We are on the Island now, and have been here for 2 weeks.
There is a bit more garbage these days, but it has just been eastern, where all the locals camp out at the beach with all the families for 1-2 weeks and that being coupled with the (rather small) effects of the strike of the public workers, seems quite logical. It's like in the US on the 5th of July or after a Superbowl.
We don't see a lot of empty stores, especially not considering that so many new malls are opening and stores switches to them.
I haven't been to the Red Light district, so cannot comment on that, but I have in most part of the world, where I have been, it is there, but here in Aruba we never paid any notice to it. It is away from the normal tourist district, so people who want it can go, and for the rest of us, its not noticeable (except for the advertising in the free newspapers).
We never walked in the area of the 1 or 2 streets downtown where there are a few homeless hanging around, we have only driven through it, since there are no shops or anything which you need to go to. I guess you have a choice, in all major cities around the world there are areas where I would not walk alone on a dark night. I have never had anyone begging for my money (except the jewelery shops) and I have never been anywhere in the world where I feel more safe than here.
The health care issue, I cannot comment as I have no idea, but from what other people say you have good local as well as US doctors and facilities here, bot public and private.
Regarding all the property development: There is a big property boom here, but that is because of people like you and me and thousands of others want a piece of paradise for ourselves.
It is a natural progression, when people discover that a place is a dream location, there will be someone to fulfill that increased demand. (Just like sex, drugs, religion etc). It happens in all the desirable locations all over the world.
We just took over our house here which we will use a couple of months of the year as a second home and I never felt better about a big buying decision, so I hope, for your sake, that you will also some day have you own piece of heaven here.

Best wishes

Carsten