Recently, California Gov. Gavin Newsom granted $130.7 million for local governments addressing homelessness, including clearing encampments. 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 encampments as they see fit. In early August, Newsom was even filmed removing homeless people’s belongings from public view in Mission Hills in Los Angeles County. The governor is seen at one point grabbing and tossing random items into a pile, and at another, dragging a cart filled with various items including a large blanket. Those must have belonged to someone. What has that person used for cover at night in the two months since? I wonder whether the governor asked himself the same question.
I am now a primary care doctor, and during my training years, I took care of homeless people who arrived at the hospital’s doors for various reasons: a drug overdose, an infected wound, new unexplainable chest pain. These things also happened to people who were not homeless.
But sometimes, I managed the kinds of crises that almost exclusively happened to homeless people. One patient’s belongings were stolen, and she was left without any insulin, a precarious position to be in as someone whose body doesn’t make any because of type 1 diabetes. Of course, she wound up in the ICU in my care with severe diabetic ketoacidosis, a complication of diabetes that can be deadly if not treated urgently.
It wasn’t the first time that had happened. Many patients with heart failure came to the emergency room gasping for air, their hearts flailing and overfilled with blood for the same reason. People with opioid use disorder, experiencing severe withdrawal, arrived with belly pain, diarrhea, palpitations. For the same reason: They had lost their medications during a sweep or after their belongings were stolen overnight, and no insurance plan would prematurely refill such expensive, sometimes tightly controlled medications. These are some of the overlooked consequences of encampment sweeps.
Among many reactions to Newsom’s video, one struck me the most: Abdullah Shihipar, a writer and researcher at Brown University’s People, Place and Health Collective, quote-tweeted the video with the matter-of-fact caption: “he’s stealing someone’s belongings.” I immediately thought about the many patients I’ve taken care of in extreme health crises because someone stole their belongings including their medications, or following the chaos of an encampment sweep.
Some may argue that the stories of homeless people with vulnerable health I am sharing are just anecdotes, and that sweeping the encampments is good overall for the communities afflicted by high homelessness rates. But scientific research on this matter suggests otherwise.
First, chronic conditions requiring daily medications are more common among people who are homeless. Their health is more fragile, with illnesses exacerbated by the lack of adequate shelter. Among those conditions are substance use disorders. In 2023, the Journal of the American Medical Association published an in-depth study of 23 cities in the U.S. which found that involuntary displacement of homeless individuals, usually in the form of encampment sweeps, leads to significant increases in drug overdoses. As I’ve illustrated above, losing one’s medications is likely one of the ways this happens.
But worsening stability is another one, leading to less engagement with the health care system, and making it more difficult for homelessness outreach workers to find them and follow up with them. The same study found that involuntary displacement leads to significant decreases in initiation of medications for opioid use disorder which 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 swept “to protect the safety and well-being of our communities,” to borrow from Newsom’s reaction to the SCOTUS ruling. In some cities, there may be theoretically enough shelter beds to house the homeless population, in which case, officials may be even less sympathetic to those who opt out of shelters to sleep in encampments. But the reality is more complicated. Shelter beds are not necessarily guaranteed, and they often have strict occupancy rules that render shelter-living either impossible for individuals deemed less vulnerable (e.g., men with no children), or an infantilizing, even oppressive experience for adults who may have lost a lot materially but would like to preserve their dignity and autonomy.
To be clear, clearing trash from the street is an important aspect of our environment’s health, but it must be delineated from clearing the possessions of those who are homeless. (Greater availability of trash cans on the street would likely reduce the extent to which garbage piles up near homeless encampments.) Encampment sweeps may help maintain a veneer of order in our cities, but they do not address the deeper problem of the overwhelming homelessness rate in California. After executing the largest study of homelessness in California, University of California, San Francisco researchers made clear recommendations on how to reduce and prevent homelessness, based on the stories from across the state: increase the stock of affordable housing, strengthen eviction protection laws, and raise the income of adults experiencing extreme poverty. These are common-sense policies that will require time to come to fruition.
In the interim, 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’ “Inside Safe” program to move people from encampments to vacant hotel rooms is a good example, and it has contributed to reducing the number of unsheltered Angelenos. Bass reminds other leaders that encampment sweeps do nothing but shuffle people around without solving key underlying issues in California: the low number of shelter beds for homeless people and the dearth of affordable housing.
Bass is on the right side of history: Encampment sweeps only brush the problem under the rug.
Max Jordan Nguemeni 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 Reaction” about culture, politics, and health.