Episode 249: Unhoused and Underserved 

Lizzy: Hi, I'm Lizzy Ghedi-Ehrlich

Lisa: and I'm Lisa Hernandez.

Lizzy: And we are your hosts for Scholars Strategy Network's No Jargon. Each month we'll discuss an American policy problem with one of the nation's top researchers without jargon. And this month we're talking about the homelessness crisis facing the country with a focus on what can we actually do.

Lisa: It's so interesting to think about the issues that people who are houseless are facing because it encompasses so much. It's, there's so many, like basic necessities that need to be met, that when you think about it, they're also basic necessities that everyone in this country should have met. Um -

Lizzy: Hmm.

Lisa: So I feel like it's, it's very encompassing of so many issues that are just like basic human rights that people should have access to.

Lizzy: Right. And if you have access to them, if you have your own home, or if you're just fitting the model of the type of American that we allow to exist in public spaces, you can go into a shop. And do certain things there. And it turns out that doesn't apply to everyone. And if you're not living in an urban center where houselessness is very visible, I think it can be really easy to not think about this at all in the ways that our public infrastructure has changed to not support people.

It's, it's subtle if you've maintained the privilege of being able to use public and private spaces equally to meet your needs. And that's just not true of everybody living in America.

Lisa: Yeah, I mean it's, it's interesting to think about where people are allowed to be, um, according to even just face value, like what that person looks like, what they seem like. Because I mean, most people are able to access a store or a supermarket, et cetera, but when you are someone that is visibly supposed to be on the outskirts of society, according to, you know, all these policies that we have in place that are pretty much keeping people without a house, without access to their basic necessities, then you're not even allowed to meet your basic needs by going into a private facility, like the rest of us do.

Like if I have to use the restroom and I'm outside, I could potentially go to a Walgreens, um, and use the restroom there. But some people are denied access to even that.

Lizzy: Yeah. Well, it turns out it's actually affecting everyone more than we know. This need for policy to define who is allowed to be in the public versus who is not, is affecting people who are not experiencing houselessness. And it has a public health implication as well. It's not just about making people who don't have homes uncomfortable so that they -

I don't even know what the effect of that is supposed to be, how that would help them. Um, but it's also that if you deny people's spaces where they can meet their basic hygiene needs, that's gonna be a problem. And it's not gonna be a problem just for them. Um, this is a community issue, not just about equality or humanity or any of those things, but I'm excited to get into it with our expert today.

In this week's episode, I spoke to Megan Welsh Carroll, Associate Professor of Criminal Justice and Public Administration, as well as Director of the Project for Sanitation Justice at San Diego State University. She currently conducts research about the disappearance of basic sanitation resources in urban environments.

How people experiencing housing deprivations survive in sanitation deserts where restroom access is limited or of poor quality, and how we can work toward a vision of sanitation justice amid climate change and widespread housing affordability crises. Here's our conversation.


Lizzy: Hi, Professor Carroll. Thanks so much for coming on No Jargon.

Megan: Thank you so much for having me, Lizzy. I'm excited to be here.

Lizzy: So we are equally excited to talk about community-based support, resources for individuals who are affected by homelessness. Um, you know, that's a big part of your expertise. But before we get there, I wanna set the scene a little bit. Talk to me about the housing crisis in this country.

Megan: Oh boy. Lizzy, how much time do we have and where should I begin? Um,

Lizzy: Sorry, starting off real big. See what? See what you can do.

Megan: Starting with the big questions. Well, so for folks who maybe aren't a total data nerd around housing and homelessness issues in the US, I can set the scene for you with just a few, statistics just to kind of drive home what's happening and then, we can kind of take it from there.

So, you know, more than half a million people on any given night in the US are experiencing homelessness. this is of increasing concern here in our country because we had about a decade or so where homelessness was decreasing. and then around 2017 we started to see an uptick. And then as we know, the Covid 19 pandemic and our housing affordability crisis that you've already mentioned has really, uh, made that a lot worse for folks.

