Housing Insecurity as a Public Health Crisis: From Framework to Action

For those of us with deep roots in California, we understand better than most that homelessness is layered and complex. It is not a one-off issue, but the result of multiple, intersecting factors that compound over time.

Los Angeles County has taken a critical step in naming the problem. The challenge now lies in operationalizing this framework, translating recognition into coordinated action that addresses the layered and intersecting harms individuals face.

Through my work researching housing insecurity and homelessness, one reality has become clear: health plays a significant and often overlooked role in this crisis. Housing has long been recognized as a social determinant of health, yet it continues to be treated as separate from healthcare systems and policy design.

With Los Angeles County declaring housing insecurity a public health crisis and advancing local preference policies, there is now a formal acknowledgment of what research and lived experience have consistently demonstrated: housing instability is not only a consequence of inequity, but a driver of adverse health outcomes across populations.

The relationship between housing and health is both direct and compounding. Individuals experiencing housing instability are more likely to encounter chronic physical conditions, untreated mental health needs, and increased utilization of emergency medical services. In 2024, nearly 494,446 low-income renter households lack access to an affordable home, underscoring the scale of housing precarity in Los Angeles County. At the same time, individuals experiencing homelessness visited the Emergency room services about 6 times per year on average, versus 1.6 times for those who are housed, reflecting the downstream strain on healthcare systems when stability is absent.

Research continues to affirm this connection. The California Statewide Study of People Experiencing Homelessness (CASPEH) identifies a clear relationship between poor health and homelessness and provides critical insight into the depth of need. Nearly half of adults experiencing homelessness rate their health as poor or fair—four times higher than the general population. Chronic disease is widespread, with six in ten individuals reporting at least one chronic condition and many managing multiple illnesses simultaneously. Tobacco use rates are significantly higher, further compounding long-term health risks. At the same time, physical limitations are common, with over one-third of individuals reporting difficulty completing daily living activities.

These dynamics are not theoretical. They are reflected in the lived experiences of individuals navigating multiple, overlapping crises. Consider Alex, a veteran living with post-traumatic stress disorder. Despite efforts to maintain employment, the cumulative impact of untreated mental health challenges led to chronic physical health conditions, ultimately resulting in job loss. The loss of income placed his housing at risk, further exacerbating both his mental and physical health. Alex’s experience illustrates how housing instability, health deterioration, and economic vulnerability operate as interconnected and mutually reinforcing factors.

This intersection highlights a broader systemic issue: individuals are rarely navigating a single point of vulnerability. Instead, they are experiencing layered and compounding challenges that require coordinated, cross-sector responses. However, funding mechanisms and service delivery systems often remain fragmented, reinforcing silos between healthcare, housing, and social services. As funding landscapes continue to evolve, the need for integrated, cross-functional approaches becomes increasingly urgent. Addressing housing insecurity as a public health crisis requires a system capable of responding to the full complexity of individuals’ needs, rather than isolated components of those needs.

Concurrently, the advancement of local preference policies introduces an equity-focused dimension to housing policy. Gentrification and displacement have disproportionately impacted low-income communities and communities of color, often displacing long-standing residents from neighborhoods experiencing new development. Local preference policies seek to mitigate this by prioritizing individuals who already reside within these communities for new housing opportunities. While not a comprehensive solution, this approach acknowledges the structural dynamics of displacement and attempts to preserve community continuity and stability.

The County’s declaration represents an important conceptual shift. By framing housing instability as a public health issue, it opens the door for policy alignment across sectors and prioritizes prevention-oriented strategies essential to individual and community health.

Asha Wasuge is a policy advocate focused on housing insecurity and health equity, working in the service of unhoused and at-risk populations. She is also an OpEd Project Ambassador.