1
Assessment of Chosen Community
The group of homeless in St. Paul, Minnesota, downtown was the largest population that
was evaluated for this assessment, and a windshield survey of the population was conducted
close to the Union Gospel Mission, Dorothy Day Center, and Mississippi River camp sites. The
individuals are dispersed among emergency shelters, transitional housing, and homeless sites
such as parks and underpasses. They experience high unemployment or low-income, unstable
work, often with chronic disease, mental illness, or incarceration histories, and many have
limited education and low household incomes. Survival is the focus of life, with little to spare for
preventive health. As Healthy People 2030 acknowledges, homelessness is a major social
determinant of health that drives inequality in nutrition, mental health, and chronic disease
management (Office of Disease Prevention and Health Promotion [ODPHP], 2020).
Their health outcomes are much worse than those of the general population. Homeless
persons are three to four times as likely to have chronic conditions such as diabetes,
hypertension, and cardiovascular disease (CDC, 2024). 44% of homeless adults in Minnesota
have one or more chronic diseases and 57% have a mental disorder, the most common reason
being unstable housing causing poor disease control and frequent use of emergency services
(Wilder Research, 2023a). Hospitalization rates are between nearly five times higher for
conditions that are avoidable, and average life expectancy is reduced by about 20 years, due to
main causes of death from unattended mental disorder, addiction, and infectious diseases
(Pumariega et al., 2022; National Health Care for the Homeless Council [NHCHC], 2021). These
health inequities are magnified by additional risk factors such as severe environmental exposure,
malnourishment, high tobacco and alcohol use, and limited access to preventive services
(Wiewel & Hernandez, 2022). The children are disproportionately impacted, with more
developmental delays and missed schooldays due to health complications (Wilder Research,
2023b). These findings highlight the importance of evidence-based health promotion
interventions that address physical and behavioral health simultaneously and reduce care system
barriers to a minimum.
Analysis of the homeless population
, 2
The homeless in downtown St. Paul are more disproportionately affected with chronic
illnesses such as hypertension, diabetes, and respiratory infections, and also exhibit high rates of
untreated mental illness and drug abuse (Bensken et al., 2021). Limited healthcare providers and
transitory nature of homelessness inhibit continuity of care, but evidence-based treatment has
been encouraging. "Housing first" initiatives reduce hospitalization and outcomes by stabilizing
dwelling before addressing other needs (Eide, 2020), while street medicine, mobile health
clinics, and incorporating behavioral health services into shelters increase access and trust
(Kaufman et al., 2024; Bravo et al., 2022). There remain barriers like mistrust, cultural
differences, competing priorities, and funding constraints.
Demographically, African Americans and Native Americans are disproportionately
homeless—37% and 12%, respectively, yet comprising only 7% and 1% of the state's population
—highlighting housing and healthcare discrimination, as well as systemic racism (Olivet et al.,
2021; Wilder Research, 2023b). The population is somewhat more male (55%), but also includes
women, single mothers with children, and unaccompanied minors (12%), with most in middle
age but also some young adults and old adults. Education is low, with about 40% lacking a high
school diploma, limiting job opportunities (Bensken et al., 2021). These vulnerabilities not only
cause harm to the individual but place a burden on the larger population, as preventable
hospitalization drives up the cost of uncompensated care and communicable disease such as
influenza, tuberculosis, and COVID-19 is more easily spread in congregate settings (CDC, 2024).
Addressing these inequities is crucial to improving health equity, reducing hospital burden, and
protecting broader public health.
Characteristics of the Chosen Community
The homeless in downtown St. Paul are heterogeneous but share vulnerabilities in
common that affect their health status. The most recent Wilder Research study (2023b) shows
that approximately 7,940 Minnesotans experience homelessness on any night, nearly 2,000 of
whom were in Ramsey County, where St. Paul is located. Demographically, African Americans
and Native Americans are wildly overrepresented: African Americans, who make up about 7%
of Minnesota's total population, are 37% of the homeless. Native Americans, who are only 1% of
the state's population, are 12% of the homeless. These disparities reflect the impact of systemic
racism, housing discrimination, and limited access to health services (Olivet et al., 2021).
