News

Housing is a primary social determinant of health and a new study published in Health Affairs shows that lung and colorectal cancer mortality was higher among veterans who were unhoused compared to those who were housed. Hannah C. Decker, MD, of the University of California, San Francisco and lead author, and her colleagues suggest that "adopting the VA’s strategies in other settings where people without housing seek care, particularly for patients diagnosed with cancer, may help improve outcomes in this vulnerable population."

At least 19 states are directing funds from Medicaid programs to help patients who are experiencing homelessness find housing and avoid eviction. Evidence supporting redirecting Medicaid funding to housing is mixed. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "It’s much better than nothing, but it’s far from providing the long-term housing and stability that people really need."

Hosted by the California Partnership to End Domestic Violence (the Partnership), lead researcher Anita Hargrave, MD, UCSF BHHI Policy Director Tiana Moore, PhD, and CPEDV staff dove deeper into policy recommendations and solutions that arose from the California Statewide Study of People Experiencing Homelessness (CASPEH) findings on the intersection of intimate partner violence and homelessness. The webinar featured an in-depth discussion of local and state opportunities, as well as funding and programmatic policy recommendations for advocates, policymakers, and other decision-makers.

Volunteers, on a clear night in San Francisco, count the number of people who are unhoused on the streets. Groups of people were assigned specific areas, and write down whether a person is confirmed, suspected, or if no one on the block is unhoused. The point-in-time count is nationwide. However, the counts are not perfect and some groups are undercounted. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homeless families do everything they can to stay out of the public eye because they are really worried, for good reason, that their children will be taken from them."

The point-in-time count is a survey that measures the number of people staying in shelters. Data from the point-in-time count has its limitations, but the information is still valuable. San Francisco has a team of workers and volunteers to conduct the count; each group is given a detailed map of streets and alleyways and instructions on how to record the findings. With regards to the value of point-in-time count, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "It’s easy to understand that there are way too many people experiencing homelessness, but it would help us to understand what is happening in people’s lives right before they’re homeless."

A special report on the relationship between intimate partner violence and homelessness in California by the UCSF Benioff Homelessness and Housing Initiative, found that 1 in 5 women who become homeless in California flee their homes to escape violence. Participants described the need to plan their exit in advance and to accumulate resource; however, of those who experienced intimate partner violence in the 6 months prior to homelessness, only 12% sought help from a domestic violence organization. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Some people honestly had no idea what is a domestic violence shelter. Other people told us when they had to run, they had to run. They didn’t have time to figure out where to find a shelter."

A special report, released by UCSF Benioff Homelessness and Housing Initiative, explored the relationship between intimate partner violence (IPV) and homelessness in California. Findings from the report showed how violence and economic insecurity can be intertwined. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "There are only so many places you can hide when you’re unsheltered."

A growing number of people with lived experience of homelessness are finding opportunities in California to influence academic projects. More entities are beginning to create entire boards or councils of people who know what it is like to lose their housing. With regards to including a lived expertise advisory board in UCSF BHHI's California Statewide Study of People Experiencing Homelessness, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "The researchers had missed an entire world of economic insecurity, and the survey was much richer because the board members could see things the researchers could not."

California accounts for about a third of the nation’s homeless population and among this population, seniors are the fastest growing group. Research shows that living on the streets prematurely ages and sickens people. “When talking about homelessness, 50 is the new 75,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Whether it be measures of cognitive decline, mobility, problems with function falling, all of the things that we usually think of happening to people in late life just happen to people 20 or 30 years earlier,” said Dr. Kushel. “And tragically, people also die.”

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."