And so I'm speaking to you from San Diego, California, which we're typically ranked around number five in terms of the number of folks experiencing homelessness in our community. We' re ranked about fifth in the US. Um, so this is something that we're talking about locally here every day.

It is a headline, right? It is a news story here.

Lizzy: Number five. That's pretty high up there. Tell us what you know then, as a person living in that situation, you know, who is most affected by homelessness? Like San Diego is having an issue. What does San Diego share with maybe other cities that are ranked pretty high up there? Like, where are we feeling the most impact?

Is there a difference between rural versus urban settings? Is it about access to other services like healthcare?

Megan: You know, homelessness exists everywhere. It is more visible in some locations than others. Folks of color are most affected by homelessness,full stop, over the course of a person's life. If you are Black or African American, you are three times more likely to experience homelessness

at some point compared to a White American. And that rate is about twice as likely for Black folks compared to Hispanic or Latino identifying folks . Individuals with physical disabilities make up about 10% of the general public, but amongst the homeless population, and especially folks living outdoors, which is what we refer to as unsheltered homelessness, about 58% of folks experiencing unsheltered homelessness have some sort of physical disability, 58%.

Lizzy: I wanna pause to unpack that for a minute. Um, and we are actually, we, so our next question was about to be talking about the distinction between sheltered and unsheltered homelessness. And now you've got me really interested in that distinction and exploring it, but also people with physical disabilities.

Why so much of this particular type, like what are the levers that work there causing that?

Megan: That is a bigger question than I think we can answer in the time that we have together here today. But we need more conversations about exactly that question. Lizzy, our social safety net is not showing up for folks the way we need it too, and we see it most profoundly for folks with chronic illnesses, mental health issues, these systems of support that we have in place are egregiously and long-term underfunded, and so folks are not getting the help that they need in order to stay in housing. And then as we'll discuss once you fall out of housing into homelessness, pulling yourself out of that hole. And the systems that we have available to support people in doing that are simply not where we need them to be, to meet the amount of need that we have currently across the US and in our local communities.

Lizzy: I also want to call myself out a little bit for noting what I thought was a pretty, you know, striking statistic, um, about the disproportionate makeup of people with physical disabilities who are represented within unsheltered homelessness populations, and not. That same reaction to disproportionality by race, among homelessness populations because I'm, I'm realizing that there's an idea there that when we're talking about populations in the US by race, of course, I accept that our, the policies we have and the safety net we provide is going to result in unequal racial outcomes.

And so I didn't gasp at that in the same way. And I wanna, I wanna note that for everyone and how that's something I wanna explore in myself and change, um, because that is very wrong and that is just as striking a statistic. And that is just as much evidence of the failure of some of these systems. And also something else that I'm sure is equally true for people with disabilities, that it's not just that we don't have the right types of supports in place or enough to meet demand, but also that maybe some of these policies are designed specifically to not support certain groups of people.

Megan: Bingo. Completely agree. Yes. Uh, and that's really what I've devoted my research agenda to trying to illuminate. Right, which is, you said something so important there about really taking for granted that racism is baked into our social policy. That's something we all do, right? Because it's been around for so long that I think we struggle to think outside of it to different alternatives.

How can we undo what is literally, as you're saying, centuries of racial discrimination that play out across our social systems, but that we see so profoundly here, um, when we talk about housing deprivation.

Lizzy: So I wanna take this big amorphous, wicked problem of poverty and drill it down a little bit. Like what are we, if we can get away from that idea of, man, this is huge. Man, this is beyond any one of us. Then we can sort of take it apart and think about what is in the realm of something that is actionable or a research question that could actually be answered.

 And I love that we're about to talk about what you actually do, which I think is just a great example of like what it looks like when someone is comfortable with, you know, categorizing an issue at that big, giant level, and then still doing something that has an effect. So first up, uh, on that chain of command, we wanna talk a little bit about federal policy efforts.

