Category Archives: health equity

Homelessness Among Individuals with Disabilities: Influential Factors and Scalable Solutions

By Erin Vinoski Thomas, MPH, CHES, Health and Disability Fellow, NACCHO; and Chloe Vercruysse, MBA

This post originally ran in NACCHO Essential Elements blog.

People experiencing homelessness lack sustainable access to housing and instead turn to emergency shelters, transitional housing, or places not meant for overnight residence. In the Unites States on a single night in January 2018, 552,830 people experienced homelessness; between 2.5 and 3.5 million people experience homelessness over the course of any given year. Housing is an important determinant of health, and those who experience homelessness are at greater risk for health challenges.

People with disabilities are disproportionately likely to experience homelessness. Point-in-time counts (i.e., counts of the people in a community experiencing homelessness on a single night) suggest that nearly one quarter of individuals experiencing homelessness have a disability, including physical, intellectual, and developmental disabilities, as well as mental health and/or substance abuse disorders.

Social-Ecological Factors Influencing Homelessness among People with Disabilities

Societal Level:

Federal policies, such as those regulating wages and supplemental security income (SSI), influence homelessness among people with disabilities. For example, many people with disabilities work for subminimum wage, contributing to higher poverty and homelessness rates. Other federal policies limit the amount of income and assets people receiving SSI can have, making it difficult for them to prepare financially for a crisis (e.g., death of an older caregiver).

Community Level:

Many shelters are inaccessible to people with disabilities, which has been the subject of recent litigation in several major cities, including Chicago and New York City. When denied access to shelters, nearly seven in 10 people with disabilities who experience homelessness stay in dangerous locations (e.g., on sidewalks or under bridges), directly affecting their health outcomes.

Shelter staff also may be inadequately trained to work with people with disabilities. This issue particularly affects people whose disabilities are often “invisible,” such as people with autism. Front-line staff may not be equipped to provide reasonable and necessary accommodations to these populations, such as alternatives to pat-downs and accommodations for other sensory needs.

Interpersonal Level:

People with disabilities experience housing, health care, employment, and wage discrimination, preventing or making it difficult for them to secure sustainable housing and income necessary to meet their basic needs.

Evidence-based and Scalable Solutions

Many evidence-based programs exist to address factors influencing homelessness. These programs have the potential to be scaled up to reduce and prevent homelessness among people with disabilities.

Housing First:

The Housing First model, first implemented in New York City in 1992, emphasizes the provision of permanent supportive housing (PSH) to address the needs of individuals experiencing chronic homelessness. [1] Existing evidence demonstrating the effectiveness of PSH led the U.S. Interagency Council on Homelessness to endorse Housing First as the solution to chronic homelessness. Utah adopted a ten-year plan to end chronic homelessness by 2015. During this time period, the state reduced its chronically homeless population by 72%.

Emergency Preparedness and Response:

Emergency situations can cause and exacerbate homelessness, particularly among vulnerable populations. Emergency preparedness and response programs designed to consider the needs of marginalized communities have been effective in tempering the effects of such disasters on homelessness. Some Florida counties, for example, have developed strategies to effectively address the emergency needs of people with disabilities experiencing chronic homelessness. Strategies include developing task forces, streamlining and integrating various human service agencies, and designating specialist-staffed shelters to assist this population.

Post-Secondary Education:

Post-secondary education (PSE) programs that include students with disabilities may serve as an “upstream” solution, connecting people with disabilities with education and employment, thereby reducing their risk for homelessness. In the state of Georgia, for example, a network of nine inclusive PSE programs have been developed over the past five years; these programs have been effective in placing over 75% of graduated students in gainful employment. Over 250 inclusive PSE programs currently exist across the US.

How Local Health Departments and Their Staff Can Get Involved

  1. Needs Assessment –Local health departments (LHDs) should include people with disabilities who experience homelessness or face housing challenges in their community health assessment and community health improvement planning efforts. Intentionally including this population in the Mobilizing for Action through Planning and Partnerships (MAPP) process may highlight specific health and social issues that LHDs can work to address.
  2. Training – Many LHDs, particularly those that have worked with NACCHO’s Health and Disability Technical Assistance program, are already conducting training for their staff on people with disabilities and their specific health needs. LHDs might consider partnering with local shelters and other organizations working with chronically homeless populations to train their staff on interacting with people with disabilities.
  3. Advocacy – Public health workers can serve as powerful advocates for implementation of Housing First and similar models to improve housing instability and chronic homelessness in their jurisdictions.


