Bridging Political Divides to Tackle the Worsening Social Crisis of Homelessness
Last month, our medical clinic staff held a memorial service for five of our patients. Each was an extraordinary person with remarkable strength — people we came to know well as they fought daily battles against homelessness and its companion burdens of illness, loneliness, and suffering. All died too young.
I have spent nearly 20 years of my career as a physician caring for patients experiencing chronic homelessness. One of public health’s greatest challenges is remaining agile — constantly adapting to the shifting tides of policy to maximize our impact on the patients and communities we serve. When it comes to chronic homelessness — defined by profound human suffering, staggering costs, and an average age of death around 50 — we cannot afford delay or paralysis.
This year has brought significant shifts in federal policy on homelessness. In spring of this year, the US Department of Housing and Urban Development (HUD) announced significant funding cuts. In July, an executive order proposed rolling back evidence-based Housing First programs and expanding institutionalization for those with severe mental illness or substance use disorders. Then on August 11, the administration announced a federal takeover of Washington, D.C., citing homelessness as a key driver, with the President sending a text stating, “Homeless have to move out IMMEDIATELY” — without addressing the obvious question: to where?
The message is clear: the current state of homelessness in America is not acceptable — and I think most would agree with this. Too many Americans have grown accustomed to walking past individuals on the streets, numb to their humanity and their suffering. The science of “dehumanization” is fascinating and also a bit haunting — how our brains can quickly and reflexively dehumanize those suffering the most in our society in order to avoid the pain and time of empathy. It makes sense — homelessness can be absolute hell. Loneliness, isolation, a high prevalence of historic trauma, constant dehumanization — if we took time to really appreciate the suffering of the unhoused individuals we pass on our streets, we would be paralyzed with empathy. So, we avoid using the quick and easy tools of bias, stereotypes, and especially blame to dehumanize and move on. If it is “their fault,” then it is not our problem. We don’t like to struggle with the “extraordinarily complex” — so we oversimplify, typically blame the individual, and move on. It’s a reflexive, lazy, but convenient response — and it’s also extraordinarily expensive and deadly.
Homelessness is a national crisis, but its pain, suffering, and mortality play out daily in our local communities — that’s where real solutions must come from. We are currently hemorrhaging taxpayer dollars on the avoidable and expensive human suffering of chronic homelessness. We need to do better — much better — by innovating solutions across the full spectrum of homelessness. This ranges from prevention — such as expanding affordable housing to address the long-standing gap between wages and housing costs — to improving care for the sickest patients experiencing chronic homelessness in the context of severe mental illness and substance abuse, expensively being tossed around disjointed safety nets of jails, hospitals, and shelters. Through neglect or through misguided enablement — both lazy and dehumanizing in their own ways — we often shrug off patients into predictable and costly poor outcomes. There is nothing humane about letting someone die on the street with a needle in their arm, drink themselves into organ failure or cognitive dysfunction, or have their lives violently controlled by delusions and hallucinations.
Now is the time for engagement and collaboration at the local level. People often present political “resistance” as a badge of honor — but if resistance is your only move, every time, it can quickly become intellectual laziness. Especially at the local and state level, we can’t afford to either engage or "take four years off" depending on who is in the White House and whether you are in a blue or red district. This will inevitably result in cycles of start-and-stop stagnation — not the continuous discussions, policies, and analysis that will be needed to solve our complex social issues.
We must be better at conversation and be less focused on conflict. To debate and collaborate with people we disagree with. We especially cannot allow the growing pathology of political polarization at the federal level to continue to metastasize into our communities. We have a much better chance at effectively solving complex issues — especially those involving expensive human suffering — if we talk and listen to our fellow neighbors and residents at the city, county, and state levels. It is what the vast majority of Americans (and voters) who have not been polarized to political extremes would like to see.
If homeless advocates and public health officials are concerned that federal policies will start to criminalize and demonize homelessness in their communities, stay away from the table — and it most likely will.
There are realistic solutions that exist. Not ones involving mass incarcerations, or widespread institutionalizations, or forced relocations that will expensively exacerbate, instead of efficiently address, root causes. We need to try to tackle the “extraordinarily complex” in an effort to meet our obligations to govern for the "common good" as we strive to live up to shared values and principles — ones we learned in classrooms, living rooms, and congregations that should, and still can, even in 2025, unite us, not divide us. It could be an awesome reminder of how we can and should come together as a community along shared principles to tackle our most significant and most expensive social issues.
There are billions of dollars and thousands of lives at stake. We can’t afford not to.
About the Author:
Dr. Brian Klausner, a Georgetown-trained internist and Notre Dame graduate, has dedicated his career to caring for patients experiencing homelessness in Boston and Raleigh. A leader in population health, he helped establish WakeMed’s Center for Community Health, Innovation, and Equity and co-chaired Wake County’s Familiar Face Task Force. His nationally recognized work has been featured in Politico, USA Today, NPR, and Modern Healthcare.