The Public Health Implications of Homelessness in California Today

Public Health Policy Analysis: AB , as amended -- Homeless Shelters: Safety Regulations.

Today, there are more than 5.5 million homeless people in the United States (The state of homelessness in America, 2021), and tens of thousands of these homeless people are living on the streets in California despite increasingly aggressive attempts by the state government to provide effective solutions to this chronic problem. The purpose of this paper is to provide an overview of a current health problem affecting the State of California that is being addressed by a proposed law, AB 362 and how this new law would address the problem of homelessness in the state today and in the future. In addition, an assessment concerning the severity of the health problems that are associated with California’s homeless problem is followed by an overview of AB 363, as amended (hereinafter alternatively “the bill”) and the respective stakeholders that will be potentially affected by it should it become law. Further, an examination of the promises included in the bill and its corresponding expected outcomes is followed by a discussion of the multiple problems that are arrayed against the bill’s passage and implementation and a description of potential unexpected consequences as a result of the bill becoming law from a public health perspective. Finally, the paper concludes with a series of recommendations that are based on the foregoing research and the findings that emerged.

Overview of the health problem:

Although precise figures are unavailable, most current estimates indicate that California’s homeless problem is amongst the most severe in the United States today, accounting for a significant percentage of the nation’s total homeless population. For example, according to Elias (2021), “No one knows precisely how many of the state’s approximately 161,000 homeless prefer to keep sleeping in tents and under tarps, as about two-thirds of the California homeless do each night” (para. 3). As noted above, California’s mild climate allows this type of homelessness to proliferate even when there are local ordinances against these shelters.

Not surprisingly, California’s homeless population suffers from many if not all of the same health problems as the homeless populations in other states, including most especially respiratory ailments, poor nutrition, dermatological conditions, mental health issues and substance abuse problems (Alarcon & Tipu, 2020), some of which are moderated only in part perhaps by the state’s more temperate climate compared to most other states in the country. Notwithstanding this mediating factor, though, the homeless people living in California are faced with a wide range of health problems that have a severe effect on their well-being as discussed further below.

Severity of the health problem:

In reality, living on the streets with little or no ready access to hygienic facilities, poor nutrition, and exposure to the elements will likely exacerbate any preexisting health problems as well as cause a multitude of others. In this regard, Alarcon and Tipu (2020) emphasize that, “People experiencing homelessness suffer from a risk of mortality three to four times that of the general population and are at high risk for contracting severe acute respiratory syndrome coronavirus 2 and for developing Covid-19 because of underlying comorbidities [including] include lung disease and immunocompromised states” (p. 37). In other words, there are virtually no health problems that homelessness does not exacerbate, and the harsh condition of homelessness can cause a wide array of physical and mental health conditions that were not already present. Against this backdrop, it might appear reasonable to suggest that anything that can be done to alleviate this suffering would receive widespread public support, but this is not exactly the case with the bill as noted below.

Overview of the bill and stakeholders:

In the broadest sense, the stakeholders that are potentially affected, directly or indirectly, by the bill include not only the targeted homeless population of California, but neighboring states and even the entire American taxpaying population as well. Indeed, California’s multi-trillion- dollar budget is the largest in the country and it is reasonable to posit that tremors in the state’s budget for any reason will have nationwide and even global implications. These issues also mean that California lawmakers are already hard-pressed to identify viable and timely solutions to the state’s homelessness problem, but more than two-thirds (66%) of California taxpayers believe that the hundreds of millions of dollars already being spent on this problem have been used ineffectively (Roberts, 2019).

At present, California maintains a network of 691 homeless shelters that employ around 15,000 people that earn in excess of $1 billion with assets of about $2 billion (California homeless shelters, 2021). The network of homeless shelters are primarily based in major urban areas as set forth in Table 1 below.

Table 1

Five most populated homeless shelters in California by city

Metro area

# Nonprofits

Employees

Revenues

Assets

Los Angeles

San Francisco

Riverside

Sacramento

San Diego

Source: California homeless shelters, 2021

It is noteworthy that there are some significant differences in the revenues generated by San Francisco’s 86 shelters compared to Los Angeles’s 270 shelters, with the former earning about $33 million more than the latter despite having just around 32% as many homeless facilities. Irrespective of the metro area involved, though, it is clear that the stakes are high for lawmakers, taxpayers and the homeless alike in California today. It is little wonder, then, that a majority of California taxpayers have become increasingly frustrated with the state’s efforts to address this problem from a humanitarian perspective.

