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May 16
0

Vision Driven Change

By | Health, The Global Is Local | 2 Comments

A few nights ago my wife and I had a conversation with our friend Peter. In contrast to our method of deciding our fate (last minute panic combined with procrastination and our desire to live in the moment), Peter was describing himself as vision-driven in his decision making process. By coincidence, the following morning I sat among a large group, including my fellow ChangeEngine blogger Scott Burkholder, loosely organized around the concepts of social entrepreneurship and a vague but optimistic vision of a better city.

These conversations have given me pause for thought, and to consider the role of this social innovation/social change blog platform. Our group of authors approaches the challenge of promoting positive social change from a variety of perspectives, and most of us have personal investment in the projects and programs that we write about.

I’ve occasionally thought that the quote attributed to Ghandi on a million self-satisfied bumper stickers — “Be the change you want to see in the world” — might be an appropriate mission statement for ChangeEngine. I looked up the phrase and found that he has been misquoted for the purposes of bumperstickerability. As corrected by the New York Times:

If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do.”

Not surprisingly, Ghandi is a smidge more complex and a tad more profound than the sentiment captured on a bumper sticker.

My conversation with Peter and the breakfast group the following morning centered around the potential for individuals and small groups to generate substantial change. Both interactions emphasized the importance of envisioning a better place, even if the precise vision of a better future is vague. In a way, it doesn’t really matter. The effort counts.

Making an effort toward positive change almost certainly shifts the expectations, changes the conversation, and re-frames the possibilities for a community in need of transformative positive change. If Ghandi were a statistician, he might have talked about shifting or weighting the mean, if he were a talk show host, he might have talked about seeding the audience, but since he was an agent of transformative change, he talked about changing ourselves in order to change the world.

Hasdai Westbrook, our editor extraordinaire and Change-Monger-in-Chief, regularly reminds me to consider the social innovation components of the various issues that I address in my columns, and often this is a challenge for me when writing about burgeoning pandemics in Saudi Arabia. Today, however, I am struck how the health of the city is affected by all of its residents and their activities. Planting community gardens and socially responsible investment are both contributers to the same vision, and are relevant to the health of the greater community.

Barton, H.; Grant, M., 2006. A health map for the local human habitat. The Journal of the Royal Society for the Promotion of Health

My beat is Public Health, with local and global implications. At its core, Public Health is concerned with trends and interventions at the population level. While those in the research and analysis end of the field must be driven by process and procedure, those engaging in interventions must be driven by vision.

No public health intervention is undertaken without a vision of a better future for the population, but I believe that the definition of health intervention should be broadened considerably. From urban farms to the Mayor’s public safety initiatives to public art projects, there are a great number of activities taking place in Baltimore (and around the world) that directly and substantially impact population health. These activities impact the education, nutrition, economics, safety, and appearance of our neighborhoods, which can have a profound impact by shifting the mean toward a healthier city and and a healthier world.

Next time, The Gluten Wars, A Health-Conscious Society Loses Its Mind

Apr 25
0

Fewer Baltimorians Headed HOME

By | Homelessness, The Race to End Homelessness | No Comments

They’re back! If you’ve attended a Baltimore Community Association meeting this month, you’ve seen them: armed with letters, announcements, and news from the state’s capitol, legislators have finished a three-month session in Annapolis and returned to the city. As they make the rounds and reconnect with constituents, there is a lot of good news to discuss. While there was much impressive work accomplished, many housing advocates hung their heads at the news that one important piece of legislation had failed — again.

The HOME Act, had it survived in Annapolis, would have required landlords to accept any kind of legal income as a rent payment. Understandably, this would have been good news for people who are experiencing homelessness but hold a Section 8 Voucher. The voucher program is a federal plan that allows tenants to pay 30 percent of their income and provides subsidies to cover the rest of the rent. Despite the ghastly-long waiting list for vouchers, the theory behind the program is that a voucher holder can choose where to live rather than residing in a particular low-income building or neighborhood. This sounds good in theory, but obtaining one does not necessarily lead to housing because many property owners can legally refuse to house tenants who intend to pay with a voucher. (Income discrimination also affects people who use Social Security or pension programs to pay their rent, so the HOME Act could have created increased housing security for many people).

