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Veteran homelessness has dropped about 55% in the United States, while it has remained relatively stagnant amongst the general population. The US government has reached a consensus and has offered a wide range of programs to limit homelessness or factors that put people at risk for experiencing homelessness. The VA’s Supportive Services for Veteran Families (SSVF), the Department of Housing and Urban Development’s (HUD) Veterans Affairs Supportive Housing (VASH) program are the foundation to the efforts. Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, said "I think it gives us a blueprint of exactly what we need to do."

People experiencing homelessness are at an increased danger of dying. A recent study by the National Bureau of Economic Research showed a 40-year-old person experiencing homelessness has a similar risk of death as a 60-year-old person with housing. Previous studies have also found that people who experience homelessness have a greater mortality risk. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re letting people die because we’re not fixing the underlying crisis."

There are over 1 million emergency department visits for non-life-threatening alcohol intoxication each year, many of which are people experiencing homelessness. In this op-ed, Shannon Smith-Bernardin, PhD, MSN, RN, assistant professor of nursing, answers questions about sobering centers, the utilization of sobering centers, and the health impact of sobering centers. Dr. Smith-Bernardin writes, "Sobering centers provide an opportunity for patients to build a consistent relationship with a health care professional who is specifically trained in addiction and trauma-informed care."

Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, spoke with Jaden Jefferson about the need for affordable housing and the UCSF BHHI California Statewide Study of People Experiencing Homelessness. A major finding of the study was that homelessness doesn't affect everyone equally, communities of color are disproportionately vulnerable to being displaced into homelessness, especially Black, Latinx, and Indigenous Californians. One reason that is the case is "when we look at the history of housing in this country, what we see is that our neighborhoods were actually built through racial covenants between the government and realtors in the form of what we now call redlining", said Dr. Ponder.

Advocates for people experiencing homelessness refer to sidewalk planters as “hostile architecture” meant to push the homeless population out of sight. The tactic is not new, residents, business owners, and the city have used architecture to prevent encampments on the street. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I get why people don’t want this suffering in our neighborhoods, I really do, but because we feel so overwhelmed by the hard work we need to do to solve this crisis, people start to lose hope."

Billions have been spent to solve the homelessness crisis in California. However, while zoning laws, law enforcement and services for mental health and addiction all play a part in the solution, several state and local leaders believe only an enormous investment from the federal government can help solve this crisis; more funds are needed for rental assistance or other direct aid. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said "I fear that it’s going to require Congress to move on the big picture."

In this Politifest 2023: California's Biggest Challenges, Voice of San Diego's senior investigative reporter Lisa Halverstadt talks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, about the causes of homelessness. Dr. Kushel discusses the landmark study, the California Statewide Study of People Experiencing Homelessness, that BHHI released in June. "It turns out people who experience homelessness stay where they are. This is a homegrown problem. We can talk for the reasons for that problem, but it's, it's certainly not people rushing into our state to, to enjoy being homeless here" said Dr. Kushel.

Unhoused people made up almost half of heat-related deaths in Los Angeles County last year, though they represent less than 1% of the population. In Sacramento County, the death rate among people experiencing homelessness in 2021 from hypothermia was 215.5 times higher than the county rate overall. California's climate and housing crises are colliding. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said, "Folks experiencing homelessness are on the bleeding edge of the health crises that are happening with extremes of temperature."

On this weeks episode of As Prescribed, Alice Wertz spoke with Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF about the aging homeless population. Older people who experience homelessness tend to have health problems more commonly found in people who are in their 70s or 80s. Recent research has shown that about 48% of adults experiencing homelessness were 50 and above. "They really were hanging on every month, scraping by, barely able to make the rent,” said Dr. Kushel. “And sometime after the age of 50, something happened. And what was really interesting about these folks, as they could kind of pinpoint the moment when things fell apart.” she added.

Homelessness hasn’t necessarily become worse, but it is more visible—especially in CA cities. This is due to a combination of factors, including rising number of people who experience homelessness and living nearly full time one the street, increased real estate development in some cities, and police action in prohibiting and forcing the relocation of people experiencing homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homelessness has become more obvious without necessarily becoming worse. It's much more in your face than it was before."