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Bakersfield focused its efforts on a specific goal in 2015, to reach functional zero chronic homelessness, and by January 2020, it hit the mark. Access to quality data was essential to knowing every person experiencing homelessness, but also cooperation among agencies and strong engagement from the healthcare system was key to achieving this goal. Unfortunately, Bakersfield could not sustain functional zero homelessness. It was hard to secure affordable units. Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UC San Francisco, said "The rates of homelessness and the ability for people to exit homelessness really has everything to do with the availability and affordability of housing for low-income folks." This is the second installment of a 4 part series exploring solutions to homelessness in California.

More than 181,000 Californians were unhoused in 2023, with nearly 70% living on the streets. Cities provide resources for emergency solutions, but it is not really a solution. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re at a place in California, unfortunately, where doing well is often running in place." This is the first installment of a 4 part series exploring solutions to homelessness in California.

Homelessness has surged in the United States. It is a devastating public health crisis with ruinous, often permanent, effects on people’s lives. Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UC San Francisco, said, "We will not solve this problem by denying the enormous trauma that people who’ve experienced homelessness have been through.”

About 130,000 Montanans have lost Medicaid coverage as the state re-evaluates everyone's eligibility following a federally mandated pause in disenrollment that began during the COVID-19 pandemic. People experiencing homelessness may not have the resources to fill out the paperwork and being without health coverage can be risky. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Being out of your asthma medicine for three days can be life threatening."

During the COVID-19 pandemic, the number of Americans who got their health coverage from Medicaid increased. States are now required to check that every person is still eligible for Medicaid. However, some people who do qualify have accidentally lost coverage. This is particularly harmful for people experiencing homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "It doesn't seem like such a big deal to fill out paperwork. Put yourself in the position of an elder who's experiencing homelessness and has lost their vision and has no access to computer, no access to car, doesn't have a cell phone."

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 UCSF 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.

More Californians have fallen into homelessness, and more have died while unhoused. However, the state’s ability to track these deaths and assess the scope of the problem hasn’t kept pace. In 2022, California added a field to death records for homeless status. The data is essential to assess the state's public health interventions and shape decisions. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "One of the problems with not reporting it is that it makes it harder to act."

Margot Kushel, MD, director of the UCSF 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."

In this podcast episode of Clinical Changemakers, Margot Kushel, MD, director of the UCSF 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?"