Community solutions to homelessness, violence save lives, money

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USA TODAY

WASHINGTON — Homelessness and violence are plagues of urban life that are as deadly as any cancer. Experts say both take as many as 25 years off your life.

Speakers at a recent forum presented by USA TODAY and the insurer Cigna said there are proven ways to tackle these challenges, but lasting solutions require government funding and the involvement of local residents who know their needs best. Such community-based solutions can serve as models for the rest of the nation and pay huge dividends in helping people stay well.

“Most of what makes you healthy does not occur in the doctor’s office,” said physician Georges Benjamin, executive director of the American Public Health Association. “It occurs out in the community.”

Homelessness is one of the most pressing problems in many communities and it often results in poor nutrition, danger and stress that can lead to chronic illness. The homeless, or those worried about losing their homes, are also less likely than others to focus on their poor health, making it near impossible for the health care system to treat them effectively.

As of January 2015, 564,708 people were homeless on any given night nationally, and more than 200,000 were in families, according to the National Alliance to End Homelessness. About 15%, or 83,170, were considered “chronically homeless.” About 8%, or 47,725, were veterans.

Community Solutions is a national nonprofit that targets all of these groups, but one of its latest initiatives focuses specifically on helping homeless veterans in the nation’s capital, who will get 60 of 124 affordable units in a new building just blocks from the Capitol.

The veterans and other residents will have use of a gym and computer lab in the building, and access to employment services and a coalition of nonprofits offering social supports.

Amid the din of construction equipment on a recent afternoon, organization CEO Rosanne Haggerty described how her group views homelessness through a “health lens.”

“Stable housing is key to preserving and growing one’s health,” Haggerty said.

But it takes more than giving people a roof over their heads; it takes support that helps them keep their lives on track, she said. Once people have stable lives and housing, she said whole neighborhoods can thrive.

Community Solutions proved this in an impoverished region of Hartford, Conn.

Conditions in that neighborhood were “desperate,” she said, and life expectancy was 10 years shorter than in nearby communities. To improve residents’ health and living conditions, her organization put together a team of representatives from the city, state, area nonprofits and a local hospital. The Cigna Foundation provided a grant last year to improve economic security, education and safety in the neighborhood. Cigna’s professional staff also committed their time and talents to the effort.

Haggerty said program organizers soon realized that many of the issues that harmed health stemmed from poverty and substandard housing. One client, for example, lived in a home with no running water and suffered from poorly managed stomach pain that repeatedly prompted her to go the emergency room. After she was matched with a primary care doctor and the city fixed housing code violations in her home, the woman’s life improved and her use of the ER dropped. The first group of people in the Hartford program reduced their use of the ER by 57% — mostly by addressing non-medical issues, Haggerty says.

Community Solutions also works in the troubled Brownsville neighborhood in Brooklyn with the group Cure Violence, which was founded by epidemiologist Gary Slutkin to eradicate violent behavior as if it were a contagious disease. The two groups work with the Brownsville Community Justice Center to reduce the spread of violence and have collaborated on efforts to reduce crime in public housing. They also work together on improving the relationships between young people and the police.

Violence, including suicide, claims close to 60,000 lives annually, according to the Centers for Disease Control.

Cure Violence has reduced shootings and killings by up to 70% in some of the neighborhoods it works in. One Baltimore neighborhood with historically high rates of violence had gone 440 days without a gun-related killing up until July 2015, said Shannon Cosgrove, Cure Violence’s director of health policy. That improves the physical and mental health of a community.

“The neighborhood gets safer very fast so the people are no longer being traumatized,” said Slutkin,

Cure Violence hires community members — often people who have served time for violent offenses themselves — to work as outreach workers and what they call “interrupters,” who intercede when they learn about tension in a community.

Along with state and local governments and police departments, hospitals around many of the Cure Violence sites, including New Orleans and Chicago, help pay for the group in part because “most of them lose money” treating gunshot victims, Slutkin said. But what really makes the difference is hiring people in the community.

“It is the community that is reversing the epidemic of violence where we work,” he said. “What we do in the health sector is we guide and train the community to interrupt the events, prevent the spread and stop the epidemic.”

Benjamin said such efforts to end violence are necessary across the nation, because so far, “we’ve not dealt with that problem by any means with the diligence that it deserves.”

Ultimately, solving these persistent and thorny problems will require not just passion but also a strong financial commitment to shore up social supports, Haggerty said..

“It would be one thing if we were spending all this money on the health care system and people had great lives. But we see people again and again sicker and sicker, their life prospects undermined,” she said. “Let’s find a way to spend it better to actually get better health results and have a healthier citizenry.”