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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."

Oregon is one of several states betting on housing and outreach programs using Medicaid funds. Officials hope that by keeping people from experiencing medical crises that lead to repeated emergency room visits, Oregon will save enough money to pay for increased housing costs. California is also working to implement a program similar to Oregon's, spending more than $100 million a year on housing from its Medicaid budget. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative said, "I know that if I could get my patients who are experiencing homelessness housing, we could make everything else work better".

West Virginia leads the nation in overdose deaths per capita, presenting a paradox to people who believe that drug use is to blame for the increase in people experiencing homelessness in cities. People who lose housing are more likely to increase their drug and alcohol use. Furthermore, experiencing both homelessness and drug addiction lengthens the time it takes to solve each problem. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said, "People conflate these crises. They are related but they are far from one and the same."

Nearly one-third of all Americans experiencing homelessness live in California. Starting in the fall of 2021, Aaron Shrank and Sam Comen conducted interviews and photographed unhoused people living in Los Angeles and Northern California as a companion piece to the University of California San Francisco Benioff Homelessness and Housing Initiative’s California Statewide Study of People Experiencing Homelessness to shed light on those affected. You can read a lightly condensed version of their stories. More of Comen and Shrank’s work is available at the website Unhoused CA.