You know, when people are living in their own city, they're seeing unhoused people it, it's often thought of as a state or municipal problem. But as we've just shown, you know, it's related to all of these big other huge policy things that we do have some federal control over. So are there any, you know, current efforts that the Biden Administration is making to increase, you know, housing for Americans, decrease houselessness?

Are there other federal policies that you can think of? Are these efforts enough or lacking?

Megan: I just wanna start by reading one sentence. From the Biden Harris Administration's strategic plan to end homelessness that they released late in 2022, it's called All In. And at one point in that very lengthy report, they write,

The United States of America can end homelessness by fixing public services and systems, not by blaming the individuals and families who have been left behind by failed policies and economic exclusion. There's a lot packed into that sentence, right?

Lizzy: Yeah. And a lot that's not there. I was like, services. Yes, but also the issue is housing. It doesn't actually mention just housing people. But anyway, I'm sorry, I'm getting ahead of myself. Tell me what you hear and don't hear.

Megan: Yeah, well, let me push back on what you just said a little bit, Lizzy, because on one hand I completely agree with you, right? Homelessness is a housing problem. Full stop. That's where our heads need to be on this issue. However, you mentioned kind of the tension between the federal government and local municipalities around this issue.

A lot of cities, mine included, are really building up some false hope of a lot of housing and using that to justify expanded criminalization -

Lizzy: Hmm. Tell me more about that.

Megan: - of folks experiencing homelessness. So this is happening here in San Diego, but I can say with confidence, I know it's happening in Los Angeles. I know it's happening in New York City.

It might look a little different in these other cities, but. the overall tension is consistent. Folks in the general public, I do not know what percentage of the general public, but it is a loud minority feel very threatened by folks experiencing homelessness, or at least say that they feel very threatened.

Right, and they use that perception of homeless folks as perpetrators of crime and violence, which by the way, we know that folks experiencing homelessness are far more likely to be victimized and to be victims of crime than they are to be perpetrators. But setting that aside for a second. Right as we have grown, especially in urban environments, more and more uncomfortable by the fact that folks are falling into homelessness at a faster and faster rate.

Here in San Diego, it's 13 folks falling into homelessness for every 10 who get into housing, right? Folks who perceive unhoused people as dangerous or part of a criminal element are using this moment in time to advance evermore laws and local ordinances that make existing. Or carrying out basic behaviors in public behaviors that folks do regardless of whether they have housing or not.

Right? Sitting in public space, drinking and eating in public space, right? Existing. These basic behaviors are illegal in most cities across the US and here in, in my hometown of San Diego, we are actively pursuing yet another ordinance that would make it yet again illegal to live without housing on our streets.

And so how does this go back to the federal strategic plan? At the municipal level, all we're doing is blaming folks for their own homelessness, and so I'm very hopeful, cautiously hopeful that our mayor here in the city of San Diego will read this strategic plan from the Biden Harris administration, and will really internalize this message around not blaming individuals and families who have been left behind by these failed policies and economic exclusion, because that's what criminalization does.

It blames folks for their own homelessness while setting them even deeper back. Making it even harder for folks to be able to then get into housing again. This is done by strapping folks with a criminal record where they may not have had one previously. This is done by, carrying out involuntary displacement activities, which might be referred to in your own city as sweeps or clearings or cleanups.

When these quote unquote cleanups happen, folks lose vital personal items that may then prevent them from getting into housing. Have you ever lost your driver's license or misplaced your birth certificate? Have you ever tried to get a new birth certificate without a permanent address?

Lizzy: Yeah.

Megan: These are the tasks that we daily ask folks experiencing homelessness to do, to demonstrate again and again that they are living in poverty and are, are in need of housing and academics have a term for this, right?

For all this kinda like, oh, go here to get your driver's license. Go here to get your birth certificate.

Lizzy: Is it administrative burden?

Megan: Yes, administrative burdens and the psychological costs that result from experiencing those administrative burdens time and time again, and not getting the help that you need.