By not passing the HOME Act, this behavior will continue in Baltimore City. Missteps like this one place Baltimore behind other cities in the race to end homelessness. Eleven states and 30 cities have already passed laws prohibiting income discrimination, including Philadelphia, New York City, Chicago, Philadelphia and Boston. If each of these cities is able to allow their citizens equal housing choice, why does Baltimore allow landlords to cater specifically to wealthier tenants?

You can probably guess the answer. Fear and stigma surround homelessness, even in cities that have pledged to end it. There might be abstract support to end homelessness, but it becomes dicey when a formally homeless person is about to become your neighbor. It seems people are much more comfortable donating a dollar from inside a car than passing a low-income person in the hallway of their building. This “Not In My Backyard” mentality deters landlords from accepting Section 8 voucher holders, for fear it might upset other tenants. In reality, low-income housing has been shown not to decrease property values.

Recently, speculation surrounding sequestration suggest that Housing and Urban Development (HUD) budget cuts could actually lead to some current Section 8 tenants having their voucher revoked. In New Orleans, 700,000 recently awarded vouchers were revoked last month. It is unknown which cities will be forced to follow suit.

Baltimore should make every effort to preserve the Section 8 vouchers that have allowed low-income individuals safe and affordable housing. It is unacceptable to reverse someone’s path to housing stability. Even more crucial is a system to provide a voucher system that actually works. By working with HUD, federal policy makers, and local landlords to reduce stigma, income discrimination, and evictions, Baltimore could pull ahead in the race to end homelessness.

Perhaps next year Baltimore will be able to catch up to other cities. Until the next legislative session, income discrimination presents a significant barrier to housing, one that will slow Baltimore in its plans to end homelessness.

IMAGE CREDIT. Hasdai Westbrook.
Mar 29
0

The Keys to Housing and Health

By | Homelessness, The Race to End Homelessness | No Comments

Last week’s tragedy in Baltimore’s City Shelter showcased the many faults of homeless shelters. Both in Baltimore and nationally, these places can be overcrowded, unsafe, and not equipped to work with people who might be mentally ill or combating addiction. Having never stayed the night at a shelter, I am wholly unqualified to evaluate which of these shortcomings is the most serious, but my biggest gripe with shelters is something else.

The biggest fault of homeless shelters is simply that they are only ever meant to be temporary. The most commonly mentioned solution when people discuss homelessness actually does nothing to alleviate homelessness. Someone can stay in a shelter every night for a year- or longer- and be no closer to permanent housing. Homeless shelters are only a band-aid on a potentially deadly issue. Despite the human and financial costs to homeless shelters, these institutions do nothing to improve the lives of those who stay there.

Shelters, like band-aids, serve a purpose. Immediate resources are not unimportant, but they cannot be the only solution we offer those who experience homelessness in our cities. This week, fellow ChangeEngine author Robyn Stegman suggests that even when people are experiencing homelessness, they have the right to their own money and to make their own decisions. Housing First is the radical idea that people have a right to housing. Housing first programs focus on housing people as rapidly as possible, providing supportive services, and providing a standard lease (without mandated therapy).

For years, the path out of homelessness required jumping the hurdles of finding employment, remaining clean from drugs and alcohol, and maintaining a mental health regimen. Many programs that serve homeless citizens impose such rules on their clients before they will help find them housing. In 2005, Health Care for the Homeless, a Baltimore health care agency, moved 30 people who were about to be evicted from a local park into their own housing and found that nearly all of these individuals were able to remain housed. Having housing led many people to successfully secure an income and participate in mental health treatments.

Here’s the shocking thing about a program that doesn’t require its users to be clean, employed and seeking treatment before they are allowed a safe place to live: it works. In a New York City study, 84 percent of active drug users housed remained in their housing. This statistic is higher than what plenty of social service programs achieve by requiring clients to abstain from drugs and alcohol before “earning” housing. In Seattle, housing people who were chronically homeless and addicted to alcohol (without requiring clean time) not only allowed for most study participants to remain in housing — it reduced costs for the city by $2,449 per person, per month.

