In this op-ed, Alma Yates, MSW, the Education Program Manager at the Benioff Homelessness and Housing Initiative, and Lourdes Johanna Avelar Portillo, PhD, an alumni postdoctoral fellow with the Benioff Homelessness and Housing Initiative, call to recognize menstrual health as a human right. Many countries and the United States have tried implementing initiatives that address menstrual health inequities, but "period poverty" continues, especially in armed conflicts." Dr. Portillo and Ms. Yates write, "Everyone who menstruates –  in conflict zones and refugee camps, in shelters and unhoused – needs and deserves access to necessary information, sanitary products, and facilities to manage their periods safely and with dignity." 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, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, outlines the civic responsibility physicians have, even as private citizens, to be thoughtful in how they share their views. She explains that free speech protections are crucial for physicians regarding their practice of clinical medicine, but physicians should take care to not create an environment that could cause patients harm. Dr. Raven writes, "While hate speech from a physician's private social media account may be protected by the First Amendment, it stands in stark contrast to the ethical embodiment of 'first do no harm.'" 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, Claudine Sipili, one of the California Statewide Study of People Experiencing Homelessness Lived Expertise Advisory Board co-chairs, calls for restoring dignity to people experiencing homelessness. She outlines the need to prioritize human worth and respect while pursuing practical solutions to address homelessness. "The erosion of dignity that comes from losing one’s home can make it more difficult to take advantage of housing solutions." Ms. Sipili 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.

This paper describes the qualitative component of a large mixed method study, the California Statewide Study of People Experiencing Homelessness. The qualitative study consisted of seven sub-studies across eight counties, each exploring different dimensions of homelessness. BHHI researchers recruited participants from the overall sample, a statewide representative sample of adults experiencing homelessness recruited in eight counties, based on their responses to questions from the survey interviews. The researchers' mereological study design presents an approach for developing complex qualitative policy studies across a range of topic areas.

The Centers for Disease Control and Prevention recommends new covid-19 booster vaccines for all. A boost in protection is important to protect people against severe COVID and death. However, structural factors have prevented booster uptake among those who could benefit the most from the vaccine. Booster rates among people who experience homelessness is largely unknown. Tiana Moore, PhD, the Policy Director at the UCSF Benioff Homelessness and Housing Initiative is concerned that people experience homelessness face high barriers to vaccination. Dr. Moore said, "Many of our participants talked about concerns about leaving their belongings when unsheltered since they don’t have a door to lock."

There are a lot of myths about people who are homeless in California: They’re from another state. They don’t want a job. They don’t want a home. A new study published by the University of California, San Francisco, paints a different picture, one of people who were working and living in poverty in the state until they suddenly lost their homes. Not knowing where to turn, they ended up on the street, where they endure violence and poor health as they try for years to climb back to stability. “Something goes wrong, and then everything else falls apart,” said the study’s lead researcher, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Everything in their life gets worse when they lose their housing: their health, their mental health, their substance use.”

People who inject drugs (PWID) experience housing instability and other structural barriers, making it hard for PWID to complete direct-acting antiviral (DAA) treatment of Hepatitis C. Researchers found that simple, low-cost medical storage containers, can be incorporated as a key component of a medication management plan. It is important to create a non-judgemental approach to providing HCV care.

Black Californians make up only 7% of the states population, but make up more than 25% of the state's population of people who experience homelessness. The number is higher in Sacramento County, where 31% of the population experiences homelessness. The obstacles to housing, employment, income and health care that Black Californians have historically faced are also among the pathways to homelessness. "The situation for unhoused Black Californians is dire, but it is not insurmountable,” said Tiana Moore, PhD, the report’s co-author.

This UCSF study examined whether permanent supportive housing reduces the use of acute health care and other services among people experiencing chronic homelessness. The Permanent Supportive Housing program intervention was able to house 86% of chronically homeless adults randomized to the treatment group based on their high use of multiple systems. Even the most frequent clients of medical, psychiatric, and emergency services were housed successfully, as demonstrated in this study of Project Welcome Home in Santa Clara County.

This New York Times article reports on increasing deaths among people experiencing homelessness and highlights a recent JAMA Network Open study from UCSF Benioff Homelessness and Housing Initiative researchers. BHHI faculty members Maria Raven, MD, and Margot Kushel, MD, are quoted.

