Racial discrimination in the life course of older adults experiencing homelessness: results from the HOPE HOME study

ABSTRACT

Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness but little research has examined the relationship between race and homelessness. We aimed to understand the relationship between race and the experience of homelessness for older adults. We used grounded theory methodology to analyze in-depth qualitative interviews (n = 65) of persons experiencing homelessness. We recruited participants who were enrolled in two sub-studies of the Health Outcomes of People Experiencing Homelessness in Older Middle AgE (HOPE HOME) Study in Oakland California. We identified two major themes within interviews with Black participants (n = 52) related to race: (1) participants experienced overt racial discrimination in early life and (2) structural racism precipitated and perpetuated adult homelessness. Further, we identified sub-themes of structural racism that contributed to participants becoming or staying homeless: criminal justice discrimination, employment discrimination, exposure to violence, premature death, and limited family wealth. We developed a theoretical model of how these elements of structural racism may increase susceptibility to homelessness. These relationships between racial discrimination and homelessness may serve as targets for policies aimed at preventing homelessness.

KEYWORDS:

• Homelessness
• housing
• racial discrimination
• structural racism
• health disparities

Acknowledgments

The authors thank Dr Lisa A. Cooper, Dr Andrea Lopez, and Dr Alex H. Kral for their review of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Prior presentations

2018 Society of General Internal Medicine Annual Meeting, 2018 UCSF 12th Annual Health Disparities Research Symposium.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of the University of California, San Francisco and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Notes on contributors

Dereck W. Paul Jr, MS is an MD Candidate at the University of California San Francisco (UCSF) where he served as a Co-President of the Student National Medical Association (SNMA) UCSF chapter and is a SNMA David E. Satcher Research Fellow in Health Disparities.

Kelly R. Knight, PhD is an Associate Professor in the department of Anthropology, History, and Social Medicine at the University of California San Francisco where she studies the social construction and experiences with addiction, comorbidity, chronic pain, motherhood, and citizenship.

Pamela Olsen, MA is Clinical Research Coordinator at the Center for Vulnerable Populations at the Zuckerberg San Francisco General Hospital and Trauma Center and University of California San Francisco where she researches aging and homelessness as part of the HOPE-HOME project team in Oakland, CA.

John Weeks is a Clinical Research Coordinator at the Center for Vulnerable Populations at the Zuckerberg San Francisco General Hospital and Trauma Center and University of California San Francisco where he researches aging and homelessness as part of the HOPE-HOME project team in Oakland, CA.

Irene H. Yen, PhD is a Professor in the School of Public Health at the University of California Merced where she studies the social epidemiology of place, race, and social status.

Margot B. Kushel, MD is a Professor of Medicine and Director of the Center for Vulnerable Populations at the Zuckerberg San Francisco General Hospital and Trauma Center and University of California San Francisco where she studies housing, homelessness, and health, and leads the UCSF Benioff Homelessness and Housing Initiative.

Additional information

Funding

This work was supported by grants from the National Institute on Aging [grant numbers K24AG046372 and R01AG041860] and the National Institute on Minority Health and Health Disparities [grant number R25MD006832]and the Student National Medical Association’s David E. Satcher MD, PhD Research Fellowship for Health Disparities.