On a far more superficial and inhumane note, however, anecdotal reports indicate that the state’s homelessness problem is also driving many of the more affluent taxpayers to other states simply because they “don’t like looking at them.” For instance, former Olympian gold medalist, former reality television star and current candidate in California’s gubernatorial race, Caitlyn Jenner, recently noted in a televised interview with Fox New’s Sean Hannity: “My friends are leaving California. I said, 'Where are you going?' And he says, 'I’m moving to Sedona, Arizona, I can’t take it here anymore. I can’t walk down the street and see the homeless'” (as cited in Pitofsky, 2021, para. 4). Notwithstanding the fact that this interview took place in a private airplane hangar that is mainly reserved for the ultrawealthy, these sentiments are likely also echoed throughout much of the state’s taxpaying population that is weary of spending even more money on a problem that just seems to get worse.

The main provisions of the bill are broad-based but all have a primary focus on the various health and safety standards that are used for homeless facilities in the state. In sum, if passed, the bill would:

· Establish minimum health and safety standards for homeless shelters, as defined, including, but not limited to, minimum standards for homeless shelter maintenance, interior air quality, sleeping rooms, and laundries.

· Require the housing, building, or health department of a local agency to serve as the enforcement agency and enforce the minimum health and safety standards within their jurisdiction, unless the local agency enters an agreement with the Business, Consumer Services, and Housing Agency Department of Housing and Community Development to enforce those standards.

· Authorize the officers or agents of the enforcement agency to enter all homeless shelters within their jurisdiction and inspect all accommodations, equipment, or paraphernalia used in connection with a homeless shelter in order to secure the enforcement with these provisions.

· Require an enforcement agency that determines a homeless shelter is in violation with these provisions to issue a notice of violation to the owner or operator of the homeless shelter, as specified.

· Require the enforcement agency to conduct at least one announced or unannounced inspection of each homeless shelter within its jurisdiction in every 6 months.

· Require the Business, Consumer Services, and Housing Agency to deem a substandard homeless shelter that fails to come into compliance with these provisions within a specified time ineligible for state funding and federal passthrough funding, as specified.

· Define “state funding” and “federal passthrough funding” to mean any grant, loan, or other type of financial assistance provided under the federal State Community Development Block Grant Program, the federal Emergency Solutions Grants Program, and other specified funding awarded by the state on or after July 1, 2021.

· Terminate specified state funding and federal passthrough funding of a homeless shelter deemed ineligible under these provisions and would deem the homeless shelter ineligible for future state funding and federal passthrough funding opportunities, except as specified.

· Require an enforcement agency to report homeless shelters that fail to comply with these provisions to the Business, Consumer Services, and Housing Agency, as specified.

· Require each enforcement agency to submit an annual report to the agency regarding the compliance of each homeless shelter within its jurisdiction that includes specified information.

· Authorize the Business, Consumer Services, and Housing Agency to adopt regulations regarding the construction and operation of homeless shelters that it determines are reasonably necessary for the protection of life and property and to carry out the purposes of these provisions, as specified (AB-362 Homeless shelters: safety regulations, 2021-2022).

In addition to the foregoing provisions, the bill also includes provisions for the reimbursement of any costs that are incurred as a result of the bill’s passage, implementation and administration to local agencies and school districts as mandated by the state’s constitution (AB-362 Homeless shelters: safety regulations, 2021-2022). Taken together, the foregoing provisions also appear to be a reasonable attempt to ensure the safety and welfare of homeless people living in the state’s network of community-based shelters. While these outcomes may not appear life-changing for most average Californians, they do represent an important initiative that will directly assist the tens of thousands of homeless that currently living in the state and these issues are discussed further below.

Promises/Expected Outcomes:

The primary sponsor of the bill is State Assemblymember Sharon Quirk-Silva who represents California’s 65th District which includes portions of north Orange County and who has championed this and related public health causes in other recent initiatives as well. According to Quirk-Silva, implementation of the bill would improve the ability of homeless shelters across the state to deliver their services in an environment that is safer for the homeless and staff members alike. The bill is also consistent with the recommendations provided by Alarcon and Tipu (2020) concerning what steps are needed for the state in general and southern California in particular. In addition, California Governor Gavin Newsom has also advocated for improved responses and solutions to the state’s homelessness problem which he characterizes as bordering on a crisis (Walters, 2021). Notwithstanding the vast amount of good the bill could accomplish for the state’s homeless population, the bill’s far-reaching provisions also carry a multi-million-dollar price tag that has naturally attracted numerous opponents as discussed below.

Problems:

No right-minded politician is going to come right out and say they are against homeless people and the argument typically focuses on how best to address the antecedents of the homeless condition. Nevertheless, as noted above, a growing number of taxpayers and city leaders are already suffering from “donor fatigue” when it comes to paying for additional services for the state’s homeless population. Likewise, city leaders in major California urban centers such as Los Angeles, San Francisco and Sacramento have also voiced their opposition to any additional spending on existing remedies that do not have the desired effect of actually reducing the state’s homeless population (Elias, 2021). Furthermore, a majority of homeless people in California have refused permanent housing even when it was available due to the combination of temperate climate and the substandard housing alternatives that are typically offered (Elias, 2021).