Baltimore’s 10 Year Plan to End Homelessness relied heavily on the Housing First Model when it was written in 2008. In Chicago, Housing First is one of three pillars of the plan to end homelessness and policy makers in Los Angeles, Boston, and New Orleans are discussing the merits of this practice. Earlier in 2013, consultants for Baltimore drafted a new version of the 10 Year Plan to End Homelessness, which mistakenly does not provide enough resources for Housing First to reach its full potential. Moving people experiencing homelessness into sustainable shelter should be a priority for any city that is looking to save lives and money. Revisions of the plan are ongoing.

For some reason, many people think that safe, affordable housing is a carrot we can hold up as an incentive to force others to make huge life changes. If shelters were used only as temporary places to stay instead of consolation prizes, we would see a dramatic decrease in not only the number of people experiencing homelessness, but also the number of people struggling with debilitating mental illness and addiction. Cities could literally hand people they keys they need to overcome addiction and maintain their mental health. Housing is not a prize for the healthy — housing is a human right.

IMAGE CREDIT: Pembroke Financial
Mar 01
0

You Can’t Slam A Revolving Door

By | Homelessness, The Race to End Homelessness | 5 Comments

I have never stayed overnight in a hospital. My only real surgery was to remove my wisdom teeth. After that, I vaguely remember being walked by my mom to a waiting car, brought home, and allowed to sleep — in my own bed — for the better part of the next 24 hours. Even with the puffy cheeks, it was worlds better than the common post-surgery experiences of someone who doesn’t have someone to pick them up, some way to transport them, and some place to sleep.

Medical recovery for someone who is homeless means taking open wounds, broken bones and compromised immune systems out into the elements. You don’t get to stay an extra night in a hospital bed just because you don’t have another bed to move to. Some Medical Respite Centers do exist, providing a place for those without housing to recover, but only in limited quantities. There are 25 beds for medically fragile homeless people in Baltimore City, 104 in Boston, 30 in Denver, four in Austin, zero in Detroit and zero in New Orleans. Even when beds are available, patients are not always referred to them.

Perhaps busy hospital staff believe that the homeless are the responsibility of shelters, not medical centers. In Los Angeles, a hospital recently got a $125,000 fine for “dumping” as many as 150 patients in homeless shelters. This is hardly a medically sound plan, because shelters cannot even accept patients if their health needs are too great. A person with an oxygen mask, an open wound, or a contagious disease is typically not allowed in a shelter. Even inside the shelter, patients run the risk of having their prescriptions lost or stolen. Not surprisingly, this often lands the recently discharged back in the hospital — this time, in the emergency room — with infection or complications from their treatment. Hospitals can become traps for the people experiencing homelessness — a revolving door of disease and disarray.

What might be the easiest first step to improving recovery — asking an individual if he or she has a place to go — is hardly implemented when talking with patients. One study found that only 44 percent of homeless patients were asked about their housing accommodations for the night after their discharge, and 11 percent spent the first night after leaving the hospital outside.

The right questions and improved resources can change the health outcomes for homeless individuals. In California, hospital discharge procedure for the homeless sometimes includes a bus pass. In Austin, the founder of a city housing program proposed a new policy, in which he suggests patients not be sent away from medical care if they lack a safe and stable place to go. The plan, called Discharge No One Into Homelessness (DNOIH), is only a petition now, but its implementation could help improve health among homeless populations.

Over 200 cities in the United States have developed 10 Year Plans to End Homelessness, yet homeless patients are often discharged without so much as a plan for the next 10 hours. If we cannot ensure short-term health, there is little hope for more long-term change.

IMAGE CREDIT. Courtesy of Global Good Group.
Feb 01
0

Being Homeless is A Full Time Job

By | Homelessness, The Race to End Homelessness | One Comment

I have a few friends who work in organizations focused on job and employment training. Because I work in a housing agency, we often have chicken-or-egg-type debates when we talk about the route to reducing poverty – a home or a job? Which needs to come first to end the cycle of poverty?