And then we layer on top of that racial discrimination that a lot of folks know they're going to experience when they walk in the door.

And definitely if they are approached by a police officer. We are not setting folks up for success in terms of saying yes to services when we do offer it. People are on decade long waiting lists for housing. The housing is not coming nearly fast enough. And so, you know, when you started this question about, well, why didn't Biden mention housing in that sentence? Well, housing is important, but I gotta tell you, Lizzy, with the folks that we interview on a regular basis, permanent housing is a distant dream.

They're trying to make it through the day and survive the night.

Lizzy: Um, and now we wanna talk about your work, you're a scholar and you're an advocate, and we wanna talk about something really concrete and that I think you'll be able to draw back to this idea of criminalization and what do we actually need to do to serve people, so that they could access the supports and eventually housing that they might need or want. so I wanna talk about providing aid to people who are unhoused and families who are unhoused at the local level. This is what you research and work on. You're the co-founder and director of the project for Sanitation Justice at San Diego State University. I wanna talk about your project, and I wanna start by talking about sanitation justice, because that's a term we haven't brought up yet.

Megan: Well, thank you so much for letting me talk about bathrooms, Lizzy. I'm very excited. Yes. What can I tell you about sanitation justice?

Lizzy: I mean, you're Dr. WC, so you must know if no one else does.

Megan: Well, I'll take a crack at it. So here's my pitch for why folks should care about sanitation justice. You know, more than a century ago, public restrooms were considered to be a vital public good. We started calling them restrooms, in part because they were viewed as spaces where folks could take a moment to collect themselves, attend to their basic needs, maybe check their appearance, freshen up, and carry on with their day.

And now fast forward to 2023 and in cities across the US public restrooms are disappearing. If they exist at all. They are often disgusting and they may be lacking some of the very basic resources that we have all kind of come to count on. And to think of as very basic kind of public health and dignity features, especially of our urban landscape, right?

So being able to meet your basic bodily functions when you're out and about and on the go, being able to wash your hands with soap and water, having toilet paper available, those sorts of things. That is not uniformly available in cities across the US and we've even seen since the Covid 19 pandemic, a lot of restrooms were closed during the peak of our public health crisis during that pandemic.

They are slow to reopen. And here again, you know, I think we've hit upon another wicked problem here, Lizzy, where we're seeing quite a bit of opposition coming from a lot of different places, to increasing restroom access. So we started working on public restrooms here in San Diego quite simply because there was a desperate need for it. So I do a lot of my kind of community based action research in partnership with a San Diego, organization that works to advocate for and empower folks experiencing homelessness, called Think Dignity, and Think Dignity runs several kind of mobile services for folks experiencing homelessness here in San Diego. And one of their signature services is a mobile showers program. And so for about 16 years, Think Dignity has been advocating for increasing public restroom access, specifically to benefit folks who don't have stable housing.

But showers as an extension of public restrooms is also a really profound need we're seeing here in San Diego. But let me back up for a sec and talk a little bit about how we got to the Project for Sanitation Justice and kind of the public health imperative that really drove the, the beginnings of our work.

 So Think Dignity, as I mentioned, has been serving communities of folks experiencing homelessness here in San Diego for about 16 years. They were on the front lines of one of the first, but now unfortunately many public health outbreaks that are directly related to the lack of public restroom access.

So in 2016, 2017, we had an uh, hepatitis A outbreak here that sickened nearly 600 people and killed 20 people in San Diego. Um, most of those folks that were affected, sickened and killed were folks experiencing homelessness. Hepatitis A, for folks who don't know what that, disease is, is it's an infectious disease that is spread through fecal oral contact, and it is preventable by increasing access to restrooms.

There is empirical evidence to show that if you offer more restrooms, open defecation goes down. They saw this in San Francisco fairly recently. They opened up a few additional restrooms and then they looked at the kind of reports to the city of poop and the reports of poop went down. And so this feels like a very solid public health, right?

