Last month, Judge David Carter ordered Los Angeles officials to find shelter for all homeless people in downtown L.A. by October 2021. This follows Mayor Eric Garcetti’s call for spending $1 billion to address the area’s homelessness crisis. These are unprecedented actions that speak to the significant and tragic state of homelessness in Los Angeles, but they reflect urban tensions that have deep roots. The long history of American “skid rows” suggests that solving this crisis requires understanding the true dimensions of the problem and the diverse needs of homeless people, something we have long failed to do.

In the late 19th century, transient workers uprooted by industrialization gathered in cities near job opportunities. The shabby districts they occupied came to be known as skid rows, a name they kept for more than 100 years. Skid rows were primarily home to single men and contained inexpensive lodging, restaurants and bars. Those men who couldn’t afford lodging received help from religious missions, which offered sermons, meals and overnight accommodations. Many police stations and later municipal shelters also offered a place to sleep for a night.

During the Great Depression, as formerly working-class people joined the homeless, crushing need outstripped existing systems of assistance and long bread lines wrapped along city sidewalks as encampments sprouted up everywhere possible, including New York City’s Central Park. President Franklin D. Roosevelt started the Federal Transient Program, a system of shelters designed to keep homeless individuals and families off the streets. This bold program acknowledged that homeless people often lacked the local residency required to access relief programs and funded assistance for localities to distribute.

Yet, even as Roosevelt’s New Deal helped create a federal government-provided social safety net for the first time, programs such as Social Security targeted people with a stable life and home address — which made them ill-suited to help those Americans on skid row.

Instead, on the nation’s skid rows, most assistance came in the form of alcoholism treatment programs, owing to a misunderstanding of the diverse population living there. During the 1940s, when addiction studies were in their infancy, homelessness was seen as “end-stage alcoholism,” even though some on skid row were not especially heavy drinkers and many had taken up heavy drinking only after becoming homeless. This one-size-fits-all approach did little to help people who needed medical care, mental health treatment, job training or those who worked regularly, but did not earn enough to pay for housing.

Yet, instead of addressing the complex roots of homelessness, most of the public outrage about skid rows came from better-off Americans wanting to avoid the homeless having an impact on their lives. Politicians and business owners in districts abutting skid rows complained that their property values suffered due to the presence of homeless people. Homeowners worried about their safety and the trauma their children experienced watching human suffering daily.

Given that these constituencies voted and had access to media coverage, public officials aimed to confine homeless people to skid rows. Police officers routinely rounded up homeless people found in other parts of cities and relocated them to skid row, sometimes against their will.

When this containment policy wasn’t effective enough, some city officials tried to use urban renewal to banish the homeless entirely from downtown areas. During the 1950s, Boston, Chicago, Detroit, Minneapolis, Philadelphia and St. Louis, among other cities, demolished deteriorating skid row districts.

The outcry from upper- and middle-class Americans over skid rows only intensified during the 1970s and 1980s as cities suffered from disinvestment and White flight, and the crack cocaine epidemic took hold. During this era, more Black and Latino people facing systemic racism became homeless, as did women fleeing domestic violence and those impoverished by widowhood and divorce. In New York City, planned urban renewal of the Bowery — the city’s skid row — had failed, but the district eventually gave way to gentrification. As skid rows disappeared, homeless people in some cities migrated in large groups to other neighborhoods, while in others they scattered across the city.

Politicians turned to harsher policing to discipline homeless people and displace them from city streets. Perhaps most memorably, New York Mayor Rudolph W. Giuliani used aggressive policing tactics against the city’s homeless population, even going so far as to deny churches the right to allow homeless people to sleep on their steps. Giuliani’s move was emblematic of how cities nationwide treated homeless people in the 1990s. Ordinances increasingly criminalized behaviors such as sleeping on the street, public urination and loitering.

The need to resort to zealous policing reflected the durability of homelessness, in part because generations of assistance had been misguidedly conditioned upon behavioral change. Religious missions routinely rejected guests who were intoxicated. Countless assistance programs required applicants to attend scheduled appointments, take prescribed medications, avoid negative contact with law enforcement and otherwise demonstrate readiness before they could receive housing. These guidelines proved prohibitive for many, especially after the deinstitutionalization of many mentally ill people beginning in the 1970s.

Tactics have begun to change over the past 15 years, as public officials adopted a Housing First strategy, which promoted housing as the solution to homelessness. Clients living in a stable housing environment, many experts believe, are better equipped to embark on sobriety, education, career-preparation and other self-improvement projects. Such programs still struggle to find suitable housing placements for the least stable and most mentally ill people, as well as those battling severe addiction. But these programs prove beneficial to many facing less dire situations.

In recent years, many homeless people have congregated in West Coast cities with milder weather and more hospitable policies, including Los Angeles, San Francisco and Seattle. Even as many cities demolished their skid row areas in the 1970s, Los Angeles officials oversaw the consolidation of social services and lodging downtown. By 2020, as the economy suffered the effects of the global pandemic, Los Angeles was home to more than 41,000 homeless people, many of whom lived on skid row.

Today, the city is at a crossroads. Its current initiatives demonstrate a real commitment to spending the money needed to address the city’s homeless crisis. Yet, more than the amount spent, the way the “problem” is defined will determine the effectiveness of these efforts.

Is the problem that of thwarted gentrification and homeowners’ annoyance with the homeless or that of human suffering? Will the money be used to aid the homeless or to fund efforts to arrest them?

Expansive programs grounded in Housing First policies offer a promising start. A successful effort also will need funding for addiction recovery programs for all who seek them. Many people on skid row are also former inmates of the jail and prison system and are deeply in need of supportive programs aiding their reentry to daily life. Women, children and families also need different sorts of programs than single men.

This is a tall order. But President Biden has proposed investing trillions of dollars in our nation’s infrastructure, jobs and families. Many pundits have likened his ambitions to those of Roosevelt, who tried to house all the nation’s homeless during the depths of the Great Depression. Coordinated federal, state and local efforts could make that vision a reality. If not now, when?