Poor people of color in urban areas in the United States have a reduced chance of living in safe surroundings because of the high prevalence of intractable conditions such as substance use, incarceration and homelessness. These conditions create a dangerous environment where the wellbeing of residents is in jeopardy. Substance use is the most significant risk factor for incarceration, and episodic periods of imprisonment cause unstable housing and homelessness. In turn, unstable housing and homelessness are closely correlated with substance use and recidivism, creating an all-too-common cycle of substance use, prison time and homelessness. Policies and interventions attempting to address this cycle do not appreciate the multidimensional nature of the problem. Current piecemeal strategies often exacerbate one risk while trying to address another. Even worse, existing governmental bureaucracies inhibit the creation of a comprehensive solution by employing organizational silos in which resources invested by one section (housing, for instance) reap benefits only for others (mental health and primary care).
To break this cycle of intractable problems and improve conditions in urban areas, a multilevel approach must be implemented. The approach must collaboratively engage communities at the street-level to provide services while simultaneously engaging the policy processes at the governmental level to establish comprehensive policy solutions.