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DATE: |
September 27, 2022 |
21 |
SUBJECT: DECLARING HOMELESSNESS A PUBLIC HEALTH CRISIS (DISTRICTS: ALL)
B
OVERVIEW
A person’s housing stability is inextricably linked to their health. Living on the streets is unsafe, inhumane, and causes harm to people’s physical and mental health. The County of San Diego (County) has made deep investments to address homelessness and its associated public health ramifications. The County’s recently created Department of Homeless Solutions and Equitable Communities (HSEC) has made great strides in a short time to address the needs of people experiencing and at-risk of homelessness. HSEC has created bold, specific, and attainable plans in the County’s Framework for Ending Homelessness (Framework) as well as the County’s Comprehensive Homeless Policy. These guiding documents speak to the significant actions HSEC has undertaken to provide outreach, services, and a path to permanent housing for people experiencing homelessness in the region. Additionally, virtually every department within the County’s Health and Human Services Agency has programs that address the health and wellness of our unhoused community members. As a County, we are investing in behavioral health services, homeless outreach, strategic housing solutions, and working with local jurisdictions, non-profits, and businesses to tackle homelessness. The County’s programs, services, goals, and investments acknowledge the intersection of homelessness and health. Formally declaring homelessness a public health crisis will advance the priority of solving homelessness with innovation and by further coalescing all County departments, local jurisdictions, community stakeholders, and resources toward the shared goal of preventing and ending homelessness.
RECOMMENDATION(S)
CHAIR NATHAN FLETCHER AND VICE CHAIR NORA VARGAS
1. Declare homelessness a public health crisis.
2. Direct the Chief Administrative Officer to:
a. Act as the lead convener with the 18 incorporated cities and with the Regional Task Force on Homelessness acting as the backbone organization to foster collaboration and further the work towards developing a comprehensive, innovative regionwide approach to addressing homelessness, including cross-system solutions, clear lines of responsibility and partnership, and associated metrics for purposeful results and embed updates on the regional collaboration in the regular reporting to the Board on the County’s Framework for Ending Homelessness.
b. In the 2023 first quarter update to the Board on the County’s Framework for Ending Homelessness, which includes a comprehensive assessment of services and housing offered to people experiencing homelessness, also include:
i. recommendations to continue to optimize services and access to housing;
ii. potential new incentives to cities and community partners to create emergency housing solutions, permanent housing, and affordable housing;
iii. innovative approaches to reducing public health disparities among those experiencing homelessness;
iv. the potential economic impact to the County associated with unaddressed homelessness; and
v. financial investments needed to significantly reduce homelessness.
c. As part of the County’s Homeless Solutions and Prevention Action Plan led by Department of Homeless Solutions and Equitable Communities to identify needs and opportunities for access to housing and supportive services, develop short-term and long-term recommendations based on the needs and gaps identified in the comprehensive assessment being conducted by Homebase.
d. In the 2023 first quarter update to the Board on the County Framework for Ending Homelessness, develop a plan for implementation of the policies set forth in the County’s Comprehensive Homeless Policy, A-128, including, but not limited to, enhancing data collection capabilities, developing dashboards that measure the performance and outcomes of the County’s homeless services and programs, establishing metrics for coordination and alignment of County services, 24-hour access to social workers or appropriately trained professionals and associated after-hours housing options, expanding social work services for crisis situations when law enforcement responds to calls for service, and preventing disruption of public benefits during people’s life disruptions.
e. Authorize the Agency Director, Health and Human Services Agency to research and apply for future funding opportunities related to addressing the public health crisis of homelessness throughout the region in the current and future fiscal years.
EQUITY IMPACT STATEMENT
According to the Regional Taskforce on Homelessness, from October 2020 through September 2021, there were at least 21,000 individuals who accessed temporary housing such as shelters or interacted with homeless outreach workers. Additionally, during 2022 Point-in-Time Count, the one-night snapshot of homelessness in our region, 8,427 individuals were identified as living on the streets or in shelters. People of color are disproportionately represented amongst people experiencing homelessness with 24 percent of unsheltered individuals identifying as Black or African American-roughly five times the proportion of African Americans in the region. Additionally, over 3 percent identify as American Indian, Alaska Native, or Indigenous - nearly three times the proportion in the region. People over the age of 55 are also over-represented in the unsheltered community. Of those experiencing homelessness in the region, 12 percent have physical disabilities. Ensuring equity in all aspects of homelessness prevention is a key principle in the County’s Framework for Ending Homelessness. Bringing the focus of the entire County enterprise to solving the public health crisis of homelessness will assist those who are disproportionately represented in the homeless system.
SUSTAINABILITY IMPACT STATEMENT
Declaring homelessness a public health crisis will result in sustainability enhancements in terms of health/wellbeing, equity, economy, and environment. It will contribute to County of San Diego Sustainability Goal No. 2 to provide just and equitable access to County services and Sustainability Goal No. 4 to protect the health and wellbeing of everyone in the region. Using a public health lens to address homelessness will improve the overall health and resiliency of the vulnerable population experiencing homelessness and the health and resiliency of our communities.
FISCAL IMPACT
There is no fiscal impact associated with today’s action. There may be future fiscal impacts based on recommendations resulting from today’s action, for which staff will return to the San Diego County Board of Supervisors with recommendations for consideration and approval. Funding for future costs will need to be identified by the Health and Human Services Agency and will proceed once identified. The department will monitor its budget and return to the Board with mid-year action to adjust the budget as necessary and/or incorporate future budgets as funding becomes available. At this time, there will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
There is a high cost to the negative impact homelessness has on human life, health, and productivity. This board letter sets forth the dramatic effects homelessness has on the health of the individual, but it also impacts the health and well-being of the surrounding community.
