Skid Road

Skid Road: On the Frontier of Health and Homelessness in an American City is a narrative history, set in my hometown of Seattle, Washington. Skid Road explores the intersection of safety net health care and homelessness. Skid Road includes a print book (July 2021, Johns Hopkins University Press) and a companion video project. Skid Road deepens our understanding of the historical roots of poverty and homelessness, trauma and resilience, and the role of charity and safety net health care and public policy in King County. I am interested in how a large, socially progressive urban area like King County responds to the health needs of people marginalized by poverty and homelessness.

Skid Road book description from Johns Hopkins University Press:

Home to over 730,000 people, with close to four million people living in the metropolitan area, Seattle has the third-highest homeless population in the United States. In 2018, an estimated 8,600 homeless people lived in the city, a figure that does not include the significant number of “hidden” homeless people doubled up with friends or living in and out of cheap hotels (oftentimes with pimps). In Skid Road, Josephine Ensign digs through layers of Seattle history—past its leaders and prominent citizens, respectable or not—to reveal the stories of overlooked and long silenced people who live on the margins of society. 
The sometimes-fragmentary tales of these people, their lives and deaths, are not included in official histories of a place. How, Ensign asks, has a large, socially progressive, city like Seattle responded to the health needs of people marginalized by poverty, mental illness, addiction, racial/ethnic/sexual identities, and homelessness? Drawing on interviews and extensive research, Ensign shares a diversity of voices within contemporary healthcare and public policy debates.
Informed by her own lived experience of homelessness, as well as over three decades of work as a family nurse practitioner providing primary healthcare to homeless people, Ensign is uniquely situated to explore the tensions between caregiving and oppression, as well as charity and solidarity, which polarize perspectives on homelessness throughout the country. A timely story in light of the ongoing healthcare reform debate, the affordable housing crisis, and the COVID-19 pandemic, the stories from Skid Road illuminate issues surrounding poverty and homelessness throughout America.
“Timely, unique, and important. I have never read a book quite like this one. A gifted writer, Ensign uses narrative history to reveal various intersectionalities and tensions in the machine of structural and systemic inequities, oppression, violence, and trauma. Her storytelling touches on racism, sexism, xenophobia, colonialism, and religion as historical contributors to the live, undulating city of Seattle we have today. History buffs, especially Seattle ones, will find it irresistible.”—Sara K. Rankin, Seattle University School of Law

Here is “Commitment” my brief (5-minute) video about the history of the first official homeless person in Seattle, King County, Washington and mental health treatment.

Here is “Brother’s Keeper,” my 5-minute video about the history of the Poor Laws and the healthcare safety net in Seattle, King County, Washington.

Here is “Ark of Refuge,” about the Housing First model of care and the historical (and colorful) figure of Dr. Alexander de Soto and the Wayside Mission Hospital:

“Ark of Refuge”

Here is “Shacktown,” about Seattle’s longstanding lack of safe, affordable housing and how our homelessness today is tied to our city’s historical land use, municipal zoning laws, and exclusionary and racist housing policies:


Here is a twenty-five-minute video, “Listening to Skid Road,” about the history and current situation of homelessness in Seattle–King County. It highlights content from my Skid Road oral history interviews. Seattle-based documentary filmmaker Jill Freidberg was the story editor.

Link to “Listening to Skid Road.”

These are several edited oral history interviews that I use in teaching and advocacy work:

The following is a gallery of photographs of people who have completed oral history interviews with me for the project. As of April 2023, I have completed fifty oral history interviews with people who work—and live—at the intersection of health and homelessness in King County. They will be archived in the University of Washington Special Collections in Seattle.


This project was supported, in part, by an award from 4Culture. Additional support for the audio portion of the DS videos comes from Jack Straw Productions. My Skid Road project is also funded, in part, by the University of Washington Simpson Center for the Humanities, the University of Washington College of Arts and Sciences, the National Endowment for the Humanities, and Humanities Washington.


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