Unsheltered homelessness reflects a stack of personal and community risk factors for veterans

The largest such survey ever conducted, led by Stefan Kertesz, M.D., shows that weather, rents and personal factors contribute to unsheltered homelessness.

New researchBirmingham sky line at night. The largest such survey ever conducted, led by Stefan Kertesz, M.D., shows that weather, rents and personal factors contribute to unsheltered homelessness. from the University of Alabama at Birmingham and Birmingham VA Medical Center’s Stefan Kertesz, M.D., reports that, among veterans experiencing homelessness, unsheltered experiences correlate with individual and community risk factors. 

Kertesz, professor with UAB’s Division of Preventive Medicine, says the study aimed to objectively look at the causes of unsheltered homelessness in a survey of 5,406 veterans who have been homeless in the past two and a half years.  

“Some claim that unsheltered homelessness is best addressed as an addiction problem,” Kertesz said. “I’m an addiction doctor, and I can say that is why, some of the time, a person ends up on the streets; but we wanted to offer a fuller and more evidence-based account of why some wind up homeless and on the streets.”  

The survey examined personal and community characteristics, citing nine personal and two community factors including low income, criminal justice or jail history, poor social support, high psychological distress, medical conditions, drug problem, warm weather, and low shelter bed availability.

Kertesz says each one of the personal and community characteristics added moderately to the chance of a person’s having been unsheltered or homeless — ranging from 10 to 50 percent. When stacked together, the more risk factors a person had, the more likely they were to have been unsheltered in the six months before the survey. 

Stefan Kertesz, M.D. Stefan Kertesz, M.D.
(Photography: Lexi Coon)
Still, Kertesz says many continue to polarize the debate on homelessness. 

“Let’s depolarize the homeless discussion by using evidence,” he said. “Yes, personal vulnerabilities can help us in understanding who is going to wind up unsheltered; but it’s just not one vulnerability like addiction. It’s really a stack of vulnerabilities. The more you have, the greater the chance you will be without a place to stay.” 

He adds that some personal vulnerabilities also reflect community decisions, such as having a criminal record or not having money.

“Those are things we can actually fix, partly through our community policies and the kinds of assistance we offer,” he said. 

The U.S. Department of Veterans Affairs Health Services Research and Development branch provided funding for this research.