1. From Pathology to Population
Measuring and Managing Homelessness
Craig Willse
Program in Sociology
The Graduate Center
City University of New York
cwillse@gc.cuny.edu

2. discourse governance
technology

4. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

5. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

6. Historical Development
of Mass Homelessness

7. Historical Development
of Mass Homelessness
• Post-war: Emergence of Skid Row districts

8. Historical Development
of Mass Homelessness
• Post-war: Emergence of Skid Row districts
• 1960s to present: “Urban renewal” and the
destruction of Skid Row housing

9. Historical Development
of Mass Homelessness
• Post-war: Emergence of Skid Row districts
• 1960s to present: “Urban renewal” and the
destruction of Skid Row housing
• Neoliberal economic restructuring
• Shift of industrial production out of U.S.
• Development of domestic knowledge and
service industries
• Rollback of public assistance programs

10. Historical Development
of Mass Homelessness
• Post-war: Emergence of Skid Row districts
• 1960s to present: “Urban renewal” and the
destruction of Skid Row housing
• Neoliberal economic restructuring
• Shift of industrial production out of U.S.
• Development of domestic knowledge and
service industries
• Rollback of public assistance programs
• Late 1970s: Mass homelessness emerges as a
“surplus population”

11. Historical Development
of Mass Homelessness
• Post-war: Emergence of Skid Row districts
• 1960s to present: “Urban renewal” and the
destruction of Skid Row housing
• Neoliberal economic restructuring
• Shift of industrial production out of U.S.
• Development of domestic knowledge and
service industries
• Rollback of public assistance programs
• Late 1970s: Mass homelessness emerges as a
“surplus population”
• 1987: McKinney-Vento Homeless Assistance Act

12. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

13. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

14. “chronic homelessness”
“chronically homeless”

15. Dennis Culhane
Randall Kuhn
• “Applying Cluster Analysis to Test a Typology of Homelessness by
Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data”
• “Patterns and Determinants of Public Shelter Utilization Among
Homeless Adults in New York City and Philadelphia”

16. The ‘chronically homeless’ population could be
characterized as those persons most like the
stereotypical profile of the Skid Row homeless.
These are people who are likely to be entrenched
in the shelter system, and for whom shelters are
more like long-term housing than an emergency
arrangement.
Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a
Typology of Homelessness by Pattern of Shelter Utilization: Results from the
Analysis of Administrative Data” (1998)

17. In general, being older, of black race, having a
substance abuse or mental health problem, or having a
physical disability, significantly reduces the likelihood of
exiting shelter.
Dennis Culhane and Randall Kuhn,“Patterns and Determinants of Public Shelter
Utilization Among Homeless Adults in New York City and Philadelphia” (1998)

18. The term ‘chronic homeless’ treats homelessness
with the same language, and in the same
fashion, as a medical condition or disease, rather
than an experience caused fundamentally by
poverty and lack of affordable housing.
National Coalition for the Homeless (2002)

19. Voice of America News
Broadcast July 30, 2008

20. Voice of America News
Broadcast July 30, 2008

21. the “medicalization”
of social problems

22. case management
technologies

23. “ The logic of social services is that we’re
being paid to make life better for these
people. Therefore, our judgement is
paramount, and [clients] ought to be
following that. And when you complicate it
further with our conventional view of
addiction, where it’s all about, you know,
shaming someone until they come around
and start making better decisions for
themselves . . . the whole thing just
becomes a big mess.
”

24. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

25. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

26. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

27. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

28. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology
of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of
Administrative Data” (1998)

29. Michel Foucault

30. Michel Foucault
Disciplinary
medicine
case management
individual
attitudes and behavior

31. Michel Foucault
Disciplinary Biopolitical
medicine public health
case management statistics
individual population
attitudes and behavior patterns and costs

32. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

33. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

38. Malcolm Gladwell, “Million Dollar Murray”
The New Yorker, February 13, 2006

39. Malcolm Gladwell, “Million Dollar Murray”
The New Yorker, February 13, 2006
• 119 chronically homeless in Boston for 5 years
• 18,834 emergency room visits
• Minimum cost: $1,000 / visit

40. Malcolm Gladwell, “Million Dollar Murray”
The New Yorker, February 13, 2006
• 119 chronically homeless in Boston for 5 years
• 18,834 emergency room visits
• Minimum cost: $1,000 / visit
• 15 “chronically homeless inebriates” in San Diego for
18 months
• 417 emergency room visits
• Total average bill: $100,000 / person

43. • Death rates twice as high
• 11x more likely to contract tuberculosis
• Rates of HIV twice as high
• 16x more likely to contract HIV
• 75 new HIV cases / 100,000 adults in NYC
• 1,241 new HIV cases / 100,00 adults in
shelter system

44. the “economization”
of health

45. From a conservative’s perspective, it
saves taxpayers money. Research has
“ even shown it’s cheaper in the long run
to fund [housing] programs because it
reduces recidivism rates. And it’s really
expensive to go from shelter to street
to psych hospital to jail to community
courts, through all these revolving
doors. So that’s what I use sometimes
when I’m talking to a government type.
I’ll talk about how it’s really beneficial
for people, but then if I’m really trying
to sell somebody on it who hates
”
homeless people, that’s what I’ll tell
them about it.

46. Project 50

47. Project 50: Vulnerability Index
Developed by Boston Health Care for the Homeless Program

48. Project 50: Vulnerability Index
✓ More than three hospitalizations or
emergency room visits in a year
✓ More than three emergency room visits
in the previous three months
✓ Aged 60 or older
✓ Cirrhosis of the liver
✓ End-stage renal disease
✓ History of frostbite, immersion foot,
or hypothermia
✓ HIV+/AIDS
✓ Tri-morbidity: co-occurring psychiatric,
substance abuse, and chronic medical
condition
Developed by Boston Health Care for the Homeless Program

49. Individual Population
Vulnerability Index
the economization of health

50. Individual Population
Vulnerability Index
the economization of health

51. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

52. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

53. The New York Times, 1990-2009
Number of articles on “chronic homelessness”
20
18
16
14
12
10
8
6
4
2
0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20

54. The New York Times, 1990-2009
Number of articles on “chronic homelessness”
20
18
16
14
12
10
1998
8 Culhane
6 & Kuhn
4
2
0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20

55. The New York Times, 1990-2009
Number of articles on “chronic homelessness”
20
18
16 2002
14 Federal
Program
12
10
1998
8 Culhane
6 & Kuhn
4
2
0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20

56. The New York Times, 1990-2009
2007
Number of articles on “chronic homelessness” NYC
Program
20
18
16 2002
14 Federal
Program
12
10
1998
8 Culhane
6 & Kuhn
4
2
0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20

57. The New York Times, 1990-2009
2007
Number of articles on “chronic homelessness” NYC
Program
20
18
16 2002
14 Federal
Program
12 1993
10 Giuliani
1998
8 Statement Culhane
6 & Kuhn
4
2
0
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20

58. “ I think we have the same interests. The
business community in Downtown,
some of the leaders are a little bit . . .
hard to swallow. But we have the same
interests, right? I mean, I don’t think
they give a crap about homeless people,
but they wanna see no one sleep on the
street, and we wanna see no one sleep
on the street.
”

59. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions

60. From Pathology to Population
I. Historical Background
II. Chronic Homelessness
III. The Vulnerability Index
IV. Accidents of Neoliberalism?
V. Conclusions