We need to talk about race in solutions to homelessness

Six days after Gov. Gavin Newsom declared a state of emergency, the LA Alliance for Human Rights, a coalition of business interests formed in the guise of protecting human rights, sued the city and county of Los Angeles. It alleges that local leaders are failing to provide beds for all of Los Angeles’ 59,000 individuals experiencing homelessness. While the lawsuit was not filed in response to the COVID-19 pandemic, within days of the filing, U.S. District Judge David O. Carter called all parties, including intervenors — advocates for people experiencing homelessness — to an emergency hearing. The lawsuit therefore became a forum to hold the city and the county accountable for formulating and executing a plan to ensure the safety of unhoused individuals during this state of emergency.

Communities across California are taking unprecedented action to protect public health and safety, including rapidly attempting to provide shelter for people experiencing homelessness. At stake are the individual lives of thousands of people whose health and well-being are challenged by lack of shelter each day — a public health crisis that existed long before the pandemic. That crisis will only be magnified as COVID-19 takes hold in encampments and crowded shelters.

What should not be lost in the rush to meet this moment are the existing racial disparities in homelessness and service delivery, including who is housed and who stays housed. Black people experience homelessness at much higher rates than all other races and ethnicities. That reality, overlaid with racial disparities already apparent in access to COVID-19 testing and treatment, shows we cannot afford to ignore race if we are to develop and maintain systemic solutions to homelessness.

The LA Alliance for Human Rights Sues the Government on Behalf of Business Interests

LA Alliance for Human Rights ostensibly seeks to hold the city and county accountable for the homelessness crisis. The Alliance is particularly concerned with the use of public funds earmarked for addressing homelessness, urging that these funds can be used more effectively to move people off of the streets. In its lawsuit, the Alliance takes aim at the effort to build supportive housing, which the suit states is too expensive and slow, and frames the need as not for this type of long-term housing, but for immediately available beds.

The lawsuit was filed with the right sense of urgency, but with a skewed perspective of the humanitarian issues at stake. Contrary to its name, the LA Alliance for Human Rights is primarily composed of downtown Los Angeles business interests whose profits have been disrupted by the effects of homelessness on the streets. The lawsuit misuses the spirit of the welfare and civil rights laws that it relies on for its complaint, including the 14th Amendment’s equal protection clause, the California Disabled Persons Act, and the Americans with Disabilities Act. These laws are intended to ensure a humane quality of life for the poor and equal participation in society for protected classes of people, not to advance the profit-making interests of private businesses that are at the heart of the lawsuit.

Despite the flawed premise, the lawsuit did succeed in immediately bringing together city and county officials, homeless advocates, and business interests to address the concerns posed by COVID-19. It is imperative, however, that local officials do not waste this opportunity to start implementing long-term solutions to homelessness, and do so with a race equity lens.

Systems and Institutions Created Racial Disparities in Homelessness

Efforts to address or ameliorate homelessness can never be effective if they do not intentionally examine race and racism in the causes, conditions, and proposed solutions. Noticeably absent from the Alliance’s 92-page complaint was mention of how homelessness disproportionately affects black people, and how any equitable or injunctive relief necessarily involves addressing that racial disparity.

In downtown Los Angeles, the area the lawsuit is most concerned about, nearly half of the individuals experiencing homelessness are black, yet black people represent only 9% of the general population in Los Angeles County. Homelessness, as discussed in a previous article, is the result of failures in our public and private institutions. Among these failures is the failure to adequately address racial inequities in the design and outcomes of housing and social services programs. The history of anti-black racism is directly related to the disproportionate representation in the unhoused population. Our public officials need to examine the links between racism and poverty and homelessness, and from there, design solutions that meaningfully address the consequences.

The Los Angeles Homeless Services Authority, a joint powers authority of the city and county of Los Angeles established to administer services, has taken some steps to apply a race equity lens to its work. In 2018, LAHSA convened the Ad Hoc Committee on Black People Experiencing Homelessness. The ad hoc committee issued a report with recommendations to improve racial equity in service delivery by LAHSA, the city, the county, and nonprofit homeless service providers.

