Pushed to the Margins: The Human Costs of a Growing Housing Crisis

Those structural reasons are what brought Alexandra Collins to the field of public health. As an assistant professor of epidemiology and a member of the People Place and Health Collective (PPHC) in the School of Public Health, Collins sees the intersectionality of homelessness and substance use as part of a broader story. Her work with the PPHC focuses on these kinds of complex and interwoven public health issues.

“We have projects that look at everything from eviction rates to overdose, to evaluating the Overdose Prevention Center that's opening,” Collins says, referring to the PPHC’s contribution to the first state-sanctioned overdose prevention center, which will open in Rhode Island this fall. “The idea is to understand the broad-level drivers that are shaping people's health outcomes, often around substance use,” she says. Collins notes that amid the gains won by the PPHC and other advocates around substance use, the fundamental challenge of finding stable housing in Rhode Island continues.

Encampments Swept Aside

Last May, Providence dismantled some of the city’s encampments of unhoused people, displacing entire communities. The evictions highlighted a major divide between unhoused advocates and city officials surrounding the lack of public resources available to those who have been evicted—mostly in the form of alternative housing options. 

These sweeps, including one at “the Dunes,” a major encampment in Providence’s Wanskuck neighborhood, have compounded an environment of instability among unhoused people, according to Dr. Matt Perry, clinical assistant professor of family medicine at the Warren Alpert Medical School. As a doctor with Providence Community Health Centers, Perry cares for folks at the Crossroads Rhode Island health clinic, and has seen the impact of these evictions.

“People are constantly stuck in this cycle of being kicked out and moving again,” Perry says. They explain that the cycle of moving and resettling creates unsafe conditions, as people are forced into greater seclusion and often choose to cut ties with the health providers trying to reach them. “When people have access to continuity, then I can start to provide for them,” Perry says.

“All it's doing is moving people around, but also moving people deeper into hiding, which is really dangerous for them,” says Smith of the encampment sweeps. “It increases the risk that they will come to harm. And it also makes it harder for folks to maintain continuity with us, and vice versa, which impedes access to housing.”

Karen Andes, director of master’s programs and associate professor of behavioral and social sciences in the School of Public Health, has worked with unhoused populations around the world, including in South America. She says when governments act without a plan in place, unhoused people end up worse off. “When [people] get kicked down the road and we don’t know where they are for a while—that’s when things get lost.”

These cycles of raids and resettlement are playing out across the country. Some cities, like New Orleans, are opting for a proactive approach to the crisis. In 2024 their city council created an Office of Homeless Services and Strategy to coordinate efforts aimed at reducing the city’s unhoused population and addressing long-standing housing insecurity. While they, like Providence officials, are clearing encampments, they are also connecting those evicted with housing alternatives and resources funded by a multi-million dollar federal grant.

Andes says the lack of housing alternatives for displaced people in Rhode Island is dangerous by comparison. When communities become scattered, they have diminished access to basic needs and overdose prevention, she explains. “Nutrition, sanitation, water, all of those things are issues,” Andes says. “It’s protective to be in a larger community.”

Learning from Failed Policies

In spite of Rhode Island’s rising cost of living and scant housing inventory, finding housing for those who want to be housed should be possible, says Andes. “What drives me crazy is that it's a solvable problem in Rhode Island. The absolute size of the problem is actually manageable here,” she says, referring to the nearly 2,500 people experiencing homelessness in the state. “And it’s unfortunate because if the [political] will were there, Rhode Island could really be a sentinel for other places.”

Collins voiced a similar assessment, arguing that Providence’s size lends itself to practical solutions. “I think the scale at which it's happening in Providence or Rhode Island is quite unique just because we are so small, it's a fixable problem.” Collins sees it as a failure of policy to ignore the long-standing housing shortage in Rhode Island, which has consistently ranked among the lowest states for new housing construction per capita. 

But Rhode Island may be poised to change course, following a recent session of the state legislature. In August, Governor Daniel McKee signed into law a package of fourteen housing bills that are intended to spur development of new housing or adapt old stock. The package also makes accommodations for low-income housing by updating zoning laws which have historically hampered their development. The Governor also proposed floating the largest housing bond in the state’s history, in order to jump-start Rhode Island’s sluggish housing construction.

Making Connections, Finding Solutions

In spite of the many challenges facing community advocates, a slew of new housing policy proposals have found traction in recent months. Andes points to the proposed solution of pallet shelters, a form of temporary housing that received funding in the 2024 state budget, but as of now remains unoccupied.

“[Providence] could be a place where we experiment with the pallet shelters that are sitting empty right now. Why are they empty? Because people can’t agree on what we have to do to keep them safe,” says Andes, referring to changes sought by regulators that would allow the shelters to operate within the state’s building code requirements. As Providence and other Rhode Island cities update zoning and building codes, affordable housing could be poised to make its biggest gains in decades.

For Perry, updating regulations is important, but changing public perceptions is the first step. Reframing how unhoused people are viewed will go a long way toward reforming the systems that marginalize them. “We should be doing our best to give the power of decision making to those experiencing [homelessness],” they say. “We need to accept the problem for what it is and meet people where they are.”

Megan Smith says forming connections with the community helps to motivate her work. And she is heartened to see the community-based work of her students, as the future generation of providers. “The thing that has always drawn me into this work is the people. The relationships I have with people and getting to deeply hear from people about themselves, their lives, their experiences, their worldview. That's something that we can protect as an organization and as a community of practice. So that gives me hope. That gives me hope that that's something that they can't take from us, and something that matters.”