Assessment of Chosen Community
The group of homeless in St. Paul, Minnesota, downtown was the largest population that
was evaluated for this assessment, and a windshield survey of the population was conducted
close to the Union Gospel Mission, Dorothy Day Center, and Mississippi River camp sites. The
individuals are dispersed among emergency shelters, transitional housing, and homeless sites
such as parks and underpasses. They experience high unemployment or low-income, unstable
work, often with chronic disease, mental illness, or incarceration histories, and many have
limited education and low household incomes. Survival is the focus of life, with little to spare for
preventive health. As Healthy People 2030 acknowledges, homelessness is a major social
determinant of health that drives inequality in nutrition, mental health, and chronic disease
management (Office of Disease Prevention and Health Promotion [ODPHP], 2020).
Their health outcomes are much worse than those of the general population. Homeless
persons are three to four times as likely to have chronic conditions such as diabetes,
hypertension, and cardiovascular disease (CDC, 2024). 44% of homeless adults in Minnesota
have one or more chronic diseases and 57% have a mental disorder, the most common reason
being unstable housing causing poor disease control and frequent use of emergency services
(Wilder Research, 2023a). Hospitalization rates are between nearly five times higher for
conditions that are avoidable, and average life expectancy is reduced by about 20 years, due to
main causes of death from unattended mental disorder, addiction, and infectious diseases
(Pumariega et al., 2022; National Health Care for the Homeless Council [NHCHC], 2021). These
health inequities are magnified by additional risk factors such as severe environmental exposure,
malnourishment, high tobacco and alcohol use, and limited access to preventive services
(Wiewel & Hernandez, 2022). The children are disproportionately impacted, with more
developmental delays and missed schooldays due to health complications (Wilder Research,
2023b). These findings highlight the importance of evidence-based health promotion
interventions that address physical and behavioral health simultaneously and reduce care system
barriers to a minimum.
Analysis of the homeless population
, 2
The homeless in downtown St. Paul are more disproportionately affected with chronic
illnesses such as hypertension, diabetes, and respiratory infections, and also exhibit high rates of
untreated mental illness and drug abuse (Bensken et al., 2021). Limited healthcare providers and
transitory nature of homelessness inhibit continuity of care, but evidence-based treatment has
been encouraging. "Housing first" initiatives reduce hospitalization and outcomes by stabilizing
dwelling before addressing other needs (Eide, 2020), while street medicine, mobile health
clinics, and incorporating behavioral health services into shelters increase access and trust
(Kaufman et al., 2024; Bravo et al., 2022). There remain barriers like mistrust, cultural
differences, competing priorities, and funding constraints.
Demographically, African Americans and Native Americans are disproportionately
homeless—37% and 12%, respectively, yet comprising only 7% and 1% of the state's population
—highlighting housing and healthcare discrimination, as well as systemic racism (Olivet et al.,
2021; Wilder Research, 2023b). The population is somewhat more male (55%), but also includes
women, single mothers with children, and unaccompanied minors (12%), with most in middle
age but also some young adults and old adults. Education is low, with about 40% lacking a high
school diploma, limiting job opportunities (Bensken et al., 2021). These vulnerabilities not only
cause harm to the individual but place a burden on the larger population, as preventable
hospitalization drives up the cost of uncompensated care and communicable disease such as
influenza, tuberculosis, and COVID-19 is more easily spread in congregate settings (CDC, 2024).
Addressing these inequities is crucial to improving health equity, reducing hospital burden, and
protecting broader public health.
Characteristics of the Chosen Community
The homeless in downtown St. Paul are heterogeneous but share vulnerabilities in
common that affect their health status. The most recent Wilder Research study (2023b) shows
that approximately 7,940 Minnesotans experience homelessness on any night, nearly 2,000 of
whom were in Ramsey County, where St. Paul is located. Demographically, African Americans
and Native Americans are wildly overrepresented: African Americans, who make up about 7%
of Minnesota's total population, are 37% of the homeless. Native Americans, who are only 1% of
the state's population, are 12% of the homeless. These disparities reflect the impact of systemic
racism, housing discrimination, and limited access to health services (Olivet et al., 2021).
