Moral Hazard: A Hazardous Term

At the “Rethinking Homelessness” conference in Montreal, Dennis Culhane spoke about the successes in the US around housing first models, and rapid prevention.  One thing that he mentioned in prevention programs is that we have to be careful of ‘moral hazard’.  The way he used the term, was around individuals utilizing resources to assist the homeless who didn’t truly qualify.  Or, the idea that programs that are too accessible will be taken advantage of (moral hazard is more frequenlty conceptualized in this context as people not taking as much personal initiative to prevent challenges if they have a safety net).

In a nutshell, he was expressing that we need to have strict boundaries around a programs so that they are not misused or over-used.  This is an idea that was tossed around in my work as a nurse at a drop-in health centre for homeless persons, that we need to be careful to screen out people from using our services who don’t qualify.  So, for example, if we give out emergency food, we need to be sure that people aren’t just walking in off the street and asking for food, even though they are housed.

I believe that this term is problematic, and reflective of a certain ideology that I am not comfortable with.  The idea here is that there are a bunch of free-loading people around just waiting to take advantage of social services.  However, it has been our experience that those who access our services that are not officially homeless clients of the health centre are still those who are at risk of homelessness.  Therefore, we don’t mind if they use our services, as it is actually a form of prevention.  Perhaps this food, or socks, or shower, or whatever, is a piece that will help them never officially qualify for our programs.

That said, with limited budgets for programs tartgeted at specific populations (ie. people who are experiencing homelessness), we do need to be intelligent about how we use our resources.  But I believe that this actually reflects another discussion around how awkward it is to define programs around housing status, which is such a fluid thing.

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