Stigma and Prejudice Against Individuals Experiencing Homelessness

Part of the Current Clinical Psychiatry book series (CCPSY)


More than two million people experience homelessness annually in the United States, with point-in-time estimates indicating the presence of greater than 500,000 homeless individuals nationwide in a single night in January 2014. Despite these numbers, homeless individuals struggle every day under the weight of anti-homeless stigma and oppression that render them seemingly invisible yet vulnerable to acts of violence, restrictions on the activities related to homelessness, sexual assault, exploitation, and human trafficking. This stigma, reflected in general society, city legislation, law enforcement, and even the health care system, dramatically decreases the quality of life of homeless individuals and further marginalizes a population that already struggles with meeting the basic human needs of food, clothing, and shelter. These anti-homeless sentiments date back centuries in America to before the birth of the nation, and vestiges of historical anti-homeless ideologies dating back to colonial times can be found in modern iterations of legislation and societal attitudes toward individuals experiencing homelessness today. Individuals experiencing homelessness are three to four times more likely to die prematurely than the general population, reflecting marked disparities in health outcomes for this population compared to the general population. Eliminating stigmatization of homeless individuals will require multi-disciplinary, concerted efforts involving the legislative, social services, law enforcement, and health care fields.


Homelessness Stigma Prejudice Discrimination Health care 


  1. 1.
    Burt M, Aron L, Lee E, Valente J. How many homeless people are there? Helping America’s homeless: emergency shelter or affordable housing? Washington DC: Urban Institute; 2001. p. 23–54.Google Scholar
  2. 2.
    Henry M, Cortes A, Shivji A, Buck K. The 2014 annual homeless assessment report to congress. Office of Community Planning and Development. Washington DC: U.S. Department of Housing and Urban Development; 2014.Google Scholar
  3. 3.
    The McKinney-Vento Homeless Assistance Act. General definition of homeless individual. 42 U.S. Code § 11302; 2009.Google Scholar
  4. 4.
    Kuhn R, Culhane D. Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data. Am J Community Psychol. 1998;26(2):207–32.CrossRefPubMedGoogle Scholar
  5. 5.
    Kusmer K. Down & out, on the road. Oxford: Oxford University Press; 2002.Google Scholar
  6. 6. Overview of BLS statistics on unemployment. [Internet]. 2015 [Cited 8 Feb 2015]. Available from:
  7. 7.
    Arnold A, Crowley S, Bravve E, Brundage S, Biddlecombe C. Out of reach 2014. [Internet]. National Low Income Housing Coalition. 2014.Google Scholar
  8. 8.
    National Coalition for the Homeless. Who is homeless? Fact Sheet. [Internet]. 2009. Available from:
  9. 9.
    The National Center on Family Homelessness at the American Institutes for Research. America’s youngest outcasts: a report card on child homelessness. Waltham; 2014.Google Scholar
  10. 10.
    The National Law Center on Homelessness and Poverty and the National Coalition for the Homeless. Homes not handcuffs: the criminalization of homelessness in U.S. Cities. 2009.Google Scholar
  11. 11.
    National Coalition for the Homeless. Share no more: the criminalization of efforts to feed people in need. Washington, D.C: National Coalition for the Homeless; 2014.Google Scholar
  12. 12.
    Webster R. Homeless given 3 days to leave encampment under Pontchartrain expressway. The Times-Picayune. [Internet]. 2014 [Cited 8 Feb 2015]. Available from:
  13. 13.
    National Coalition for the Homeless. Vulnerable to hate: a survey of hate crimes & violence committed against homeless people in 2013. Washington, D.C: National Coalition for the Homeless; 2014.Google Scholar
  14. 14.
    Martin D. Experiences of homeless people in the health care delivery system: a Descriptive Phenomenological Study. Public Health Nurs. 2008;25(5):420–30.CrossRefGoogle Scholar
  15. 15.
    McCormack R, Hoffman L, Norman M, Goldfrank L, Norman E. Voices of homeless alcoholics who frequent Bellevue hospital: a qualitative study. Ann Emerg Med. 2015;65(2):178–186.e6.CrossRefPubMedGoogle Scholar
  16. 16.
    Wen C, Hudak P, Hwang S. Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. J Gen Intern Med. 2007;22(7):1011–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hwang S, O’Connell J, Lebow J, Bierer M, Orav E, Brennan T. Health care utilization among homeless adults prior to death. J Health Care Poor Underserved. 2001;12(1):50–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Baggett T, O’Connell J, Singer D, Rigotti N. The unmet health care needs of homeless adults: a National Study. Am J Public Health. 2010;100(7):1326–33.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    O’Connell J. Premature mortality in homeless populations: a review of the literature. Nashville: National Health Care for the Homeless Council, Inc.; 2005.Google Scholar
  20. 20.
    Hibbs J, Benner L, Klugman L, Spencer R, Macchia I, Mellinger A, et al. Mortality in a cohort of homeless adults in Philadelphia. New England J Med. 1994;331(5):304–9.CrossRefGoogle Scholar
  21. 21.
    Barrow S, Herman D, Córdova P, Struening E. Mortality among homeless shelter residents in New York City. Am J Public Health. 1999;89(4):529–34.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hwang S, Lebow J, Bierer M, O’Connell J, Orav E, Brennan T. Risk factors for death in homeless adults in Boston. Arch Intern Med. 1998;158(13):1454–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Baggett T, Hwang S, O’Connell J, Porneala B, Stringfellow E, Orav E, et al. Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Int Med. 2013;173(3):189–95.CrossRefGoogle Scholar
  24. 24.
    Baggett T, Chang Y, Singer D, Porneala B, Gaeta J, O’Connell J, et al. Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. Am J Public Health. 2015;105(6):1189–97.Google Scholar
  25. 25.
    O’Connell JJ. Stories from the shadows: reflections of a street doctor. Boston: BHCHP Press; 2015.Google Scholar
  26. 26.
    Kertesz S, Holt C, Steward J, Jones R, Roth D, Stringfellow E, et al. Comparing homeless persons’ care experiences in tailored versus nontailored primary care programs. Am J Public Health. 2013;103(S2):S331–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    King Jr T, Wheele M, Wheeler M. Medical management of vulnerable and underserved patients: principles, practice, and populations. New York: McGraw-Hill Medical Publishing Division; 2007.Google Scholar
  28. 28.
    O’Connell J, Oppenheimer S, Judge C, Taube R, Blanchfield B, Swain S, et al. The Boston health care for the homeless program: a public health framework. Am J Public Health. 2010;100(8):1400–8.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Boston Health Care for the Homeless ProgramBostonUSA
  2. 2.Department of MedicineBoston University Medical Center, Boston University School of MedicineBostonUSA

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