Recently, California Governor Gavin Newsom awarded $130.7 million to local governments addressing homelessness, including clearing camps. It comes in the wake of a June Supreme Court ruling that gave cities full authority to implement and enforce policies that would allow them to clear camps when they see fit. By early August, Newsom was tied filmed removing the belongings of homeless people from public view in Mission Hills in Los Angeles County. The governor is seen at one point grabbing random items and throwing them into a pile, and at another point dragging a cart filled with various items, including a large blanket. They must have belonged to someone. What did that person use for cover at night in the next two months? I wonder if the governor has asked himself the same question.
I’m now a GP and during my training I cared for homeless people who arrived at the hospital for various reasons: a drug overdose, an infected wound, new unexplained chest pain. These things also happened to people who were not homeless.
But sometimes I managed the kinds of crises that happened almost exclusively to the homeless. One patient’s belongings were stolen and she was left without any insulin, a precarious position as someone whose body does not produce insulin due to type 1 diabetes. Naturally, she ended up in the ICU under my care with severe diabetic ketoacidosis, a complication of diabetes that can be fatal if not treated urgently.
It wasn’t the first time that happened. Many patients with heart failure came to the emergency room for the same reason gasping for air, their hearts flailing and overflowing with blood. People with opioid use disorder who had severe withdrawal symptoms presented with abdominal pain, diarrhea and palpitations. For the same reason: they had lost their medications during a search or after their belongings were stolen overnight, and no insurance policy would prematurely replenish such expensive, sometimes tightly controlled medications. These are some of the overlooked consequences of clearing encampments.
Of the many responses to Newsom’s video, one stood out to me the most: Abdullah Shihipar, a writer and researcher at Brown University’s People, Place and Health Collective, quoted the video with the factual caption: “He’s stealing someone’s belongings.” I immediately thought of the many patients I have cared for in extreme health crises, either because someone stole their belongings, including their medications, or after the chaos of a camp cleanup.
Some may argue that the stories of homeless people in fragile health that I share are just anecdotes, and that sweeping the encampments is generally good for the communities affected by high homelessness rates. But scientific research shows otherwise.
First, chronic conditions requiring daily medication are more common among homeless people. Their health is more fragile and diseases are exacerbated by the lack of adequate shelter. These conditions include substance use disorders. In 2023, the Journal of the American Medical Association published a in-depth study of 23 US cities showing that the involuntary displacement of homeless people, usually in the form of camp cleanups, leads to a significant increase in drug overdoses. As I illustrated above, losing medications is likely one of the ways this happens.
But the deterioration in stability is another cause, leading to less involvement in the health care system and making it more difficult for outreach workers to find and monitor them. The same study found that involuntary displacement leads to significant decreases in the use of medications for opioid use disorder that we know are tremendously protective against overdoses and overdose deaths.
To many officials, the presence of homeless encampments is a symptom of chaos in the city, and they must be wiped out “to protect the safety and well-being of our communities,” Newsom said. response to the SCOTUS ruling. In some cities, there may theoretically be enough shelter beds to house the homeless population, in which case officials will be even less sympathetic to those who choose not to stay in the shelters but to sleep in encampments. But the reality is more complicated. Shelter beds are not necessarily guaranteed, and often are strict occupancy rules which either make shelter life impossible for individuals considered less vulnerable (e.g., men without children), or become an infantilizing, even oppressive experience for adults who may have lost much materially but would like to maintain their dignity and autonomy.
To be clear, picking up trash from the streets is an important aspect of the health of our environment, but it should be separated from picking up the belongings of homeless people. (Greater availability of trash cans on streets would likely reduce the rate at which trash piles up near homeless encampments.) Encampment sweeps can help maintain order in our cities, but they do not address the deeper problem of the overwhelming homelessness rate . in California. After running the largest study of homelessness in CaliforniaResearchers from the University of California, San Francisco have made clear recommendations on how to reduce and prevent homelessness, based on stories from across the state: increase the stock of affordable housing, strengthen laws protecting against evictions and increase adult incomes who live in extreme poverty. This is a common sense policy that will take time to come to fruition.
In the meantime, it is critical that leaders address the barriers homeless people face when seeking refuge in our shelters and identify alternative short-term housing options. In Los Angeles, Mayor Karen Bass said “Inside Safe” program moving people from encampments to vacant hotel rooms is a good example, and it has helped reduce the number of unsheltered Angelenos. Bass reminds other leaders that clearing encampments does nothing but shuffle people around without solving California’s core underlying problems: the low number of homeless shelter beds and the lack of affordable housing.
Bass is on the right side of history: Encampments only sweep the problem under the rug.
Max Jordan Nguemeni is a family physician and assistant professor of general internal medicine and health care research at the David Geffen School of Medicine at UCLA, where he conducts health equity research. He writes the Substack column “Side effect‘about culture, politics and health and was a 2021 STAT Wunderkind.