  1. Padgett, D., Henwood, B. F., & Tsemberis, S. J. (2016). Housing First: Ending homelessness, transforming systems, and changing lives. New York, NY: Oxford University Press.

Advancing Health Equity and Racial Justice: Emerging Lessons from Los Angeles County’s Community Prevention and Population Health Taskforce

By Manal J. Aboelata, MPH, Deputy Executive Director, Prevention Institute

Across the country, local jurisdictions are employing a variety of tactics to achieve health equity and racial justice. In 2016, as Los Angeles County prepared to integrate the departments of mental health, public health, and health services under a single health agency umbrella, the Board of Supervisors recognized the value in creating an advisory body that would tap into the knowledge and expertise of community-based organizations and LA County residents to elevate priorities, challenges, and opportunities to eliminate gaps in public health outcomes through a focus on the determinants of health and wellbeing. This profile details the early days of the Taskforce, including its efforts to embed community-based health equity perspectives into county decision-making and center racial justice within its focus on health equity. It also outlines the critical role of the local public health department in supporting the Taskforce. The aim of this profile is to provide those in and outside of LA with a snapshot of this nascent effort and emergent lessons for those interested in addressing health equity and racial justice by forging stronger ties between local government decision-makers and diverse organizational and community-based interests. Though it’s too early to claim “success”, this profile sheds light on some of the formative experiences of the Taskforce to inform those interested in testing similar approaches elsewhere and provide background for those seeking to contribute to the effort underway in LA County. Continue reading

Preventing HIV Perinatal Transmission and Congenital Syphilis in Broward County Florida

The following Model Practice was submitted by the Florida Department of Health in Broward County. To access this Model Practice and to view the full application, click here. NACCHO is currently accepting applications for the 2018–2019 Model Practices Program until December 12. Learn more and apply today.

Broward County, Florida has a population of approximately 1.9 million people and hosts an estimated 10 million visitors each year. It is a very diverse community with residents from 200 different countries and nearly 130 languages spoken throughout the county. Minorities account for nearly 59.5% of the population, making it a minority/majority county. Continue reading

Fostering Agency Through Local Public Health

By Grenadier, Andrea, BA; Holtgrave, Peter, MPH, MA; Aldridge, Chris, MSW, NACCHO

This article originally ran in the Journal of Public Health Management and Practice.

When public health departments support all aspects of the public’s well-being—beginning with striking at the roots of health inequity—it can create transformational change. Part of this process is encouraging people in communities to determine their own futures, to express agency; something that is rooted in action and power. So, how does local public health get there? Continue reading

NACCHO Annual 2018: Take a Glimpse into New Orleans Public Health

Interview by Taylarr Lopez, Communications Specialist, NACCHO

Torrie Harris, Dr.P.H., MPH is a Health & Equity Strategist at the New Orleans Health Department (NOHD). In the following post, she discusses her role within the department, shares how NOHD is addressing the public health burdens of maternal and infant issues and mental health, and highlights the fun things NACCHO Annual 2018 conference attendees can do during their visit to New Orleans. Continue reading

Local Public Health Spreads Importance of Good Oral Health during Children’s Dental Health Month

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

The oral cavity, including the teeth and surrounding structures, are necessary for adequate nutrition, proper speech and a positive self-image.  Although tooth decay is largely preventable, it continues to be the most common chronic disease of early childhood.1  Dental health can impact school performance when a child has untreated tooth decay with resulting pain that affects their ability to concentrate, sleep at night or even attend school, “more than 51 million school hours are lost each year to dental related illness.”2 Taxpayers share approximately 11% of the $113.5 billion spent nationally on dental care expenditures, a percentage that has increased over the years as dental care utilization continues to increase among children.3  Children with cavities in their primary (baby) teeth are three times more likely to develop cavities in their permanent (adult) teeth which could contribute to broader health problems including diabetes and cardiovascular disease.4 Continue reading

Health Equity Matters: Bridging the Gap between Underserved Populations and Access to Care

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

What is Health Equity?

Public health is built on the foundation that all people have a right to health. Health equity is the principle that every person should have the opportunity “to attain their full health potential,” regardless of social, economic or environmental conditions. Achieving health equity requires valuing all individuals and populations equally, acknowledging and repairing historical injustices, and investing in those communities. Across the United States, state and local jurisdictions have made it their mission to reduce and eliminate health inequities in their communities. There are many root causes of health inequities, including racism, class-based oppression, gender inequity, and other forms of systematic injustices. These create societal conditions that influence an individual’s health such as: the quality of education, housing, neighborhood environment, and employment opportunities leading to disproportionate health outcomes, to name a few. Continue reading