Governor Newsom of California and advocates agree that the homelessness crisis is decades in the making, but opinions differ over whether Governor Newsom's conservative policy approach will help fix the issue. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "There is no easy way out of this. I have deep compassion for everybody’s frustration. I’m frustrated. I want this problem to be over. I understand this is unacceptable, but I think when you’re in a hole, you need to stop digging."

Governor Gavin Newsom issued an executive order on July 25, 2024, providing authority for state and local officials to clear unsafe homeless camps. The order advises local jurisdictions to adopt a version of the California Department of Transportation encampment policy, requiring officials to give people experiencing homelessness in encampments a 48-hour notice before a sweep and work with organizations to help anyone displaced. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "In the long term, ending homelessness in California will require increased investments in housing and support services, while simultaneously making it easier to rapidly develop affordable housing."

On July 25th, 2024, Governor Gavin Newsom issued an executive order directing state agencies to clear "dangerous" homeless encampments from state land. State agencies will assess encampments to identify any “imminent threat to life, health, safety or infrastructure.” The new executive order faces criticism from civil rights groups and advocates for people experiencing homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "If we move people from one place to another place, that doesn’t meet our goal."

Existing literature on people experiencing homelessness (PEH) draws on non-representative samples from service providers, populations with comorbidities, or areas with disproportionately high sheltered homelessness, leading to bias. Nearly a third of PEH in the US and over half of unsheltered PEH live in California. Researchers from the UCSF Benioff Homelessness and Housing Initiative designed a rigorous state-representative survey of PEH to investigate the antecedents of homelessness, understand health, and inform policy solutions. This is the first large representative study of PEH, beyond a single county, to draw inference on a large population that did not depend on service utilization.

Oakland begins a sweep of a homeless camp since the US Supreme Court's landmark ruling in City of Grants Pass v. Johnson last month loosed clearance rules. This sweep highlights the need for more housing and shelter. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "At the end of the day, what people really want is housing."

The prevalence of tobacco use among populations experiencing homelessness is between 60% and 80%. In this qualitative study, researchers examined attitudes toward tobacco control policies among older African American homeless-experienced smokers. Researchers identified seven major themes from their in-depth semistructured interviews. They found that older African American homeless-experienced smokers face significant barriers to smoking cessation.

In a long-term study of older people experiencing homelessness in Oakland, 26% of the participants died within a few years of being enrolled, UCSF BHHI researchers found. The study, funded by the National Institute on Aging, recruited people who were 50 and older and homeless, and followed them for a median of 4.5 years. Researchers examined how factors like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected participants' risk of dying. They found that people who first became homeless at age 50 or later were about 60% more likely to die than those who had become homeless earlier in life, and those who remained homeless were about 80% more likely to die than those who were able to return to housing.

As cities work to clean up homeless encampments under increasing pressure from Gov. Gavin Newsom and housed residents, RV communities present a distinct — and notoriously difficult — challenge, especially with more and more Californians taking up residence in them. UCSF Benioff Homelessness and Housing Initiative Director, Margot Kushel, found in her research that people living in RVs are reluctant to give them up for anything short of permanent housing — a dilemma when there’s little to offer. Berkeley officials designed their strategy with that in mind. To get the program to work, city staff and nonprofit outreach workers spent roughly three months coaxing residents, explaining their offer, listening to concerns and making accommodations to the shelter policies where possible. A one-dog-per-person rule stretched to allow four dogs in one room; friends were allowed to bunk together.

Graham Pruss, PhD, a post-doctoral scholar at the UCSF Benioff Homelessness and Housing Initiative, was interviewed about a Portland, OR, vehicular campsite in a year that saw a self-made community confront its disaffiliation from the rest of society. “Vehicle residency is the biggest problem in America that no one’s talking about,” said Pruss.

In California during the pandemic, Project Homekey has created housing for people experiencing homelessness by purchasing hotels and converting them to housing. Each room is life changing to a degree that almost no other intervention can provide. In long-term studies of homeless people who have moved to permanent housing, Margot Kushel, MD, director of the UCSF Benioff Homelessness Initiative has found that basically every determinant of health improves.

Tobacco use is common in people who experience homelessness; however, research in homeless and unstably housed (HUH) women is sparse. Researchers found that the most common reason for tobacco use was to reduce stress and anxiety. The findings suggest that tailored counseling and healthcare interactions that include smoking cessation efforts and address food insecurity during treatment.

The California Statewide Study on People Experiencing Homelessness researchers included people who were formerly or are currently experiencing homelessness. In this op-ed, Claudine Sipili, one of the Lived Expertise Advisory Board co-chairs, writes about the landmark study and her experience participating with the project. She writes, "Throughout the study, the board members’ guidance helped create a safe and dignified space for survey participants to share their experiences openly. By involving individuals with lived experience, we gained deeper insights into the complexities of homelessness."

Margot Kushel, MD, and Kirsten Bibbins-Domingo, MD, discuss how the pandemic has highlighted "a tale of two Californias."

In this op-ed, Margot Kushel, MD, Tomiqua Moss, and Jen Loving explain how scaling evidence-based solutions to prevent and end homelessness can yield tangible results. They characterize the underlying, interlocking causes of homelessness as structural racism, income inequality, and lack of affordable housing for low-income households. "The research is clear: When there is more affordable housing in a community, fewer people experience homelessness," they write. "Providing affordable housing with permanent subsidies and supportive services, if needed, is the best way to end homelessness. Such programs have for years successfully housed more than 90% of those with the most severe disabilities."

In this op-ed, Ryan Assaf, PhD, MPH, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights the common misconception among many Californians that substance use is the primary cause of people losing their housing. He outlines that drug use is correlated with the length of time someone is homeless and the extremity of their living conditions. Dr. Assaf calls for a housing first approach, writing, "Regardless of an individual’s drug use, policymakers and advocates should prioritize getting people experiencing homelessness into safe, secure and stable housing." 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, Meghan D. Morris, PhD, MPH, an associate professor at the University of California, San Francisco, explains that the proposed Homeless, Drug Addiction and Theft Reduction Act will not solve California's retail theft, but instead crowd Californian's prisons. She outlines how Proposition 47, which passed in 2014 to revise penalties for nonviolent lower-level drug offenses, reduced the state's prison population and reinvested funds in counties. Dr. Morris writes, "We risk losing another generation to the consequences of incarceration that we’ve finally begun to tackle." 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.

People experiencing homelessness have inadequate resources for regular dental hygiene and a higher prevalence of risk for tooth loss, including smoking and substance use. This study aimed to describe the prevalence of and factors associated with oral health measures in a sample of older homeless adults in Oakland, CA. Researchers conducted a cross-sectional analysis of data from a population-based study of 350 homeless adults aged ≥50. They found that tooth loss and oral pain are highly prevalent in older homeless adults.