Photo by Jon Rendell Photography
Throughout my life, especially living in San Francisco for many years, homelessness has been a major issue affecting lots of people. As you may know, San Francisco is a very wealthy city and there is no excuse for the number of houseless people on the streets. When I was there in 2022, I was appalled at the conditions of the city. One morning I was taking my car in to be serviced at 8A in the Tenderloin and it was a bit frightening. Arriving early allowed me to walk around and get familiar with my hometown. It was difficult to walk on the sidewalk or pathways because of the large number of naked people sleeping on the pavement or sitting on the ground helping each other to inject heroin or fentanyl into their arms, necks, legs, or penises. The average visitor would have been terrified, but I soon realised that I was invisible to them just like they were to the police officers who walked by constantly. People living on the streets were of all genders, all races, and all ages from 18 to 85 years old.
While working for the San Francisco Department of Public Health, I knew that the city received lots of government funding, millions of dollars to provide better services for those living on the streets. However, funds were not used to assist them. After speaking to one of the directors in the department, I was told that I was too caring and sensitive to accept that nothing could be done to help 'those' people and their families. Needles were all over the city. They were found on the floor of buses, in playgrounds for children, on Muni & Bart train tracks, and almost everywhere. I struggled to understand where all the funding went since it didn't go towards housing or feeding those who needed it the most. I continued to question if people were drug addicts and had to live on the streets, or if they started using drugs to survive and live on the streets. I learned there is a mixture of reasons and that no one could be described by looking at them.
Homelessness is a complex issue with multiple contributing factors—economic, social, political, and personal. While it may be difficult to "solve" entirely, strategies like affordable housing, supportive services, job training, mental health care, and substance abuse treatment have been shown to significantly reduce homelessness in some regions. Finland, for example, has successfully reduced homelessness with its "Housing First" model, which prioritizes permanent housing as the first step to stability.
I became curious about how many people are unhoused in America. As of January 2023, there were an estimated 582,462 unhoused individuals in the U.S., according to the Department of Housing and Urban Development's (HUD) annual point-in-time count. This number, though significant, only represents those counted on a single night and may underestimate the true number of unhoused people due to factors like temporary housing arrangements or lack of engagement with outreach teams.
People surviving on the streets in San Francisco or anywhere in the world are stronger than I am. I doubt if I could survive very long. There are so many things many of us take for granted, such as having a safe place to live with food, fresh water, warm clothing, and heating. Although we may complain, we have jobs that help us to exist. The number of deaths among unhoused individuals varies by location, but it is alarmingly high. For example, in Los Angeles County, over 1,600 unhoused people died in 2021, largely due to preventable causes like drug overdoses, violence, and exposure to harsh weather. Nationwide, the mortality rate for unhoused individuals can be 3 to 4 times higher than the general population, with hundreds, if not thousands, dying each year from similar causes.
Why do people become unhoused? Several factors contribute to homelessness, including:
Economic hardship: Lack of affordable housing, stagnant wages, unemployment, and eviction.
Health issues: Mental illness, physical disabilities, and chronic diseases.
Substance abuse: While not always the cause, it can exacerbate housing instability.
Family breakdown: Domestic violence, child abuse, or family rejection (e.g., for LGBTQ+ individuals).
Systemic issues: Structural racism, lack of social safety nets, and gentrification.
Homelessness affects people of all ethnicities and ages, though some groups are disproportionately affected. For instance, Black Americans account for about 13% of the general U.S. population but represent over 40% of the unhoused population. Native Americans and Latinx communities are also overrepresented. In terms of age, adults make up the majority of the unhoused, but youth homelessness is a growing concern. Around 34,000 youth under 25 experience homelessness without an accompanying adult, and older adults are a rising demographic as well.
Many unhoused individuals face daily struggles for survival, including finding food, shelter, and safety. Some manage through shelters, while others live in encampments or vehicles. Charities, government assistance, and community-based outreach programs provide temporary relief, but systemic issues often make it hard to escape long-term homelessness. For many, the cycle of poverty, addiction, mental health struggles, and lack of affordable housing keeps them in survival mode.
Substance abuse is both a cause and a consequence of homelessness for some individuals. Addiction may lead to the loss of housing due to job loss, family breakdown, or legal issues. Conversely, living on the streets can lead to increased substance use to cope with trauma, isolation, and exposure to violent or unsafe conditions. I remember seeing a well-dressed man in his 40s sitting on a sidewalk near my place of employment. Being very curious, I stopped and asked if I could talk to him. He smiled and said yes as he put down the book it was reading. The book reminded me of my college days. He was reading The Birth of Tragedy by Friedrich Nietzsche, not an easy book to read. I asked why he was living on the streets. Once again, he smiled and offered me to sit with him, so I did. He explained that he had been traumatised by the death of his wife and two children when a drunk driver ran a red light and killed them. He said, " I am unable to move forward with my life. He was a successful medical doctor who needed time to figure his new life out. He lost his home and family and needed to escape. A life lesson taught me to not judge anyone without walking a mile in their shoes.
