The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; email:
Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA; email:
Annu Rev Public Health. 2019 Apr 1;40:465-486. doi: 10.1146/annurev-publhealth-040617-013553. Epub 2019 Jan 2.
Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.
无家可归现象是一个持久的公共卫生威胁，困扰着发达世界的各个社区。儿童、家庭和边缘化的成年人都面临着住房不安全的终身影响，而社区则努力解决异质无家可归人群中广泛存在的各种需求。尽管有政策举措来消除无家可归现象，但无家可归的趋势仍然居高不下。复杂系统的观点为协调应对无家可归现象的动态提供了深入的了解。住房援助的持续需求给服务提供带来了压力，而在大多数国家，预防工作的实施仍然不一致。反馈过程挑战了服务提供的效率。系统动力学模型检验了消除无家可归现象的政策干预措施的假设。模拟表明，预防在系统中提供了一个杠杆点；在让人们有房住方面的微小效率，会带来不成比例的大幅减少无家可归现象。需要有政策来确保协调预防工作的可靠提供。复杂系统的方法确定了可持续解决无家可归问题的能力和限制。