It is hard to pay for security deposits, rent, furniture, and home repairs if someone has no income. Still, it is an incredible challenge to hold down a job without a place to shower, prepare food, change clothes and rest up each day. While I still fall on the housing side of the discussion, I realize that really, you can’t have one without the other. It is abundantly clear that the need for income and housing are tied together, so how should we approach these needs?

In a 2010 article on homelessness in London, The Economist made the radical claim that “The most efficient way to spend money on the homeless might be to give it to them.”  The article profiles a charity called Broadway that performed a radical housing experiment with a cohort of chronically homeless individuals and managed to move 84 percent of the group off the streets. The agency did not provide job training services or housing. Instead, it asked the individuals what they needed to improve their lives. The answers varied greatly, from shoes to television sets, but the results did not – eleven of those 13 people are now in stable housing.

What can our cities learn from a small-scale British experiment? U.K. housing policies are different from those in the United States, and when there are thousands of people experiencing homelessness, eleven people is not a grand accomplishment. But the question at the root of the experiment – “What do you need?” – is applicable to homelessness everywhere.

Too often, our policies make it impossible for someone to leave the streets or obtain employment. A formally homeless woman once explained the connection to me when she said that between appointments, waiting lists, and paperwork, “Being homeless is a full time job.” Many policies are aimed at punishing or suppressing the poor, but do nothing to help reduce the rates of people experiencing homelessness. Even well- meaning policies are usually created in meeting rooms, not shelters. In Baltimore, Chicago, and Denver, agencies have begun connecting homelessness experts – those who have actually experienced homelessness – to politicians and legislators. This testimony can provide valuable insight to policymakers and shape new legislation in ways that can actually work.

When Broadway asked people what they needed to leave homelessness, they got the right answers. If this could happen in the legal, political, and economic spheres, it would take a lot of guesswork out of policymaking. Perhaps we are wrong to wonder if the job or the apartment needs to come first – maybe there is another strategy entirely. We cannot know until we ask.

Jan 04
0

A New Year for Bills

By | Homelessness, The Race to End Homelessness | No Comments

This week’s paycheck might be slightly more substantial for many around the country. Ten states effected higher minimum wages beginning January 1st, impacting the wages of one million people. Washington state now boasts the highest minimum wage in history, at $9.19 an hour. If at some point you flipped burgers, tore tickets, or scooped ice cream for half that, the number may seem large. It might even seem like a livable wage.

Two- thirds of the one million people receiving the New Year’s Raise are over twenty, so this is not just a raise for a million teenagers working after-school jobs. We can assume that at least a portion of the group getting this “cost of living” wage might be working so they can buy food, cover expenses, have some savings,  and pay their rent. Unfortunately, that isn’t mathematically possible.

Most housing policy suggests that 30 percent of one’s income should be used for housing. A 2012 study by the National Low Income Housing Coalition compared each state’s minimum wage with the average cost of a two-bedroom dwelling in the state. The report, tellingly called Out of Reach, calculates what a necessary minimum wage would be to allow individuals to put 30 percent of their income towards housing, while still being able to afford things like food, medical attention, clothing and transportation. Below is a comparison of a state’s minimum wage (blue) and the necessary wage a person would need to afford the rent on a market-rate apartment in each city (red).

wage

While the red margins vary between cities, it is clear that not one comes close to providing a livable minimum wage to its population. (For states that have no minimum wage, the federal rate of $7.25 is used as a baseline.) In Baltimore, the livable wage is 3.2 times the current state minimum. This means a person would have to work 3.2 full time jobs to make rent. In Los Angeles, you’d need to work about three-and-a -half jobs at 40 hours each to pay your bills.

While people sometimes work two or more jobs, there aren’t  enough hours in a day to work three or four full time jobs. (As an aside, try getting hired by saying, “I need my hours here to work around the hours at my other two jobs.”) When the bills are due, the money has to come from somewhere, which is when we see the ideal 30 percent of income for housing figure jeopardized.

