6008 Assessment 2 Needs Analysis for Change
National Low Income Housing Coalition. (2023, March 16). NLIHC releases the gap 2023: A shortage of affordable homes. National Low Income Housing Coalition. https://nlihc.org/news/nlihc-releases-gap-2023-shortage-affordable-homes
Olivet, J., Wilkey, C., Richard, M., Dones, M., Tripp, J., Beit-Arie, M., Yampolskaya, S., & Cannon, R. (2021). Racial inequity and homelessness: Findings from the SPARC study. The ANNALS of the American Academy of Political and Social Science, 693(1), 82–100. https://doi.org/10.1177/0002716221991040
Sandu, R. D., Anyan, F., & Stergiopoulos, V. (2021). Housing first, connection second: The impact of professional helping relationships on the trajectories of housing stability for people facing severe and multiple disadvantage. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10281-2
Statista. (2024). Chronic health conditions among homeless in California 2022. Statista. https://www.statista.com/statistics/1462846/chronic-health-conditions-homeless-california-adults/#:~:text=A%20survey%20of%20homeless%20adults,health%20conditions%20as%20of%202022