Harvard’s Initiative on Health and Homelessness (IHH) is a rarity in the academic world—the first of its kind based at a school of public health, and one of only a handful of similar research centers at universities around the country. Almost all of them (including the IHH, which launched in 2019) are relatively new.
All this points to a problem. The contemporary homelessness crisis emerged in the 1980s, fully 40 years ago. Yet, as a public health emergency, it has remained largely overlooked in academia, even though, as IHH faculty chair Howard Koh points out, “Academia prides itself on taking on hard and complicated public health issues.”
The consequences of this absence, adds Koh, the Fineberg professor of the practice of public health leadership, are considerable: “The end result has been that students can come to a university like ours to study medicine or public health and never hear a single lecture, or never meet any faculty doing research in this field,” he says. “And then they get their degree, and they leave. And as they’re walking out, they pass homeless people on the street and have no idea how we, as a society, should address that challenge.”
As a graduate student, Jill Roncarati, M.P.H. ’07, Sc.D. ’06, who co-teaches the IHH’s new course on health and homelessness, experienced this gap. She arrived at the Harvard T. H. Chan School of Public Health (HSPH) in 2005, intending to focus on homelessness. But she discovered that no one on the faculty was working in the field (this has since changed—several HSPH scholars now study homelessness). Her advisors were wonderful, she says, but they couldn’t nurture and guide her research the way academic mentors normally do. For her dissertation, she brought in an outside scholar to help advise her, the Canadian epidemiologist Steven Hwang ’84, M.P.H. ’96, who is an expert in homeless mortality. After her graduation, Roncarati embarked on a career as an independent researcher, but without having worked and published with someone already established in the field, it was hard to make progress. “There was so much I didn’t know,” she recalls.
In 2023, Roncarati co-authored a paper in the journal Public Health Reports titled, “Establishing Academic Homes for Homelessness: A Call to Action.” It was a collaboration among several Harvard-connected scholars, including Koh, and it argued, in part, that academia’s lack of attention to homelessness is tied to a bigger, deeper imbalance: in research funding. A huge number of the public health studies are supported by the National Institutes of Health (NIH). With an annual budget of more than $45 billion, it is the world’s largest funder of biomedical and behavioral research. But homelessness doesn’t fit neatly into the agency’s structure. As Koh explains, “There’s a National Cancer Institute, and there’s a National Heart, Lung, and Blood Institute, but there’s no national institute of homelessness.” Researchers can get NIH funding by designing studies around specific diseases that affect the homeless: diabetes, mental health, lung cancer, addiction. But those studies tend to yield only a partial picture. The Department of Veterans Affairs (VA) offers funding for homelessness research that isn’t restricted by disease or condition, but it is restricted to veterans.
“The lack of dedicated research funding in this area is a major, major problem,” Koh says. “The heroes who have made homelessness research their career have really had to scramble to find funding in creative ways.” That’s one reason that there aren’t more researchers in the field, and why there has not been a robust pipeline for young scholars like Roncarati.
Others offer similar observations. “It’s a tough, tough ladder to climb to fit the work I want to do into a specific disease,” says Stefan Kertesz, M.D. ’93, a professor at the University of Alabama Birmingham whose research and clinical practice focus on homeless patients. Some of Kertesz’s work is specific to addiction, but “When I wanted to pursue a broader set of questions about what makes good care for people who are homeless, there wasn’t really a place for that at the NIH.” James O’Connell, M.D. ’82, who leads the nonprofit Boston Health Care for the Homeless Program, remembers that when the organization was just starting out in the mid-1980s, there was no clear path for how best to care for homeless people. When he and his colleagues faced questions about best practices and searched the scientific literature for answers, they sometimes found that the answers didn’t exist yet. Often, they’d end up conducting the research themselves. “What became really obvious to us was that around the country, this research was always being done by people like us, late at night or on weekends,” O’Connell says. “Because nobody’s got the money to do it.” Forty years later, the situation remains strikingly similar. “When you look around the country today, most of the people doing good research in homelessness are funded by some grant. Mostly, it isn’t federal funding.”
This is the challenge that the IHH and organizations like it are trying to address. When Koh and his colleagues at HPSH started the initiative, they envisioned it as a hub for research and education, a vehicle for advocating for policy change, and a place where communities could come for advice on what to do. The intention was to build a community of scholars, and to facilitate research funding and collaboration. The IHH is still in the pilot stage, but Koh says the goal is to raise enough money to turn it into a full-scale program.
The interest from students has been intense. The IHH’s initial course, “Homelessness and Health: Lessons from Health Care, Public Health, and Research,” became so popular that it had to be expanded almost immediately, and students have jumped at the research opportunities the IHH has been able to provide. Audrey Nguyen, M.P.H. ’23, was a teaching fellow for the course and a research assistant at the IHH. Now a medical student at UCLA, she’s planning a career as a psychiatrist for homeless patients. “There’s so much interest that’s really blossoming right now,” she says. The desire to serve underserved populations, she adds, “is why a lot of people go into medical school now, and psychiatry in particular.”
Brie Mahnke, M.P.H. ’23, who also worked at IHH as a research assistant, echoes that sentiment. She grew up volunteering with her father at a homeless shelter in her central Illinois hometown. In medical school at Indiana University, where she will graduate this spring, those childhood memories coalesced into an intention to work in homeless care. She’s seen a growing number of peers awaken to a similar aspiration during the last few years. “So, just finding out how to have a career in this field”—as she did in part while working with the IHH—“is huge.” There’s a real hunger among students in medicine and public health, she says, for training, mentorship, and professional opportunities in homeless care. As they understand with increasing clarity, Mahnke adds, “This work is desperately needed.”
