Move on to where: homelessness is a health issue

The health of a society is often judged by how it treats its most vulnerable citizens. Few groups are more vulnerable than those experiencing homelessness. Homelessness is not simply an economic problem, nor merely a failure of housing supply. It is a complex interaction of poverty, trauma, mental illness, addiction, unemployment, family violence, social dislocation and, in Aotearoa New Zealand, the enduring effects of colonisation and structural inequity. As clinicians, we see the consequences of homelessness every day in our emergency departments, outpatient clinics and hospital wards.

The Government’s proposed amendments to the Summary Offences Act 1981, commonly referred to as the “move-on orders”, have reignited an important debate about the nature of homelessness and society’s obligations to those living without stable housing.¹ Under the proposed legislation, police would be empowered to direct individuals aged 14 years and older to leave a public place for up to 24 hours if they appear to be sleeping rough, begging or occupying public spaces in a manner deemed disruptive. Failure to comply would result in a criminal offence which may lead to arrest, fines of up to NZ$2,000 or imprisonment for up to 3 months.

Supporters of the legislation argue that the measures are intended to restore public order, improve safety and address increasing concerns regarding antisocial behaviour in urban centres. The Government has emphasised that homelessness itself is not being criminalised; rather, it is the refusal to comply with a lawful instruction that would constitute an offence.

Critics, however, argue that this distinction is largely semantic. If sleeping in a public place is the consequence of having insecure housing, then penalising an individual for remaining there risks criminalising the condition itself. Officials from Te Tūāpapa Kura Kāinga – Ministry of Housing and Urban Development have advised that move-on orders are unlikely to be an effective response to homelessness, while justice officials have questioned whether there is any evidence that such measures reduce offending or improve public safety.²

Three years ago, this journal examined the growing problem of homelessness in New Zealand.³ That editorial noted that severe housing deprivation had reached alarming levels, affecting more than 100,000 New Zealanders. More recent estimates suggest that, by the time of the 2023 Census, at least 112,500 New Zealanders, including more than 34,500 Māori, were experiencing severe housing deprivation; almost 5,000 people were estimated to be living without shelter. Māori remain substantially over-represented among those experiencing homelessness.

Recent data also suggest a more nuanced picture than simple year-on-year growth.² Although many local authorities report increasing numbers of people sleeping rough, some centres, including Auckland, Christchurch and Rotorua, have reported reductions, while others, including Wellington and Napier, have reported increases.² These findings suggest that homelessness is dynamic and responsive to local conditions, housing availability and the availability of outreach services.

Homelessness is associated with markedly reduced life expectancy, increased rates of mental illness, substance abuse, chronic disease and substantially poorer health outcomes across virtually every domain of wellbeing. Māori, Pacific people, women, older adults and young people are disproportionately represented. Homelessness typically arises from an interweaving of pathways involving family violence, overcrowding, financial insecurity, disability and limited access to affordable housing. The central conclusion of that earlier editorial remains as relevant today as it was then: homelessness is fundamentally a health and social issue rather than a criminal one.

The evidence supporting housing-based interventions is compelling. Housing First programmes recognise that stable housing is often the foundation upon which all other interventions depend. New Zealand studies have demonstrated reductions in interactions with the justice system, hospital admissions, mental health crises and unemployment when stable housing is provided alongside wraparound support services.⁴

Of particular concern is the inclusion of adolescents within the proposed legislation; early contact with the justice system can exacerbate disadvantage rather than resolve it.⁵ Young people experiencing homelessness often seek out well-lit, visible locations precisely because they are safer than isolated alternatives. Displacing them risks the opposite effect: greater exposure to violence, exploitation and victimisation, and with it, the very justice-system contact this editorial has already identified as harmful. Evidence from Victoria, Australia suggests that similar measures merely displaced homelessness from central areas into surrounding suburbs, making it more difficult for support agencies to maintain contact with vulnerable people.

Community organisations have also expressed concern that repeated displacement disrupts relationships with outreach workers, healthcare providers and social services. If vulnerable people are repeatedly moved from one location to another, they become increasingly difficult to identify, support and, ultimately, house. We cannot solve a problem that we can no longer see.

The disproportionate burden of homelessness among Māori adds another dimension to the debate. The Waitangi Tribunal’s Kāinga Kore report concluded that the Crown had failed in its obligations to protect and support Māori experiencing homelessness, particularly rangatahi.⁶ Any policy response that increases exposure to the justice system without simultaneously addressing underlying causes risks exacerbating these inequities.

None of this is to argue that communities should tolerate disorder, intimidation or threatening behaviour in public spaces. The public’s expectation of safe, welcoming shared spaces is legitimate, and disorder exacts a real cost on local authorities, police, healthcare services and the community organisations left to respond. The Government has, appropriately, continued to invest in Housing First initiatives, outreach services, transitional housing and other programmes designed to address housing barriers at their roots.

There remains an important distinction, however, between managing behaviour and addressing its causes. Internationally, countries such as Wales have adopted a statutory “duty to assist” approach that recognises homelessness as evidence of failures within housing and social support systems rather than as a public order issue. Community organisations in New Zealand have argued for a similar model, emphasising prevention, continuity of care and sustained investment in long-term housing solutions.^4–6

Public order matters. But we must be careful to consider what is really driving this response: is it driven by public safety, or by the discomfort and perhaps guilt we feel when confronted with visible homelessness? Moving people from one doorway, park or street corner to another is not a meaningful solution to homelessness. People experiencing homelessness are not responsible for the failure of housing, health and social support systems; they are living with the consequences of those failures.

Homelessness cannot be legislated away. It can only be reduced through sustained investment in affordable housing, effective mental health services, addiction support, trauma-informed care, early intervention programmes and long-term social investment.

As doctors, we are accustomed to treating causes rather than symptoms; homelessness should be approached in the same way. Underneath the rhetoric, this bill risks not only representing an abdication of responsibility but also shunning our communities’ most vulnerable. Society will ultimately be judged not by how effectively it moves vulnerable people out of sight but by how successfully it helps them find a place to call home.