Why there are so many unsheltered homeless people on the West Coast

1/4 of homeless people in the U.S. live in California, despite Californians making up only 12 percent of the population

Lantz Rowland poses in front of his tent outside Seattle, Washington. REUTERS/Shannon Stapleton

One-quarter of homeless people in the U.S. live in California, despite Californians making up only 12 percent of the population.

Not only is homelessness more common on the West Coast but it is also more visible, because a higher proportion of homeless people are unsheltered. In the U.S., 24 percent of homeless people sleep outside, in vehicles or somewhere else not meant for human habitation. But that varies greatly from place to place: In California, 68 percent of homeless people are unsheltered, compared to just 5 percent in New York.

Visitors to the West Coast may be shocked to find the tents that line cities from San Diego to Seattle. Like a modern-day “Grapes of Wrath,” the tents are a stark reminder of the suffering of the thousands living outside, homeless.

What’s to blame for such high numbers of unsheltered homeless on the West Coast? The reason isn’t drug use, mental health problems or weather. Rather, it is due to the extreme shortage of affordable housing.

Life unsheltered

As a physician and researcher who provides medical care for people experiencing homelessness, I have seen firsthand how devastating homelessness is to health.

Being unsheltered is terrifying, humiliating and isolating. People living without shelter lack access to toileting facilities, sinks and showers. They have no way to store or prepare food and no protection from the elements. Hunger is common.

Sleeping in makeshift beds or on the ground, they get little sleep. They must contend with having their possessions stolen. They face frequent forced moves, which disrupt relationships and make it difficult for family, friends or service providers to find them.

People who are unsheltered are at high risk of physical and sexual abuse. If they struggle with substance use disorders, their use of drugs and alcohol occurs in public, leaving them open to arrest. There are no places to refrigerate or store medicines, no place to receive mailed appointment reminders or a visit from a visiting nurse, no place to dress a wound or plug in medical equipment like oxygen. Without access to hygiene facilities, they are at high risk for communicable diseases like hepatitis A.

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