UCSF

When there is not enough housing for all who need it, housing agencies must triage and prioritize who receives assistance, and who is left out. In this dissertation, I explore how people in the social and healthcare safety net are sorted and stratified by technologies, service providers, and definition of need. I focus on the increasing incorporation of illness into definitions of housing need and vulnerability and how biomedical logics have emerged as central to systems that prioritize people experiencing housing insecurity, homelessness, and poverty.

My findings are drawn from 17 months of fieldwork conducted between June 2021 and October 2022. I conducted over 100 hours of ethnographic observation and 79 one-on-one interviews, including 50 interviews with frontline and mid-level service providers and leadership staff and 29 interviews with clients experiencing housing insecurity or homelessness.

In my first set of findings, I provide a brief social history of the understandings of homelessness and the incorporation of health and illness as central components and operationalizations of homeless need and vulnerability. I argue that while conceptions of homelessness—and specifically the return of health and illness criteria—seek to identify some of the most vulnerable people experiencing homelessness and match them to housing, such definitions stratify and ration scarce housing resources in ways that create new tiers of housing need and vulnerability and generate additional forms of exclusion. Second, I explore an unexamined mechanism in the sorting and stratifying of housing opportunities: the assemblage of CE technology with its service provider users. I show how service providers have limited but important levels of discretion in the use of algorithmic systems that prioritize households experiencing homelessness into housing. Findings center around the CE system technology and underscore the importance of service provider advocacy and the ways they negotiate housing assessment and prioritization especially for households experiencing homelessness and living with a disability. Lastly, I examine the discursive work of on-the-ground service providers to show how biomedical norms and standards shape definitions of need, vulnerability, and deservingness and ultimately, housing receipt. I reveal how service providers work to fit clients to housing by constructing them as disabled or medically in need of housing. Service provider decision-making processes reveal how biomedical norms and standards shape definitions of need and vulnerability and deservingness and ultimately, housing receipt.

By investigating the processes involved in the adjudication of who should be prioritized for housing within housing rationing systems, I provide a clearer evidence base for housing and healthcare safety net institutions and policymakers to understand how social institutions both reproduce and mitigate housing inequality. Such evidence suggests how we might strengthen our ability to implement fair and equitable processes along which housing assistance is rationed and allocated in the context of housing scarcity. This research contributes to scholarly understandings of the social construction of deservingness, boundary and classification work, and technological rationalization and quantification.