Empirical evidence framework for advocating for increased public restrooms. However, for all the reasons that we spent, kind of earlier on talking about, Lizzy, in terms of our perceptions of homelessness and how we've decided to address it. Namely via criminalization rather than addressing the very real ways that people get stuck trying to get housing.

That perception extends to public restrooms, unfortunately, although whenever I'm out and about talking to folks about public restrooms, regardless of housing status, folks see the very urgent importance of having more public restrooms, right? If you are a commuter, if you ride public transit, if you're a tourist exploring a new city, you're gonna need a place to go to the restroom, right?

It's not just folks who don't have stable housing who are relying on these facilities. Yet somehow we have come to see this public good is something that, maybe some parts of our community get to have access to, i.e. tourists, while everyone else is kind of locked out and, excuse my pun, shit shit out of luck when it comes to accessing a restroom.

Lizzy: You said that historically we had this, uh, a much less contentious idea of public restrooms. They were an accepted part of public life. They were more prevalent. In fact, they were not even seen exclusively as about, you know, bathrooms or hygiene, but they were part of normal people's daily lives in public, and therefore they were provided.

That was like, point one. Now we're in a modern separate place where restrooms don't exist. The pandemic exempts exacerbated their closure, but they're much more contentious. We have a totally different public narrative about who they're for and what they need and why there is or is not a need for them.

And San Diego is really an illustration of what that current framework and conversation looks like. And I was interested in your thoughts on like how did we get from 0.1 to 0.2?

Megan: Yes. So I know that there are super duper smarter people than I who are looking at. why we have decided to privatize all our public space. This feels like a broader trend, as you're saying, Lizzy, that goes far beyond public restrooms. And so to me as a social science researcher, it feels like the biggest example currently of how our society, our American society, is so individualistic and it feels like we have become only more so, and the pandemic helped us to double down on that individualism. It felt like there was a moment of opportunity in early 2020 or in early pandemic days where we were talking about getting through this together, but instead we decided to get through it individually.

And what I mean by that in terms of public space is when I walk around San Diego now, It does not feel like we have a lot of public spaces that truly are public where everyone is welcome. Even in our parks here, we have policing of who can be in the park and when and under what circumstances and doing what things.

Right. And part of this is, you know, we have created, as I mentioned before, a lot of new laws where they previously didn't exist, to govern exactly what happens in public space and what people can be doing there. And these laws are not universally applied, right? They are applied deliberately and specifically to certain groups of people.

And I don't know how we get ourselves out of that.

Lizzy: Well then you're gonna love my next question, which is how do we get ourselves out of that? No, it is. It is more specifically, I know that you are not simply a researcher looking to expand our understanding of the problem, though you also do that. But like on the specific advocacy side, what is the Project for Sanitation Justice in San Diego doing?

Megan: The Project for Sanitation Justice at San Diego State University

is a broad team of academic researchers and community partners, from our partner organization Think Dignity. We are super multidisciplinary. Um, so we've got folks working on sanitation justice from the angles of city planning, criminal justice, public administration, public health, sociology, and we are really trying to shed light on the lack of public restroom access across our whole county and

to educate folks on the value of restroom access, not only for maybe someone's individual health or wellbeing, but for a collective public health and dignity goal. We have a vision of public restrooms as revitalizing our public spaces, as in as serving as an invitation even for folks to take advantage of these public resources.

And additionally, we have a vision of public restrooms as places of opportunity.  Currently, if there is a public restroom in San Diego, there is probably a security guard somewhere close by. We are hoping to shift that perception of public restrooms as unsafe or criminogenic to places where folks can connect with vital resources and services.

