Ungoverned and Out of Sight:

Public Health and the Political Crisis of Homelessness in the United States

If health policy truly seeks to improve population health and reduce health disparities, addressing homelessness must be a priority

Homelessness is a public health problem. Nearly a decade after the great recession of 2008, homelessness rates are once again rising across the United States, with the number of persons experiencing homelessness surpassing the number of individuals suffering from opioid use disorders annually. Homelessness presents serious adverse consequences for physical and mental health, and ultimately worsens health disparities for already at-risk low-income and minority populations. While some state-level policies have been implemented to address homelessness, these services are often not designed to target chronic homelessness and subsequently fail in policy implementation by engendering barriers to local homeless policy solutions.

In the face of this crisis, Ungoverned and Out of Sight seeks to understand the political processes influencing adoption of best-practice solutions to reduce chronic homelessness in US municipalities. Drawing on unique research from three exemplar municipal case studies in San Francisco, CA, Atlanta, GA, and Shreveport, LA, this volume explores conflicting policy solutions in the highly decentralized homeless policy space and provides recommendations to improve homeless governance systems and deliver policies that will successfully diminish chronic homelessness. Until issues of authority and fragmentation across competing or misaligned policy spaces are addressed through improved coordination and oversight, local and national policies intended to reduce homelessness may not succeed.

• Winner of the 2022 Dennis Judd Best Book Award from the Urban and Local Politics Section of the American Political Science Association
• “Ungoverned and Out of Sight provides a fresh perspective on the complex governing arrangements for American housing policy and the implications for public health. A must read for public policy and public health scholars.” — Patricia Strach, University of Albany
• “Charley Willison has written an urgently important book that explores and explains critical facets of the politics of homelessness policy. Marshalling an impressive range of qualitative and quantitative data, Ungoverned and Out of Sight highlights homelessness as a vital public health problem while advancing our understanding of how local policy processes shape homelessness governance. With remarkable clarity, devastating depth, and compelling breadth, Willison offers knowledge that is crucial for addressing homelessness as a structural political problem. This book is a must read for political scientists, public health scholars, policy makers, and everyone who is part of the decentralized complex of actors who play a role in the systems that structure homelessness.” — Jamila Michener, Cornell Center for Health Equity
• “Homelessness is viscerally experienced at the local level. Local governments play a crucial role in shaping factors that affect homelessness, like housing development and police behavior, yet direct responses to homelessness exist largely outside of local government. Why would this be? Using novel quantitative data along with in-depth qualitative evidence from three divergent cases, Charley Willison identifies four influential actors in homelessness response and explains how this history of devolution, combined with a lack of coordination among powerful players, contributed to homelessness policy responses coming up short.” — Jessica Trounstine, University of California, Merced