As we assist in the economic recovery of COVID-19, it is essential to ensure that the business community has an environment where they can thrive, where workers feel safe, and families feel welcome. As the government entity responsible for providing a broad range of health and social services to promote wellness, self-sufficiency, and a better quality of life for all, it is critically important to elevate the need to find a solution to homelessness across the enterprise.
Details
ADVISORY BOARD STATEMENT
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BACKGROUND
There is an interdependence between a person’s housing stability and their health. The Centers for Disease Control and Prevention describes homelessness as a public health concern and states that “[h]omelessness is closely connected to declines in physical and mental health.” People experiencing homelessness die, on average, 25 years earlier than people with homes. Homelessness leads to higher rates of chronic conditions, increases the risk of serious mental illness and substance use conditions, leads to endemic stress and sleep deprivation, increases food insecurity, among a host of other health ramifications. Conversely, when people have stable housing, their health is improved - they are less at risk for infectious disease, and they are able to prioritize their health needs to a greater degree than someone who is fighting for survival without a home. It is clear that the solution to homelessness and the health of those living on the streets are homes.
The health and wellbeing of thousands of San Diegans who experience homelessness are impacted by the conditions presented with not having housing. In San Diego County, 14 percent of people experiencing homelessness have chronic health conditions, 18 percent have mental health conditions, 12 percent have physical disabilities, 13 percent have substance use disorders, and 25 percent are 55 years or older. Compared to those who are housed, people experiencing homelessness are twice as likely to have diabetes and almost twice as likely to have high blood pressure or suffer a heart attack. Conditions such as HIV, Hepatitis C, depression, and substance use disorders are found at dramatically higher rates in those experiencing homelessness.
Furthermore, this vulnerable population has been susceptible to communicable infections as evidenced by the COVID-19 pandemic, the Hepatitis A outbreak of 2017, and the shigella outbreak of 2021. In San Diego County, 22.4 percent of individuals experiencing homelessness who contracted COVID-19 were hospitalized, compared to 3.7 percent of the general public who contracted COVID-19. Those experiencing homelessness were almost three times more likely to die from COVID-19 than the general public. People who experienced homelessness in 2017 more likely to contract a Hepatitis A infection, at increased risk of hospitalization, and almost three times more likely to suffer death from the infection. In the most recent shigella outbreak, virtually all cases were among individuals experiencing homelessness.
Approaching a complex problem with a public health lens acknowledges that health and well-being is influenced by a wide range of factors, many of which fall outside of typical idea of health care. These determinants of health include, where people live, income, access to food and health care, and more. All of these social determinants of health are impacted by homelessness.
Taking a public health approach is grounded in prevention and involves crafting data-driven solutions that are interdisciplinary in nature. This strategic approach leverages the expertise of experts in homelessness services, housing, public health, and behavioral health to inform collaborative efforts, evidence-based programming, and data-informed approaches. The tools the County effectively used to combat COVID-19 - data, a focus on both individual and population outcomes, a whole person approach, local partnerships, and frequent meetings to identify what needs to be done - are all public health tools that can be used to address homelessness.
HSEC and the departments of HHSA have been strategically working at the intersection of health and homelessness and they have set forth additional ambitious plans that “ensure interdisciplinary coordination” and “efforts related to behavioral and physical health, public health, housing, public safety, and the built environment that impact people at risk of or experiencing homelessness.” Additionally, in December 2021, HSEC contracted with Homebase to conduct a comprehensive needs assessment of homelessness and housing needs in the county which will also take into account the need for cross-sector planning to address the interconnectedness of chronic disease and disability and homelessness. The region will benefit from this comprehensive assessment and ensuing recommendations to address the needs and gaps identified. The County’s work preventing and ending homelessness will also be strengthened by the operationalizing of existing County policies related health and homelessness adopted by the Board in February 2022 and set forth in the County’s Comprehensive Homeless Policy, A-128.
People experiencing homelessness are required to navigate multiple systems across multiple providers and jurisdictions, including County outreach and health services, municipal housing programs, non-profit services, and more. Sustainable solutions to the challenge of homelessness requires agencies crafting solutions to move out of disciplinary and jurisdictional silos and provide a unified interdisciplinary approach that acknowledges that homelessness and health are interconnected. Declaring homelessness a public health crisis is an important step to advance the priority of solving homelessness by coalescing all jurisdictions, stakeholders, and resources in crafting solutions to the public health crisis and may open innovative funding streams.
No one level of government can solve the homelessness crisis. Meaningful progress to reduce homelessness is only achievable through development of a comprehensive system - from shelter and housing to services and rehabilitation - that recognizes the integral role of all local governments working as partners. The working partnership proposed in this Board Letter will align our local governments with opportunities for collaboration and clear responsibilities to meet the unique needs of our diverse communities and to address the public health crisis of homelessness. From that solid foundation, developing partnerships with local businesses and non-profit sectors will naturally align with the region’s shared goal of preventing and ending homelessness.
Stable housing makes it easier to become and remain healthy. Conversely, being healthy helps people remain stably housed. The solution to homelessness and the health of those who are experiencing homelessness are homes. The County of San Diego has devoted extraordinary resources to ending homelessness in recent years, including HSEC and HHSA’s interdisciplinary approach to caring for unhoused residents. The approach has at its core the intersection between health and housing. It is time to formally acknowledge that homelessness is a public health crisis that deserves an urgent, cross jurisdictional response.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s action supports the County of San Diego’s 2022-2027 Strategic Plan initiative of Equity by promoting the value of equity in health and housing.
Respectfully submitted,
CHAIR NATHAN FLETCHER VICE CHAIR NORA VARGAS
Supervisor, Fourth District Supervisor, First District
ATTACHMENTS
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