The 30 percent number was determined by the Housing Act of 1937 and is still the generally accepted measure of affordability. Those who pay a larger share of their paycheck into housing costs are deemed “house burdened.” Today, 12 million people in the United States put more than 50 percent of their income towards rent.

At this point, you might wonder what these 12 million people have to do with homelessness. These 12 million people are paying rent – they are obviously housed. While this is true, I would contest that this population is crucial to the discussion of homelessness. If half of every earned dollar goes towards someone’s housing, there is a lot that stands to be cut from the budget. Healthy food, warm clothing, reliable transportation, necessary medical care – all off these things stand to be compromised when a household budget is overtaken by rent bills.

However a “house burdened” household reconfigures its budget, we can assume there is not a lot of money left for savings. This puts a person on the constant edge of a crisis. An accident, an illness, an unexpected expense – there isn’t money left for things like this. These people are okay for today, but if tomorrow brings the unexpected, their housing is in jeopardy.

So, while I am sure one million Americans are happy to take home a few more dollars in 2013, this latest wage increase is hardly enough of a change to provide safe and stable living to the millions who will continue to stretch their dollars in the new year.

UP NEXT: A Look at Plans to End Homelessness

Dec 21
0

Can We Blame it All On The Economy?

By | Homelessness, The Race to End Homelessness | No Comments

If you have watched or read much news anytime in the past five years, you are likely familiar with the phrase “housing crisis.” We are, apparently, in the middle of one, and it keeps getting worse.

For thousands of people in the United States, these past years did not represent a housing crisis, because “crisis” implies a new emergency. For those experiencing homelessness, living without safe, stable housing is an ongoing reality, not a new trend brought on by the economy.

When living without a basic human right like housing, I would argue that each day could be deemed an  emergency, but it is not generally seen as such.  Because of the economy, loss of housing has gotten more attention in the past few years, and in February of 2009, a new policy was instituted that aimed to bring some economic relief to those struggling with their housing. The American Recovery and Reinvestment Act of 2009 was a measure that made $1.5 billion available for a fund called the Homelessness Prevention and Rapid Re-Housing Program (HPRP).

HPRP provided funding to quickly rehouse and stabilize those who lost their housing, so funding could be used for everything from rent to moving costs, security deposits, utilities, and case management. With a cost of $1.5 billion, this program was not inexpensive, but it might have been worth it in the eyes of the federal government. New reports released this month indicate that on average across the country, the number of people experiencing homelessness has not increased in the past five years.  In a time of “crisis,” it really is remarkable that programs were able to keep the numbers of homeless people unchanged.

Results were apparently so excellent that the HPRP ended this fall. There is no new funding available, and what has been distributed must be spent before various upcoming deadlines. Are we to understand that this means the housing crisis has ended?

I assure you that it has not. While it is impressive that the money was able to keep the homelessness rates from changing in a period of economic strain, it is also infuriating. Hearing that the rate of homelessness has not changed in five years should not be a point of pride but a sign that we have made no progress in this area for too long. Yes, thousands of people were able to avoid long-term homelessness because of these dollars, but thousands more are living the realities of homelessness every day without the same attention or help.

This money was not really meant for those experiencing homelessness. While some people might have been eligible and received some of this funding, it is clear that the bulk of the money was intended for those who were in danger of falling out of the middle class. Now that many people are stably housed, the program has closed its doors, leaving hundreds of thousands of people out in the cold.

For a price tag of $1.5 billion, the United States was able to accomplish something incredible – keeping people housed during a time of economic turmoil. This indicates that that the crisis that is housing is not a really a crisis at all. Strong programs, when funded adequately, can dramatically alleviate housing problems. Despite this success, we gave up in September of 2012, content with keeping the numbers steady.

Why not keep working? There are still hundreds of thousands of people living in a true housing crisis, and the solution to the problem is not so complicated.

Next Time: Who Pays for Homelessness?

[Photo: Times Union]