What it will take to end homelessness in the Bay Area

Recent reports from the homeless Point in Time counts confirm what Bay Area residents know: Homelessness remains our region's biggest challenge. What these counts do not show are the successful efforts to prevent and end homelessness for thousands — and how much worse the problem would otherwise be.

That these efforts have fallen short does not mean they were the wrong strategy, but rather that the scale has not met the need.

To truly understand this crisis, we must first acknowledge the true causes of homelessness in our community. While the visible individual circumstances of people experiencing homelessness may grab our attention, decades of evidence shows that the underlying causes of homelessness are the interlocking problems of structural racism, income inequality and lack of affordable housing for low-income households.

The research is clear: When there is more affordable housing in a community, fewer people experience homelessness. On that score, California fails. In California, there are only 23 units of housing available and affordable for every 100 households with “extremely low-incomes,” or those who make less than 30% of the region's median income. Using this metric, California is short 1 million units of housing.

Mounting evidence shows how our homelessness crisis has been exacerbated by systemic racism. Policies excluding people of color from buying homes, such as redlining and exclusionary zoning, the targeting of Black and Brown households for predatory lending before the 2008 foreclosure crisis, and ongoing discrimination in rental housing have all led to the stark racial disparities in homelessness that we see today.

Fortunately, strategies focused on addressing these root causes of homelessness can have tremendous impact.

Decades of high-quality scientific evidence have shown that providing affordable housing with permanent subsidies and supportive services, if needed, is the best way to end homelessness. Such programs have for years successfully housed more than 90% of those with the most severe disabilities. For others, providing ongoing rental assistance (such as Housing Choice Vouchers) and some help navigating the system is enough to keep folks stably housed. Further, studies show that prevention interventions — such as one-time rent payments and legal support in eviction proceedings — can successfully prevent people from becoming homeless.

When policymakers scale evidence-based solutions, we see tangible results. That's exactly what the federal government did with veterans, and we've seen veteran homelessness reduced by half when homelessness among other groups has increased.

So, what will it take to end homelessness?

The scale of the underlying challenges means that it will take even greater commitment and resources to provide safe, affordable housing for all.

Policymakers at all levels must invest in proven solutions at the scale of the need in our communities. For example, the following actions would make a huge positive impact.

All local jurisdictions must invest more in affordable housing for the lowest income renters, launch large-scale targeted homeless prevention programs, and rapidly bring more supportive housing units online; the state must create a permanent, dedicated source of funding to build and operate more affordable and supportive housing and fund other proven housing solutions; and the federal government, which provides rental subsidies for only 25% of eligible households, must make housing vouchers an entitlement, like food stamps or Medicare.

Seeing our neighbors struggling to survive in conditions unfit for human habitation is shocking and unacceptable. We have a collective interest in solving the homelessness crisis. To do so, we need to follow the evidence, double down on what is working and commit the resources necessary to end this crisis.

Dr. Margot Kushel is a professor of medicine at UC San Francisco, and division chief and director of the UCSF Center for Vulnerable Populations. Tomiquia Moss is the founder and chief executive officer of All Home. Jennifer Loving is the chief executive officer of Destination: Home.