ArticleBMC public health2026
A comprehensive assessment of health hazards faced by people experiencing unsheltered homelessness in Denver, Colorado (October - November 2023).
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUnsheltered living settings, such as encampments, pose significant health hazards to those residing in them. However, limited understanding of these hazards hinders efforts to address the health and safety needs of unsheltered individuals. Some U.S. cities have encampment restrictions, resulting in the involuntary displacement of people staying in public spaces. In response, locations called Temporary Supported Communities (TSCs)-government-sanctioned encampments providing a place to eat, sleep, and access case management-emerged as an interim housing option when permanent housing is unavailable. It is unknown whether TSCs reduce the health hazards experienced by residents compared to public encampments. Therefore, we evaluated observed and self-reported health hazards faced by people experiencing unsheltered homelessness in Denver, Colorado, compared hazards between public encampments and TSCs, and assessed the prevalence and impact of involuntary displacement.
methodsWe conducted a cross-sectional survey about perceived health hazards with 187 people experiencing unsheltered homelessness in seven public encampments and three TSCs in Denver, Colorado, October-November 2023 through an Epidemiologic Assistance investigation by the Centers for Disease Control and Prevention. We paired interviews with observational assessments to document and narratively compare hazards in each setting. We calculated the prevalence of involuntary displacement and used thematic analysis to evaluate its impacts. Multiple linear regression was used to analyze differences in self-reported sanitation access and concern about health hazards by setting.
resultsParticipants in TSCs reported greater sanitation access compared with those in public encampments (p < 0.0001). Health hazard concerns were higher in public encampments, particularly waste, injuries, and involuntary displacement (p < 0.05). Observational assessments confirmed survey findings, with more waste and injury hazards in public encampments. Involuntary displacement was a top concern; over half of participants reported experiencing at least one event, leading to worsened health, disconnection from services, and loss of personal items.
conclusionsWe present a framework for health agencies to identify health hazards in encampment settings and interventions to improve them. TSC residents reported better sanitation access and fewer hazard concerns, but both settings carry substantial health hazards, indicating the need for effective hazard mitigation.
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