“Pray that God would help me break the cycle of addiction,” she replied. Christina was sitting on the street corner of a Schnucks supermarket when my friends and I met her. We were volunteering with an Unhoused Ministry to hand out Ziploc bags of snacks, water, socks and masks to unhoused individuals. Christina shared that she was hungry, so I found myself following her through Schnucks as she picked up her first meal for the day. I wanted to ask her more questions about her life but I also did not want to pry, so instead, I reassured her that I would keep her in my prayers. When I parted from Christina and three of her male friends, I felt immensely unsettled. How had I conditioned myself to simply walk past unhoused people like Christina on my way to a University whose mission statement includes acting “in service of truth” and on my way to conducting research for “the discovery of knowledge and the treatment of patients for the betterment of our region, our nation and our world” ?
The United States Interagency Council on Homelessness reported that Missouri had an estimated 6,527 people experiencing homelessness on any given day in January 2020 – that is 1.13% of Missouri’s total population – of which 1,090 were experiencing chronic homelessness . These Annual Homeless Assessment Reports are estimates of state-wide point-in-time counts of unhoused people. The United States Interagency Council on Homelessness is the only organization that works at the federal level to solve homelessness and largely relies on volunteers who go out into the streets to assess the state of homelessness in different counties once a year. These numbers likely underestimate the true impact of housing insecurity and the issues that perpetuate it.
We do know, however, that the number of unhoused individuals is growing, and the issue is exacerbated in Black communities. In the City of St. Louis in 2016, more than four times the number of Black residents received emergency housing than White residents . Lisa Winters, a long-time homeless outreach volunteer hypothesized that homelessness is “where the racial disparity, the lack of access to resources and stuff, this is where it spreads out around the edges and it becomes more and more invisible” . This invisibility extends to government action to evict unhoused residents in downtown St. Louis tent encampments. One woman living in a tent encampment across from City Hall shared, “what I’m afraid of is that they’re just watching for you guys to leave and then they’re going to swoop in and clear us out and nobody will even know what happened” .
Unhoused women suffer unique challenges in access to resources due to gender-based trauma and higher amounts of drug abuse. Most of the research on unhoused women in St. Louis comes from two to three decades earlier when Drs. Smith, North and Pittsnogle worked to bring awareness to homelessness in St. Louis using mathematical models and trauma-based approaches. In 1993, the researchers found that the population of unhoused women in St. Louis was predominantly young, single, black mothers with an average of some high school education. Nearly one-third of the women had a history of substance abuse, with drug abuse being more common than alcoholism, and one-third of the three hundred study participants met the criteria for posttraumatic stress disorder . Pittsnogle has now retired from being a Professor of Mathematics and Biostatics at the Washington University School of Medicine, but he made sure to inform me that community efforts in combating homelessness are continuing.
Since 1983, the St. Patrick Center has hosted programs for individuals and families experiencing housing insecurity. Five years after its founding, the Women’s Night Program was initiated to house fifteen women experiencing homelessness and mental illness – many of them also battling addiction. After receiving federal support, the Program has expanded its capacity to thirty women. St. Louis Mayor Tishaura Jones attended the ribbon-cutting ceremony and praised the Program as “a preventative approach to public safety” .
Dr. Vetta Sanders Thompson, Co-director of the Center for Community Health Partnership and Research and researcher in cancer prevention and health disparities, is a strong advocate for preventative approaches to health and social issues. This alternative health system focuses on promoting health as opposed to waiting for disasters to occur before seeking solutions. To that end, she served as the faculty mentor for Dr. Paulette Sankofa’s research proposal to assess the needs of unhoused women between the ages of 46-62 in St. Louis. Thompson said that the Community Research Fellows Training Program was particularly interested in helping Sankofa obtain the necessary funding for her research proposal because older women leaving the workplace who find themselves unhoused are understudied. By assessing their needs and concerns, community groups and policies can be better informed on what gaps in care exist.
Through interviews with six formerly homeless women and seven currently unhoused women, Sankofa found that the women reported chronic and unaddressed health concerns facing barriers to access such as social stigma, lack of health insurance and mental illness . In addition, three of the women needed substance abuse counseling. Previous studies have shown that having a precarious living situation increases a person’s health risks with higher incidences of both chronic and acute diseases. While health insurance is an important step in giving unhoused women access to the health system, perceived unmet need was not strongly correlated with health insurance status . Nonfinancial problems around healthcare inaccessibility need to be addressed, especially since women and families are the fastest growing groups among the unhoused population . A key success of the Women’s Night Program is the establishment of a close support network between residents, counselors and staff that works to tackle those nonfinancial barriers. The social context is integral in understanding substance abuse. An unhoused woman’s personal network can either confer risk or protection depending on their connections’ access and use of drugs .
As a result of her research, Sankofa started Peace Education Action Compassion and Empowerment (PEACE) Weaving Wholeness, a non-profit that combats social isolation and increases the health and wellness of older adults by housing them in Naturally Occurring Retirement Communities. When I asked Dean Thompson about the significance of Sankofa’s work and partnership with WashU, she said that community leaders are the ones that allow for our research “lens [to be] broadened by what they see and experience.” Research on the unhoused population is especially challenging because individuals often live off the grid and have smaller social support networks. In addition, not all individuals have access to phone service, a common way of conducting interview surveys. Other unhoused people are excluded from research studies if they do not use shelters or meal programs that serve as conduits of communication between researchers and study participants. These barriers underscore the importance for concerted structural change in the field of research that bridges both the academic and the communal – bringing speech to the streets.
Edited by: Neha Perumal
Illustrated by: Sue Lee