Unsheltered-in-Place: A legal epidemiologic review of 2020 executive actions for homeless populations in five states Open Access

Abstract

People experiencing homelessness are at a higher risk of developing severe symptoms from COVID-19. In 2020, an unprecedented number of executive actions were issued across states and cities to protect constituents from the novel coronavirus, however no research has been published to evaluate these laws’ effects on protecting people experiencing homelessness from uncontrolled virus spread in public, congregate living settings. This paper presents a foundational framework for observing the characteristics of executive branch actions aimed at homeless populations during the pandemic through legal epidemiology methods. By collecting and analyzing relevant laws across five states and their major cities, this paper delivers the first four components of a full legal epidemiology assessment: a study design, law collection criteria, five state memorandum, and coding scheme. Preliminary results from the collection and coding found that among Colorado, Georgia, Illinois, Minnesota, and Washington, there was significant variety in legal tactics used to mitigate COVID-19 spread among homeless populations. Minnesota took a comprehensive approach that involved diverse stakeholders such as public schools, police, and park services, whereas Washington, Georgia, and Illinois offered brief health advisories to people experiencing homelessness. Results remain limited in both legal data and available health data on people experiencing homelessness, but the framework developed in this paper will ultimately support a 50-state legal epidemiology assessment. Further research is needed on more states to determine a larger overall trend between various tactics in executive actions (frequency, content, power, and enforcement) and their impact on protecting people experiencing homelessness from COVID-19 spread in homeless shelters and outdoor encampments. 

Table of Contents

Purpose............................................................................................................................................................. 9

Background .................................................................................................................................................... 9 Introduction.......................................................................................................................................................................................... 9

Defining “Homelessness” ............................................................................................................................................................... 9

Homelessness as a Public Health issue ............................................................................................................................... 10

Homelessness by State ................................................................................................................................................................. 12

Methodology background .......................................................................................................................................................... 13

Significance .................................................................................................................................................. 16

Methods .......................................................................................................................................................... 16

Study Design ..................................................................................................................................................................................... 17

Inclusion & Exclusion Collection Criteria .......................................................................................................................... 20

Coding Scheme ................................................................................................................................................................................. 23

Results............................................................................................................................................................. 26

Five State Memorandum ............................................................................................................................................................ 26

Discussion ..................................................................................................................................................... 33

Estimating health outcomes ..................................................................................................................................................... 38

Limitations ................................................................................................................................................... 39

Conclusion .................................................................................................................................................... 40

Appendix ........................................................................................................................................................ 41

Appendix A. 42 U.S. Code § 11302 | General Definition of Homeless Individual .......................................... 41

Appendix B. Westlaw search methods for determining relevant existing State and Federal laws ........ 42

Appendix C. Refined final qualifying dataset of Executive Orders........................................................................ 44

Appendix D. PHLIP Protocol .................................................................................................................................................... 47

References ....................................................................................................................................................54 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Sociology, Public and Social Welfare Law
Keyword	Legal Epidemiology
Committee Chair / Thesis Advisor	James V. Lavery, Emory University
Committee Members	Mara Howard-Williams, CDC Public Health Law Program

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