The ad hoc committee’s recommendations demonstrate how program design, though well-meaning and seemingly objective, can exacerbate racial disparities. Its report questioned the accuracy of the screening tool used to qualify individuals for housing services and housing placement. The Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) assigns a numerical score to individuals based on various metrics that determine the scope of services that would be provided. The VI-SPDAT has been shown to be racially biased, skewing towards higher placement in permanent housing for white individuals in other cities. Although Los Angeles County may not have the same disproportionate placement in permanent housing, the county must acknowledge and study the other challenges in using this test, such as whether it accurately scores the needs of people experiencing homelessness, especially when race influences why and how people experience homelessness.

The ad hoc committee also reported that black people experiencing homelessness face a disproportionately higher rate of return to homelessness from permanent supportive housing, even though they are housed at the same or even a slightly higher rate than counterparts of other race or ethnicity. This may signify that these individuals and families do not obtain adequate services or supports to maintain housing.

These instances of facially-neutral program designs that ended up contributing to racially-disparate implementation outcomes were created in relatively calm deliberation, where there was greater opportunity to mitigate racial bias. Contrast this with the present need for fast and urgent program design in the midst of a pandemic, which may unintentionally exacerbate existing racial disparities.

During Pandemic, Silence on Race in Homelessness and Health is Unacceptable

The leading cause of death among black people experiencing homelessness is coronary heart disease. Heart disease is a serious underlying medical condition that puts people at greater risk for severe illness from the coronavirus. In Los Angeles County, people experiencing homeless are three times more likely to die from coronary heart disease than people in the general population. The mortality rate is increasing for black people experiencing homelessness, as compared to the rate for whites, which is decreasing.

The Los Angeles Department of Public Health posits a theory for this differential trend in mortality rates: if white people experiencing homelessness are perceived to present as sicker than black and Latino counterparts, they may be more likely to meet the health-related criteria used for placement in supportive housing. As designed, the LAHSA vulnerability screening tool assigns more points to those who report health-related problems and thereby prioritizes them for housing. Relying on individuals to self-report health conditions, however, is not a true indicator of health risk since diagnosis and treatment is shown to be racially skewed where physician decision-making is influenced by implicit bias, leading to lower standards of care. The VI-SPDAT should therefore be more closely examined, as algorithms used in other systems have for whether it produces racially disparate results.

Racial disparities in accessing health care and services in times of crisis are playing out right now in the general population. Testing criteria requires health care providers to verify symptoms or exposure to a confirmed COVID-19 case. Both criteria give advantage to people who generally have more access to health care and first access to testing. In the past several weeks, COVID-19 testing results show more positive tests in Los Angeles County’s white, higher income neighborhoods, such as Melrose, Beverly Hills, and West Hollywood, with 86 to 147 positive tests each, as compared to lower income neighborhoods of color in South Los Angeles and the Northeast Valley, which report less than half those amounts.

Despite apparent disparities in who has access to testing and treatment, neither the state nor Los Angeles County have released complete race and ethnicity data related to COVID-19 testing, hospitalizations, or mortality. The county released its first trickle of race data on April 7, and only did so after mounting pressure from advocates and the public. In contrast, other states and municipalities are reporting race-related data and addressing racial equity issues head on. So should we.

Emerging information about testing disparities show how vulnerable our social systems are to perpetuating racial inequity. All of this — high rates of homelessness, chronic conditions, and medical bias — are likely to subject black people experiencing homelessness to worse outcomes in this pandemic. In times of crises, the need for quick decisions often creates racially biased results. Our systems default to entrenched policies and practices that supported racism.

The LA Alliance lawsuit inadvertently has created a forum to address two crises at once, and race should be included in these discussions. As our policymakers decide how to allocate resources, we must continue to demand that they are racially equitable. 