Monika Queisser, Social Policy Division, OECD Employment, Labour and Social Affairs Directorate
In Down and Out in Paris and London, George Orwell recalls his experiences in the 1920s living on the margins of society in the two European capitals. Orwell joined the “tramps”, as they were called, the army of people, mostly male, without stable housing, moving around between cheap hotels, shelters and often prison, occasionally finding casual jobs, pawning their few belongings to buy food, and living with the constant threat of hunger, illness and violence. Orwell was struck by how people were caught in a vicious and futile circle of homelessness, inability to work and poverty:
“There must be at the least several tens of thousands of tramps in England. Each day they expend innumerable foot-pounds of energy (…) in mere useless walking. Each day they waste between them possibly ten years of time staring at cell walls. They cost the country at least a pound a week a man, and give nothing in return for it. They go round and round, on an endless game of post, which is of no use, and not even meant to be of any use to any person whatever. The law keeps this process going, and we have got so accustomed to it that we are not even surprised.”
Almost a century later, there are almost 30 000 homeless people in Paris, 4000 of them sleeping rough, i.e. living in the streets, according to the national statistical office INSEE. In London, government data show that the number of people sleeping on the streets has risen by over one-third in the past year. Not only Paris and London are facing this problem. In Seoul, Korea the homeless population increased by 67% in two years; the number of children in homeless shelters in New York grew by 24% from 2011 to 2012.
While most of us associate homeless people with the image of solitary rough sleepers, homelessness is a much bigger issue. It includes people who use emergency homelessness services, people who live in inadequate housing, those who temporarily camp on the couch of friends, and people who live in severely overcrowded dwellings. In most OECD countries, homelessness affects between one and eight people in every 1 000 each year. Depending on the definitions, which vary widely across countries, as many as one-third of the homeless population can be sleeping rough.
Who are the homeless and how do they end up in this situation? Often, they are persons with complex needs and conditions, such as mental and physical illness or substance abuse problems. But losing one’s job, being evicted from affordable housing, and the breakdown of a relationship can also lead to homelessness. Lone parents and single women can become homeless due to domestic violence, and young people transitioning from social care often have nowhere to live. The same is true for migrants who are also at high risk of living without a stable home.
Many of the chronically homeless end up shuttling back and forth between the streets and hospitals, racking up very high health care costs. The most famous case is that of Angelo Solis in California, also called the Million Dollar Patient. Mr Solis, a homeless alcoholic with diabetes and heart disease, passed out and got picked up regularly by the police, was brought to the nearest emergency room, treated and then released back into the street, only to repeat the same cycle over and over again.
The cost to public services of caring for the chronically homeless can be up to seven times higher than average per capita social spending, and three times higher than care services that are provided in the home for the same individual. Preventing homelessness can be very cost-effective; estimates suggest that treating a homeless person with complex mental health needs is 18 times more expensive than providing preventative at-home service support.
All governments are committed to providing protection against hardship, including homelessness. But how effective and efficient are their efforts? As Orwell observes, what is needed for the homeless is “to depauperise him, and this can only be done by finding him work – not work for the sake of working but work of which he can enjoy the benefit.” But how realistic is it to expect that a person without a stable home and address will ever find and keep a job?
A new report from the OECD on Integrating Social Services for Vulnerable Groups examines the needs of the homeless and other vulnerable groups and the best policies to address these needs. It finds that strategies to house the homeless first, and then provide integrated employment, health and social care support are relatively effective in helping people exit from chronic homelessness. A major obstacle to effective support for the most vulnerable is the lack of integration and coordination of the various social services. Integrating housing support, employment services, and health care and making them easy to access will reduce the likelihood of duplicating services and spending. Integration, with one interlocutor who will assist in putting together the best package of services can generate economies of scale and help ensure that the people with the highest needs receive the services they need at the right time and in the right order.
Every society has vulnerable people; people who need support of different kinds to address personal challenges like extreme poverty, poor physical or mental health and addictions, low education and skills, and precarious work arrangements. Homelessness and instable housing conditions often lead to social exclusion, health problems, poor educational outcomes and long-term unemployment and inactivity. Every vulnerable person represents a social challenge, a moral responsibility, and a life that can be better lived. The way governments make social policy and deliver services needs to live up to this challenge.