What would it look like? If instead of that security guard, we had someone trained in mental health crisis response and could hook folks up with substance use, support and treatment if needed or wanted. What would it look like to have a healthcare clinician stationed at a public restroom where folks could get basic and vital

health information. Instead of closing restrooms, we should be doubling down on opening them and using them as places of opportunity. So what we're doing in San Diego, you know it's the municipal budget cycle right now. So we are advocating for our city to care about public restrooms and to put its money where its mouth is around this issue. We are asking the city to budget $160,000 to hire a wash director. Wash is water, sanitation and hygiene. And so we're asking the city of San Diego to hire someone who would be responsible for understanding where access to water, sanitation, and hygiene resources exist in our city, and identifying ways to expand access.

Currently, the city of San Diego operates a public web map where it lists where public restrooms are. Our research team has independently audited that web map and found that it is quite inaccurate. We are not even providing accurate  information to folks about these vital, resources. And this all goes back to homelessness because if we pin all our hopes on solving homelessness on housing, this is going to lead to

continued criminalization of folks with an empty promise of housing behind it. This is exactly what's happening in San Diego and in cities across the US where we are using police to displace folks to make them invisible. We are telling residents that this displacement comes with an offer of shelter, but it does not.

Here in San Diego, two thirds of shelter referrals that are made by police or outreach workers, in a typical week, two thirds go unfulfilled, so we are not meeting folks where they're at in terms of getting them connected with housing. We are criminalizing folks. And we are creating additional burdens and costs for folks who are homeless to get into housing.

So my vision here, right, since I started with housing, is a distant dream for a lot of folks. Public restrooms are part of the answer for making our public spaces safe, healthy, and livable for everyone. While they're waiting for housing.

Lizzy: So thank you for, you know, both your research and your advocacy, and we're all gonna be watching, uh, what happens in San Diego and seeing what the outcome is.

Um, because I want to, as, as our final question, allow you to maybe connect what you are doing, what your team is doing, what you're seeing on the ground to other parts of the country with sanitation, justice. How do you see this as a model that can be exported? What are the kinds of you know, municipal policies that should interact with the federal policies we're looking at that you would really like to see in the next couple years in cities that also have this problem?

Megan: You know, we're just coming out of a pandemic, so it's a funny time to say this, but we're not focusing enough on public health prevention and we have a very short memory when it comes to really what causes public health outbreaks and how we can prevent them. Um, so when it comes to gastrointestinal diseases that are spread through fecal contamination, public restrooms are our first line of defense, but we have somehow forgotten that.

And we've allowed kind of these other impulses or other concerns to really drive our social policy. And so I just, I wanna kind of connect back, you know, I'm a social worker, social worker by training. I have been trained for so long in this phrase that social workers use all the time called meeting people where they're at.

We have forgotten to do that. We've forgotten to do that with restrooms. We've forgotten that we need to give folks resources so that they can truly meet their most basic bodily functions with dignity and on homelessness policy more generally, we're not meeting people where they're at in terms of what it actually takes.

To get out of homelessness and into housing. Um, so I'm heartened by kind of some of the conversations that are happening at the federal level. And I'm hopeful that our cities can start to take up this work of really redressing failed policies, and making a massive shift, a massive commitment to truly meet people where they're at.

That's the only way we're gonna solve anything.

Lizzy: Yeah. Thank you so much for that Megan. I feel like we really, we took that wicked problem. Um, and it's still there. It's not that we've solved it, but I think you've shown us a lot of things, um, to pay attention to and to think about recreating that are gonna actually meet people where they're at and address it and see what that does for the bigger picture.

So thank you so much for that.

Megan: Thank you so much for having me.

Lizzy: And thanks for listening. For more on Professor Welsh Carroll's work, check out our show notes at scholars.org/no jargon. No Jargon is the podcast of the Scholar Strategy Network, a nationwide organization connecting journalists, policy makers, and civic leaders with America's top researchers to improve policy and strengthen democracy.

The producer of our show is Mandana Mohsenzadegan, and our audio engineer is Peter Linane. If you liked the show, please subscribe and rate us on Apple Podcasts or wherever you get your shows. You can give us feedback on Twitter @nojargonpodcast or at our email address, [email protected].



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