Medical School Hotline: Homelessness in Hawai‘i: Challenges, Progress, and Prospects

According to the US Department of Housing and Urban Development, homelessness is defined as, “an individual or family who lacks a fixed, regular, and adequate nighttime residence.”1 In Hawai‘i, homelessness is an increasingly prominent and complex issue due to a variety of reasons. This includes economic (high cost of living, low minimum wages), social (high levels of immigration from the Pacific region), and geographical (limited land) challenges. In the state of Hawai‘i, the Center on the Family and the Hawai‘i State Department of Human Services estimated a statewide total of 13,980 unduplicated individuals who received shelter and/or outreach services in one year.2 According to the Homeless Service Utilization 2012 Report, the grand total demonstrated a decline of 7.5% since the last peak in 2010; however, the decreased number of clients belies the alarming 43% of “new clients,” who lack prior service utilization records. In other words, almost half of the individuals receiving homeless-related services in 2012 were considered “newly homeless.” In addition, as the data collected in these reports are entirely voluntary, the generalization of resource utilization is likely an underestimation of the current homelessness situation. In 2009, the US Conference of Mayors' Taskforce on Hunger and Homelessness found that the demands for homeless assistance rose by an average of 26% across the 27 surveyed cities; the survey did not include the cities in Hawai‘i. In addition, although there was reportedly an average leveling of homeless individuals, there appeared to be an increase in family homelessness in 19 cities. The top causes for family homelessness were reported as lack of affordable housing (74%), poverty (52%), domestic violence (44%), and unemployment (44%). On the other hand, for individual homelessness, the top causes were somewhat different: lack of affordable housing (67%), substance abuse (67%), unemployment (14%), and mental illness (13%).3 Consequently, the etiologies of homelessness may vary tremendously among individuals and families, which complicates potential overarching and universal solutions. In addition, to many homeless individuals, homelessness extends beyond the mere absence of a regular dwelling. The lack of a “home” carries profound repercussions and negative connotations, such as, discrimination in finding employment and housing,4 higher incidence of mental illnesses and substance abuse,5 and difficulty in obtaining necessary medical and surgical care.4 As a result, homelessness becomes a perpetual and self-propagating cycle of economic and sociopolitical inequity for many individuals and families.