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Skid Road: On the Frontier of Health and Homelessness in an American City

How can Seattle be both a model city for upward social mobility and a place with our nation’s third highest level of homelessness? I asked myself this question in 2013 as I walked down Yesler Way, the original Skid Road, towards a homeless shelter where I supervised groups of medical, nursing, and dental students in the provision of basic foot and dental care. This question led to a five-year-long ethnographic, oral history, and archive research project that informed my book, Skid Road: On the Frontier of Health and Homelessness in an American City. The initial question and the resulting research project took me from cacophonous homeless shelters in the Pioneer Square neighborhood of Seattle to tranquil archives in Seattle, London, and Edinburgh.

According to research conducted by economists Raj Chetty, Nathaniel Hendren, Patrick Kline, and Emmanuel Saez of Harvard and their group of researchers with Opportunity Insights, Seattle ranks first in the nation for the probability that a child born in poverty will be able to move out of poverty by age twenty-six.[1] Their aim is to apply social science and economic research to understand what helps break the cycle of intergenerational poverty. What they have found is that high opportunity areas are that way because of localized factors that are not dependent on national policies. These areas tend to be more diverse in terms of race, ethnicity, age, and socio-economic status. The city-specific and neighborhood-level protective factors include better public schools, higher rates of two-parent households, higher levels of civic engagement and community cohesion. High opportunity neighborhoods are not necessarily wealthier ones. The Seattle-area experimental housing mobility program, Creating Moves to Opportunity, provides families—including homeless families—who are eligible for federal housing assistance with housing navigators and research-based advice on living in high opportunity neighborhoods. The Creating Moves to Opportunity program shows promise, not only in breaking the cycle of intergenerational poverty, but also of intergenerational homelessness. The program has been so successful that other cities are adopting it.

A nurse and public health researcher by training, I sought mentorship from historians for the oral history and archival research. Through this book project, I learned, in the words of historian David Hitchcock, that history training "is empathy training among other things."[2] As a nurse practitioner with over thirty years’ experience working with people marginalized by poverty and homelessness and with the lived experience of homelessness as a young adult, I knew all about empathy—or at least I thought I did. I had not experienced the level of empathy I developed for people I had never met and would never meet because they were long dead by the time I got to know them. I spent months wrestling with the ethical questions that emerged as I dug through the layers of history, including the story of Edward Moore. He was a thirty-two-year-old sailor from Worcester County, Massachusetts who was found half-frozen on a Seattle beach in late 1854. Edward Moore became Seattle’s first official “insane pauper” and homeless person due to the then recently enacted Washington Territorial Poor Laws, which were adapted from our country’s first Poor Laws, which where adapted from the original English Poor Laws.

Homelessness, and especially the visible homelessness of numerous tent encampments and vehicle residents, has increased substantially in Seattle during the COVID-19 pandemic, as it has in many other West Coast urban areas like Los Angeles. So too have divisive political and community-level responses to homelessness. Homelessness in Seattle has been a state of emergency since November 2015. Addressing homelessness and the related escalating cost of housing are top priorities for Seattle voters coming up on the August 3rd primary election.

How do we reconcile the fact that the Seattle of today is both a progressive, hopeful city and a place in which homelessness is such a large, growing, and deeply entrenched problem? Is it, as many critics claim, precisely because of our progressive politics that people are attracted to and then stay stuck in homelessness and poverty? Or is it, as other people say, because of the greediness of large Seattle-based corporations and our city’s concessions—selling out—to them? It’s likely a bit of both. Homelessness is a wicked problem, meaning it is complex and multifaceted, causing a high degree of conflict because there’s little agreement on its causes, much less its solutions. But having a more nuanced understanding of the historical roots of our current homelessness situation can inform more nuanced and effective programs and policies to address it.

Order Skid Road: On the Frontier of Health and Homelessness in an American City at the following link:

Josephine Ensign is a professor in the School of Nursing and an adjunct professor in the Department of Gender, Women & Sexuality Studies at the University of Washington. She is the author of Skid Road: On the Frontier of Health and Homelessness in an American City, Catching Homelessness: A Nurse's Story of Falling through the Safety Net, and Soul Stories: Voices from the Margins.

  1. “Creating Moves to Opportunity | Opportunity Insights,” accessed July 24, 2021,
  2. David Hitchcock (@Hitchcockian), Twitter, November 29, 2019,
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