Safe Ground Sacramento is a nonprofit that advocates for the decriminalization of homelessness and the establishment of Safe Ground communities. In March 2023, Safe Ground Sacramento signed a lease with the city of Sacramento. Under this agreement, the city cannot close Camp Resolution until every resident has been placed in "individual permanent durable housing." The agreement with the city is set to expire in June and the city has decided not to request an extension. This is the fourth installment of a 4 part series exploring solutions to homelessness in California.

California state lawmakers say they need more tools to help get people experiencing homelessness into treatment, debating the use of involuntary commitments. Homelessness is caused by a lack of affordable housing, not mental illness. “The problem of homelessness is that people don't have housing. If you had all the treatment in the world and you didn't have the housing, we would still have this problem,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

Cancer is the leading cause of mortality for people experiencing homelessness (PEH). However, not much is known about cancer-related surgical outcomes among PEH. This retrospective cohort study aimed to characterize access to care among PEH, evaluate postoperative outcomes, and assess costs associated with surgery for malignancy among PEH. Researchers found that PEH were less likely to undergo surgery for malignancy at cancer centers than hose who are housed. People experiencing homelessness also had a higher risk of requiring unplanned surgery.

As the coronavirus alters daily life for many Californians, state leaders are facing the confluence of two public health challenges: the virus and homelessness. “What you are seeing is two crises—homelessness and the virus—collide,” says Margot Kushel, MD, director of the Center for Vulnerable Populations at UCSF.

There is a massive shortage of affordable housing for people with very low incomes in California. Only 24 units of housing are affordable for every 100 extremely low income households in California, compared to 33 units nationally. To address the housing crisis, the statewide study on people experiencing homelessness recommend a variety of policies to increase affordable housing and provide more effort to prevent people from becoming homeless. "This is all about the disconnection between people’s incomes and housing costs" said Margot Kushel, MD, a physician who treats homeless people, and the lead investigator of the study for the UCSF Benioff Homelessness and Housing Initiative.

In this op-ed, Ryan Assaf, PhD, MPH, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights the benefits of adding Middle Eastern or North African to the US Census. He emphasized the diverse culture in the MENA communities and the importance of separating Middle Eastern or North African from White. "When Middle Eastern or North African is included as White, we lose any insight to the impact MENA communities experience." Dr. Assaf 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.

California is home to 30% of the nation's homeless population, and 50% of the nation's unsheltered population. The UCSF Benioff Homelessness and Housing Initiative released the largest representative study on homelessness in decades. The study's findings dispel common myths and take a systematic approach to understanding the causes of homelessness and potential solutions. Inside the Issues host Alex Cohen speaks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, about the landmark study and the root causes of homelessness. When talking about older people experiencing homelessness, Dr. Kushel said, "The story of homelessness in California is really older adults, usually older adults of color, living their last years on our streets."

Public policy academics Pamela Herd and Don Moynihan have an interesting brief in Health Affairs on how administrative burdens can harm the health of low-income people. Herd and Moynihan quite literally wrote the book on administrative burdens, so their work on the subject is always worth a look.

Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. Researchers conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. They assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). Researchers found a low prevalence of engagement in a full range of ACP behaviors, including contemplation, discussions, and formal ACP documentation.

In this op-ed, Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, and Gregg Colburn, Ph.D., an associate professor at the University of Washington, call for providing subsidized housing with services to people experiencing homelessness. They outline the lack of access to housing, the increase in rent, and the ongoing challenge to provide permanent housing. "The answers to homelessness are clear. It is critical that policymakers in local, state and federal governments use their power to address the acute affordable housing shortage that plagues communities in every state in the nation." Dr. Kushel and Dr. Colburn write. 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.

When pandemic aid programs begin expiring at the end of September, advocates worry that San Francisco’s most vulnerable homeless women will once again be left behind. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed the rate of violence impacting homeless seniors, women, and transgender people. After two decades of studying high rates of assault and the health impacts of homelessness, she has watched Bay Area seniors placed into hotels during the pandemic transform, to the point where staff didn’t recognize some of them. “It’s been a life-changing experience,” Dr. Kushel said. “When people regain housing, everything gets better.”