BHHI News

Margaret Handley, PhD, MPH, a professor in the department of epidemiology and biostatistics and medicine at the University of California San Francisco shares a letter she wrote to Science about how her past, her family, and a rare instrument relate to her current career focus on public health and homelessness. Dr. Handley wrote, "The idea of helping people stay in housing, or improving their lives as they revolve around the uncertainty of a storage locker existence, keeps me going on my research-weary days."

Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, delivered the Harvard Joint Center for Housing Studies’ 23rd John T. Dunlop Lecture. After the lecture there was a panel, featuring, Boston Healthcare for the Homeless founder, Harvard Medical School professor James J. O’Connell, and Peggy Bailey, a leader of a housing policy research center. The panelists shared there perspectives on policy and economic approaches to addressing the housing crisis, agreeing that providing dedicated, sustained support to unhoused individuals is necessary. “The first thing we need to do is to recognize that every single path to ending this crisis flows through housing,” Dr. Kushel said.

Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, delivered the Harvard Joint Center for Housing Studies’ 23rd John T. Dunlop Lecture. Dr. Kushel spoke about the impact that homelessness has on an individual’s quality of life, highlighting the lived experiences of unhoused Californians who participated in the California Statewide Study of People Experiencing Homelessness. After the lecture there was a panel, featuring, Boston Healthcare for the Homeless founder, Harvard Medical School professor James J. O’Connell, and Peggy Bailey, a leader of a housing policy research center. JCHS Managing Director Chris Herbert, the moderated the panel. Dr. Kushel said, "While it is really easy to blame people impacted by homelessness, doing so not only is not fair or right, but it also isn’t going to get us any closer to a solution."

Black Californians make up only 7% of the states population, but make up more than 25% of the state's population of people who experience homelessness. The number is higher in Sacramento County, where 31% of the population experiences homelessness. The obstacles to housing, employment, income and health care that Black Californians have historically faced are also among the pathways to homelessness. "The situation for unhoused Black Californians is dire, but it is not insurmountable,” said Tiana Moore, PhD, the report’s co-author.

In this podcast episode of Clinical Changemakers, Margot Kushel, MD, director of the Benioff Homelessness and Housing Initiative, spoke with host Jonathan Hoogerbrug, MD about the moral injury of being a frontline clinician and having to discharge people back onto the streets. Dr. Kushel also elaborates on her landmark research into Homelessness in California, highlighting the moral, medical, social and economic impact that that this issue has on those individuals, their families and society as a whole. Dr. Kushel said, "The people who are most impacted, obviously, are those experiencing homelessness and the impacts for them are just incalculably horrible. But it impacts everybody." She adds, "There are huge costs to society. There's the intangibles, like loss across the business, community, to tourism. There's the moral injury. What do we say to our children about what does it mean to grow up in a place where so many people are so visibly suffering?"

Some homeless shelters now offer resources so that people can squeeze in with family members. This diversion approach was pioneered by the Cleveland Mediation Center around 20 years ago. The approach is not for everyone, but it is meant to catch people before they slip into the shelter system. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Even if it doesn’t work for everybody, if it works for a certain percentage, it’s likely worth it."

Research has demonstrated that homelessness is associated with poor health outcomes. However, there are fewer studies that show that gaining housing is associated with improved health outcomes. In a recent study published in early February was hypothesis-generating and found an association between housing and improved survival. Hannah C. Decker, MD, of the University of California, San Francisco and lead author, said, "Unhoused veterans who gained housing in the year after diagnosis had better outcomes than people who remained unhoused."

The perception of people experiencing homelessness is often based on anecdote. In the first episode of WPLNs 9 part housing series, In My Place, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Khalil Ekulona to talk about the causes of homelessness, the misconceptions and myths of homelessness, and what cities can solve the problem. As the conversation moved to the misconceptions of people experiencing homelessness, Dr. Kushel said, "I think the single biggest misconception is that homelessness is synonymous with mental health and substance use problems." Dr. Kushel adds "At its heart, homelessness is a problem of housing cost."

In San Diego, people 55 and older make up at least 29% of the people experiencing homelessness. The seniors experiencing homelessness face tough choices with many of them on a fixed income and unable to afford housing costs in the city. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "When talking about homelessness, 50 is the new 75."

The mortality rate for people experiencing homelessness in America has increased in recent years. People are dying at increased rates because of overdoses, but also of things that may have been avoided if the individual had a home or regular access to preventative medical care. Furthermore, the population of people experiencing homelessness are getting older. In California, the number of people 55 and older who sought homelessness services increased 84%  between 2017 and 2021. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "As the homeless population continues to age, you’re just going to see death rates keep going up and up and up."