Ungoverned and Out of Sight: Urban Politics and America's Homeless Crisis

Chronic homelessness has severe implications for health disparities. Black Americans are four times as likely and Hispanic Americans are two times more likely to experience homelessness compared to white Americans (Fusaro, Levy, and Shaefer 2018). Homelessness contributes to high rates of chronic disease, adverse behavioral health outcomes, increased mortality, and lower rates of educational and job attainment over the life course (Fazel, Geddes, and Kushel 2014). Longer durations of homelessness are associated with high mortality rates, adverse behavioral health outcomes and chronic medical conditions; moreover, persons experiencing chronic homelessness are more likely to remain homeless as length of homelessness increases (Henwood, Byrne, and Scriber 2015; S. Kertesz et al. 2016). Homelessness and chronic-homelessness hit large metropolitan areas especially hard over the past two decades (Bishop et al. 2017a). Unsheltered homelessness, which is primarily long-term homelessness, is increasing again for the first time in ten years (Bishop et al. 2017a). Most research on homelessness focuses on empirical research identifying best practices for solutions to chronic homelessness. However, there is a wide gap in the literature investigating the political processes shaping the processes leading to the development of these best practices. This dissertation seeks to understand the political decision-making processes influencing adoption of best-practice solutions to reduce chronic homelessness. Homelessness is a unique case of a health issue that is governed by an almost entirely decentralized system – both historically and today (Jarpe, Mosley, and Smith 2018). The history of devolution and decentralization in homelessness governance makes it a unique policy space where various actors work in different ways to establish different types of policies that all attempt to manage homelessness to different ends. This dissertation argues that homelessness policy, specifically policies seeking solutions to long-term or chronic homelessness, are governed in four separate and distinct policy arenas: the state, local government, economic elites, and homeless service providers. The separation and conflict between these structural interests in policy goals and policy processes result in increased challenges to establishing and implementing effective solutions to end chronic homelessness. Challenges include limited state-level support such as financial resources and/or administrative burdens due to misaligned policy goals; inequity in political participation that may exclude at-risk populations; and, finally, limited involvement by municipal governments in many cases, which may constrain homeless programming by limiting resources and policymaking authority. This research finds that structural changes incentivizing re-centralization of homelessness governance in conjunction with increased municipal policy capacity may be required to promote coordination across the different policy spaces to overcome collective action problems and develop effective solutions to long-term homelessness.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/153426/1/cwilliso_1.pd

Cities, zoning, and the fragmented response to homelessness

America’s cities are facing a pressing homelessness crisis, with insufficient affordable housing as the chief cause. Local governments are critical policy partners in addressing and ending homelessness through their control over land use policy, what housing gets built in a community, and where it can be built. This policy brief explores the fact that there is little coordination of cities’ homelessness and zoning/land use planning policies.Community Solution

2021 Menino Survey of Mayors

The 2021 Menino Survey of Mayors represents the eighth nationally representative survey of American mayors and is based on interviews with 126 sitting mayors from 39 states. The 2021 Survey explores mayoral views on COVID-19 recovery, equity and small business, closing the racial wealth gap, and housing and homelessness. The second set of findings, released with Community Solutions, delves into homelessness, including mayoral perspectives on roles, challenges, and opportunities for addressing the crisis in their cities. The 2021 Survey continues with the support of Citi and The Rockefeller Foundation.Citi; The Rockefeller Foundation; Community Solution

Policing and the punitive politics of local homelessness policy

Advocates and researchers agree that solutions to homelessness must address the root causes. Communities need to increase access to quality, affordable permanent housing and provide the necessary social and medical services to support unhoused people remaining stably housed. Yet, local governments may not always follow these evidence-based housing policy programs, instead pursuing punitive policing or the criminalization of homelessness. Such policies do not end homelessness and may actually promote cycles of homelessness. This policy brief investigates the involvement of the police in responses to homelessness in cities across the country. The authors amass a wide array of data, including a novel survey of mayors and details of Homeless Outreach Teams from the nation’s 100 largest cities. They find that the police are highly influential in city homelessness policymaking and are frequently involved in implementing homelessness policy.Community Solution

Ecological countermeasures to prevent pathogen spillover and subsequent pandemics

Substantial global attention is focused on how to reduce the risk of future pandemics. Reducing this risk requires investment in prevention, preparedness, and response. Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations. This oversight is due in part to the lack of a clear definition of prevention and lack of guidance on how to achieve it. To address this gap, we elucidate the mechanisms linking environmental change and zoonotic spillover using spillover of viruses from bats as a case study. We identify ecological interventions that can disrupt these spillover mechanisms and propose policy frameworks for their implementation. Recognizing that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy

Tobacco 21 White Paper

As more states and cities around the nation consider Tobacco 21 policies, a team of researchers conducted policy analyses on the potential effects of Tobacco 21 in Michigan, providing considerations for implementation.https://deepblue.lib.umich.edu/bitstream/2027.42/148298/1/Tobacco 21 White Paper.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148298/3/Tobacco 21 White Paper_Mar.2019.pdfDescription of Tobacco 21 White Paper.pdf : Tobacco 21 White PaperDescription of Tobacco 21 White Paper_Mar.2019.pdf : Tobacco 21 White Pape

Paradoxes of professional autonomy: a qualitative study of U.S. neonatologists from 1978‐2017

The professional autonomy of physicians often requires they take responsibility for life and death decisions, but they must also find ways to avoid bearing the full weight of such decisions. We conducted in‐person, semi‐structured interviews with neonatologists (n = 20) in four waves between 1978 and 2017 in a single Midwestern U.S. city. Using open coding analysis, we found over time that neonatologists described changes in their sense of professional autonomy and responsibility for decisions with life and death consequences. Through the early 1990s, as neonatology consolidated as a profession, physicians simultaneously enjoyed high levels of professional discretion and responsibility and were often constrained by bioethics and the law. By 2010s, high involvement of parents and collaboration with multiple subspecialties diffused the burden felt by individual practitioners, but neonatology’s professional autonomy was correlatively diminished. Decision‐making in the NICU over four decades reveal a complex relationship between the professional autonomy of neonatologist and the burden they bear, with some instances of ceding autonomy as a protective measure and other situations of unwelcomed erosion of professional autonomy that neonatologists see as complicating provision of care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163653/2/shil13169.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163653/1/shil13169_am.pd