The LA County Department of Public Health conducted an HIA to evaluate the potential health impacts of Measure H, a ballot initiative that would raise LA County’s sales tax by one-quarter of 1 percent for a decade to fund programs designed by the LA County Homeless Initiative.
The HIA evaluated homelessness as a public health issue, examining three tiers of strategies proposed by Measure H: primary prevention, secondary prevention, and tertiary prevention. The assessment found that primary prevention, or targeting resources to people at greatest risk of becoming homeless, could yield important health benefits. However, the authors caution that this should not be a principal strategy due to the inherent challenge of identifying the target population. Because the population at risk of homelessness in LA County can have income and mental health service needs, the report found that this strategy would benefit from collaboration across LA County departments and links to appropriate services. Measure H’s secondary prevention, or early intervention to prevent chronic homelessness, features two approaches: providing rapid re-housing and addressing transitions out of institutions. Although rapid re-housing is an effective short-term solution, the report found that participants may have trouble remaining stably housed in the long term. Meanwhile, evidence showing the benefits of greater collaboration between the criminal justice system and mental health/substance use disorder professionals supports services inside jails that are proposed in Measure H. The report found that these services, along with the measure’s plan to fund short-term transitional or “bridge” housing programs, would help to reduce recidivism and likely increase rates of permanent housing among homeless people exiting institutions. Finally, Measure H’s key tertiary prevention strategy—an intervention to address chronic homelessness—is permanent supportive housing. This strategy uses stable housing as a foundation for aiding recovery and has been shown to reduce hospitalization and emergency room visits.
The report advocates cross-cutting interventions, or policies and programs that have a measurable impact on two or more of the prevention tiers described above.