Mental health plays a major role in homelessness. It is a significant factor. Around 25% of the unhoused population suffers from severe mental illnesses, such as schizophrenia, bipolar disorder, or depression, which makes it hard for them to maintain stable housing. Mental health services are often underfunded and inaccessible, contributing to a cycle where untreated conditions worsen, leading to chronic homelessness. Often you may see people shouting obscenities, screaming, or simply talking to themselves. There are times when they can become violent.
California has the largest population of unhoused individuals, accounting for about half of the national total. Cities like Los Angeles, San Francisco, and San Diego struggle with high numbers of unhoused individuals, driven by skyrocketing housing costs and insufficient affordable housing. New York City also has a large, unhoused population, though more are in shelters than on the streets compared to West Coast cities. Addressing homelessness will require comprehensive solutions, from affordable housing and healthcare reform to more robust mental health and addiction services.
The question of how to respond to unhoused individuals on the street is one that many people struggle with, as it brings up concerns about compassion, responsibility, and effectiveness. There are different approaches to be considered when encountering unhoused people:
Giving Money
Pros
Immediate Help: A small financial contribution can provide a temporary solution to basic needs, such as food, water, or hygiene products.
Empowerment: Giving money allows individuals to choose what they need most at that moment, respecting their autonomy.
Cons
Concerns Over Spending: Some people worry that money given will be spent on harmful substances like alcohol or drugs. However, there is no way to know how the money will be used, and it's not fair to assume.
Short-term Fix: While money can meet immediate needs, it does not address the long-term issues that contribute to homelessness.
If you do choose to give money, doing so without judgment and with the understanding that it's a gesture of compassion can make a difference for the individual, even if it doesn't change their circumstances dramatically. Some people prefer to give unhoused individuals food, water, or clothing rather than cash. Remember to always ask first instead of just assuming that's what they want. Often, I have seen people give them food that usually gets thrown in the closest garbage bin. Hygiene products, blankets, socks, jackets, or even gift cards to local grocery stores or restaurants may be useful.
One way to help the unhoused population more sustainably is by donating to or volunteering with local organizations that provide shelter, meals, job training, mental health services, and other critical resources. Charities, food banks, or outreach programs can have a greater long-term impact on the lives of unhoused individuals by offering structured support. If you feel comfortable, simply acknowledging someone can be powerful. A kind word, eye contact, or a brief conversation can give someone dignity, as unhoused individuals often report feeling invisible or isolated from society. If you are brave enough, you can also ask what they may need. Sometimes people appreciate someone taking the time to ask if they want a meal, directions to a shelter, or just a human connection. Be aware not to engage with someone angry or shouting. It's important to protect yourself first.
We can address homelessness at a broader level by advocating for policies that increase affordable housing, expand social services, and improve mental health and addiction treatment programs and safe spaces. Voting for initiatives that support these goals or getting involved in local government can contribute to structural solutions that reduce homelessness in the long term.
Whether you choose to give money, offer food, or support through advocacy, it's important to approach unhoused individuals with respect and empathy. The issue of homelessness is complex, and no single action will resolve it. However, small acts of kindness, combined with larger systemic efforts, can help make a difference in both individual lives and society. If you feel unsure, consider asking local outreach groups for advice on the best ways to help in your specific community. We can push our community leaders to create more affordable housing units, convert vacant buildings into shelters, and develop more accessible mental health and addiction treatment facilities. Together, we can all raise awareness by using social media, blogs, or community events to spread awareness about the reality of homelessness and push for systemic change. Dispelling myths about homelessness and educating others about the challenges unhoused people face can build support for more compassionate policies.
Public opinion plays a huge role in shaping government policies. Many people still hold harmful stereotypes about unhoused individuals, seeing them as solely responsible for their situation. As individuals, we can challenge these narratives by educating others and promoting understanding. By raising awareness about the root causes of homelessness, such as systemic poverty, lack of affordable housing, mental health issues, and addiction, we can build public support for compassionate policies that address these issues. I work hard at not discriminating because I have learned that we are all drug users, be it recreational or pharmaceutical drugs.
For me, this is why voting is so important. Voting in the presidential election can help shape national priorities. If homelessness and housing policy are important to you, you can support candidates who advocate for federal action on affordable housing, healthcare reform, and funding for social services. These issues may not get as much attention without a public mandate from voters. We must hold our elected officials accountable for what they promise by voting. If current representatives are not doing enough to address homelessness or housing, voting them out of office and electing new leadership can bring about change.
Voting on November 5, 2024, in America or voting in your country, can make a real difference, especially if you're concerned about homelessness and other social issues. While the political system can feel slow to change, elections are one of the most direct ways to influence policies and elect leaders who prioritize creating solutions. All votes matter, and yours could be the one that helps steer the country toward more compassionate and effective policies on homelessness.
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