California Governor Gavin Newsom recently awarded $130.7 million to local governments to address homelessness, including clearing encampments. This follows a June Supreme Court ruling that gave cities full authority to implement and enforce policies that would allow them to remove encampments if they deem it necessary. In early August, Newsom was also filmed removing homeless people’s belongings from public spaces in Los Angeles County’s Mission Hills. At one point, the governor is seen grabbing random items and throwing them into a pile, and at another time he is seen dragging a cart filled with various items, including a large blanket. They must belong to someone. What did that person use as a nighttime hideout for the past two months? I wonder if the governor asked himself the same question.
I’m currently a primary care physician, but during my training I worked with homeless people who came to the hospital for a variety of reasons, including drug overdoses, infected wounds, and new unexplained chest pain. I was there. This also happened to people who were not homeless.
But they also dealt with crises that occur almost exclusively to homeless people. One patient’s belongings were stolen and she was unable to take any insulin. As a patient with type 1 diabetes whose body does not produce insulin, he was in a precarious position. Of course, she suffered from severe diabetic ketoacidosis and ended up in the ICU with diabetic complications that could lead to death if not treated urgently.
This wasn’t the first time something like this had happened. Many heart failure patients come to the emergency room in search of air, but for the same reason: their hearts are trembling and flooding with blood. People with opioid use disorder and experiencing severe withdrawal symptoms arrived with abdominal pain, diarrhea, and heart palpitations. For the same reason, they lose their medications while cleaning or after their belongings are stolen overnight, and no insurance plan will prematurely refill such expensive and sometimes tightly controlled medications. It was. These are some of the often overlooked impacts of encampment sweeps.
Of the many responses to Newsom’s video, one that stood out to me the most was Abdullah Schichper, an author and researcher at Brown University’s People Places and Health Collective, who said: He quoted and tweeted the video with a factual caption. ”I immediately thought of the many patients I have cared for who have fallen into extreme health crises after someone stole their belongings, including their medicine, or after the chaos of encampment clearing.
Should we let a homeless patient use an ER bed on a frigid night, or should we free it up for someone who needs it more?
Some argue that my stories of homeless people in poor health are merely anecdotal, and that cleaning up encampments is an overall good thing for communities plagued by high rates of homelessness. Maybe. However, scientific research on this issue suggests otherwise.
First, chronic illnesses that require daily medication are more common among homeless people. Their health is more fragile and their illnesses are exacerbated by the lack of proper shelter. Some of these conditions include substance use disorders. In 2023, the Journal of the American Medical Association published a detailed study of 23 U.S. cities that found that involuntary evacuation of homeless people, usually in the form of encampment sweeps, was linked to drug overdoses. found that it led to a significant increase in As explained above, losing your medication can be one of the reasons why this happens.
But declining stability is also a problem, reducing engagement with the health care system and making it more difficult for homeless workers to identify and follow up with homeless people. The same study found that involuntary transportation significantly reduced medication initiation for opioid use disorder, which was found to significantly prevent overdoses and overdose deaths.
For many officials, the presence of homeless encampments is a sign of disorder in the city and, to borrow Newsom’s response to the SCOTUS ruling, they must be cleared “to protect the safety and well-being of our communities.” need to. Some cities may theoretically have enough shelter beds to house the homeless population, but in that case, authorities may be less sympathetic to people leaving shelters and sleeping in encampments. Maybe not. But the reality is more complicated. Beds in shelters are not always guaranteed, and there are often strict occupancy rules, making shelter living impossible for individuals deemed more vulnerable (such as childless men). Either it becomes an infantilizing and even oppressive experience for adults who may have lost a lot. Yes, materially, but we want to protect their dignity and autonomy.
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To be clear, removing trash from the streets is an important aspect of environmental health, but it must be distinguished from removing homeless people’s belongings. (More trash cans on the streets would likely reduce the amount of garbage accumulating near homeless encampments.) Cleaning up encampments may help maintain some surface order in cities, but It does not address the more serious problem of high homelessness rates. In California. After conducting the largest study of homelessness in California, researchers at the University of California, San Francisco have made clear recommendations on how to reduce and prevent homelessness, based on stories from across the state. That means increasing the stock of affordable housing, strengthening eviction protection laws, and increasing incomes for adults living in extreme poverty. These are common sense policies, but they will take time to materialize.
In the meantime, it is important for leaders to address the barriers homeless people face in sheltering and identify alternative short-term housing options. In Los Angeles, Mayor Karen Bass’s “Inside Safe” program, which moves people from camps to empty hotel rooms, is a good example, helping to reduce the number of unsheltered Angelenos. Bass told other leaders that encampment clearing only drags people around and solves important fundamental problems in California, such as a lack of homeless shelter beds and a lack of affordable housing. He warned me that there was nothing to do.
Buses are on the right side of history. Encampment sweeps only cover up the problem.
Max Jordan Guemeni is a primary care physician and assistant professor of general internal medicine and health services research at UCLA’s David Geffen School of Medicine, where he conducts health equity research. He writes the Substack column “Adverse Reactions” on culture, politics, and health.
