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In this op-ed, Maya Vijayaraghavan, MD, MAS, director of the UCSF Smoking Cessation Leadership Center, highlights the need for widespread access to tobacco treatment among people experiencing homelessness and the structural issues underpinning tobacco use. She emphasizes that in the homelessness advocacy and provider community should not normalize tobacco use among people experiencing homelessness and there is increased awareness and trained staff in shelters to provide tobacco treatment. "Providing tobacco treatment will substantially reduce harm, save lives, and improve financial stability by supporting quitting." Dr. Vijayaraghavan writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Violence against people experiencing homelessness has increased. In Los Angeles, three people experiencing homelessness were killed. The killings are a stark reminder that those experiencing homelessness are profoundly vulnerable. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The public is often very frightened of people who experience homelessness. But what they don’t realize is that people experiencing homelessness are frightened all the time."

Unhoused patients have worse outcomes and higher health care utilization compared to their housed counterparts. Previous research has primarily focused on physical and behavioral health. This retrospective cohort study investigated the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes. Researchers found that unhoused patients commonly underwent emergent operations and had more complex hospitalizations.

A record number of seniors are burdened by high housing costs. A new report from University's Joint Center for Housing Studies sounds the alarm as the US population ages rapidly. The number of seniors who will qualify for federal housing subsidies will continue to grow. The report also notes that more people over the age of 50 are losing housing for the first time. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Increasingly, the story of homelessness among adults is going to be older adults living in poverty, who are spending what should be their retirement years in the streets."

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."

In this op-ed, Cheyenne Garcia, senior research analyst at the Benioff Homelessness and Housing Initiative, advocates for policymakers, elected officials, funders, and activists to update the definition of homelessness to include those temporarily staying with family and friends. She emphasizes that the current practice of classifying such people as at risk of, rather than as experiencing, homelessness, denies them access to necessary resources and the opportunity to exit homelessness. "It is vital to dedicate more resources to those who are staying in precarious housing situations that can leave them homeless on the streets or in shelters at any time." Ms. Garcia writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

The UCSF BHHI recently released a report on the largest representative study of homelessness in the United States since the mid-1990s—the California Statewide Study of People Experiencing Homelessness (CASPEH). The CASPEH was guided by a Lived Expertise Advisory Board—a group of advisors from across the state of California who represent a range of lived and living experiences of homelessness—from rural and urban, living sheltered and unsheltered, young and old, in families and single. This webinar is about creating authentic and meaningful collaborations between researchers and people with lived experiences. Panelists discussed how this partnership between BHHI and the CASPEH LEAB brought equity, collaboration and shared power to each phase of the CASPEH. They also talked about what they did together and shared tips for forming a board to advise on research projects and programs.

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."

In this op-ed, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, explains how neighborhood design and homeownership are entrenched in Jim Crow-era segregation practices. She outlines how the discriminatory, race-based residential segregation, has contributed to Black households being disproportionately vulnerable to displacement. Dr. Ponder writes, "Structural, institutional and interpersonal racism in our housing, criminal justice and education systems mean that Black Americans disproportionately struggle to find consistent housing, are vulnerable to displacement into homelessness and face more barriers when trying to get rehoused." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Marguerita Lightfoot, PhD, MA, Associate Dean for Research at the OHSU-PSU School of Public Health, calls attention to youth experiencing homelessness in Sacramento. She outlines the higher rate of mental health-related hospitalization among youth, with almost 70% of youth experiencing homelessness reported experience depression and anxiety. Dr. Lightfoot also highlights the resources and programs that would help. "Every person experiencing homelessness needs help. But youth are too often treated as adults, and do not receive the tailored, developmentally appropriate services they require." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Leslie W. Suen, MD, MAS, an assistant professor of medicine in the UCSF Division of General Internal Medicine at San Francisco General Hospital, highlights the lack accessibility of the most effective evidence-based treatment for opioid use disorder in California. She outlines the effectiveness of methadone treatment to help people with opioid use disorder, and how Californians restrictions regarding methadone create unnecessary barriers to care. "If having to go to a clinic every day for medication isn’t onerous enough, California tacks on additional state laws that make staying in methadone treatment even more challenging for patients" said Dr. Suen. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, explains how homelessness in California is a housing issue. Others often blame California's homelessness problems on high rates of mental health and substance-use problems, but the data tells a different story. Dr. Kushel writes, "It has taken decades for California to develop its housing crisis, and it will take many years to fix it. Making the wrong diagnosis and prescribing the wrong solution won’t end the crisis." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

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."