PUBLIC HEALTH, THE POLITICS OF SCARCITY, AND THE DEATH OF CARING
Having worked with the long-time homeless population that inhabits the nooks and crannies of the streets of San Francisco for the last 18 years, I am continually in awe of the range of strength and intelligence that exists among them. Very seldom do we, as public health workers, mine this untapped innate health that exists at the core of every human being regardless of their present condition.
Those of us that have attempted to put a human face on a specialized outreach team to the most compromised homeless population have been richly rewarded. Once health and not disease drives public health we have found that everyone has the capacity to change and transform themselves. Written off as hopeless, many of the incorrigible, shot-to-the-curb homeless population has risen up like the Phoenix of Greek myth from the ashes of their former selves. Once we go down that road of accepting increasing numbers of people as expendable to the uncaring god of budget deficits, we are in danger of losing our basic humanity as a civilized society. We have long since reached that point in the United States and now must decide if we, in San Francisco, want to be willing coconspirators in the death of caring, humane pubic values. The streets are the most visible barometer of the public health of a community, city, and nation.
Are the collective wisdom of the people and our political representatives now prepared to sentence 150-plus of the most vulnerable among us to a solitary and unacknowledged death in increasingly squalid and brutal conditions on our streets, doorways, under freeways, in emergency rooms, and substandard hotels throughout the city and county of San Francisco?
We have reached a point in San Francisco where the public health officials have abandoned any radical defense of the continual dismantling of public health for the most needy San Franciscans. We are in an absolute state of emergency in public health, more ominous than any hypothetical terrorist attack. Where is the 911 Public Health Coalition to save what’s left of essential public health services for workingclass/ low income/homeless people in San Francisco.
Will public health officials be reduced to being bureaucrats in charge of eliminating all vital services for the most vulnerable among us?
In 1996, after a decade of increasing numbers of homeless deaths on the streets of San Francisco the Department of Public Health, the Coalition on Homelessness and the Department of Social Services set up a system through the Coroner’s Office to officially count the number of homeless people who die each year on the streets of San Francisco (100+ deaths each year).
Many of these tragic deaths of the most vulnerable and needy of the homeless were and are preventable! In response to this unacceptable situation DPH set up the Homeless Death Prevention Team specifically to prevent homeless deaths on the streets of San Francisco, and to improve access to treatment for this population.
There was a broad-based coalition in 1996 of city social services agencies, homeless advocacy groups, and nonprofit community social service agencies that reached a historic consensus that the increasing number of homeless deaths, and deteriorating physical and mental condition of homeless people on the streets of San Francisco was a threat to the public health of all San Franciscans.
Furthermore, it was agreed that it would lower the quality of life for all San Franciscans by increasing the spread of homelessness, unemployment, poverty, drug addiction, disease, hopelessness and unnecessary death.
In spite of this, in 2000 the Mayor’s Office eliminated the staff and resources in the Coroner’s Office to officially keep a record of the number of homeless people who die on the streets — sparing the City the annual public embarrassment from this shameful statistic. Now in 2003 the Department of Public Health is prepared to eliminate critical homeless services created to comprehensively address the complex needs of the chronic homeless population.
We, as health-based, strength-based health workers mine the innate health in each individual as the primary source of individual and public health. In essence we become an extension of the clinic (society, humanity) in the streets to re-socialize, and re-humanize each individual into a new social contract and relationship to society rooted in their own core of health and wisdom. The successful outcome of any healthcare system is directly related to its ability to tap this core of innate health that exists in every human being. This is why the small Homeless Outreach Death Prevention Team has had so much success in getting homeless people who are considered “untreatable” engaged in accessing necessary treatment services, and getting their other basic survival needs met in unimagined innovative and creative ways.
We all must consider the connection between the well-being of the least among us, and our own well-being. The collective environment we all travel in, breathe in, work in, and live our lives in is intricately bound to the well being of each and every one of us. As this collective environment we all share unravels let us ponder the preciousness of this intangible resource. It can not be bought by money alone! It may be too late to expect the public health officials, and politicians to see the writing on the wall and act accordingly. We the people will have to fill in the void left by the failure of the political system to respond to the life support system of our city being systematically destroyed. Given the great lessons I have learned from the ragtag community of the homeless on the streets of San Francisco, I am confident we can co-create a new society based on caring, nurturing, and supporting the intricate web of life that connects us all together.
Make no mistake, the lethal combination of the current economic downturn, the impending implementation of Prop. N, and the draconian budget cuts proposed by the city will cause more use of expensive emergency medical/psychiatric services, and increased disease, death and violence on the streets of our city. Does the city really want, at this critical juncture, to adopt the same failed logic of scarcity and tax elimination the rest of the country has so slovenly embraced with such drastic results to the human community. We must demand the powers that be generate new revenue to make up this budget deficit! We must identify where the fat is in our city budget and cut it out. Surely, the $2 million proposed to be spent to fingerprint homeless people in shelters should be abandoned, as well as any other extraneous positions, (i.e. special assistants to the Mayor), and various consultant positions acquired during wealthier times.
There are many ways to lessen the devastation to the most needy by eliminating all positions that are not directly related to support and delivery of critical healthcare, substance abuse, mental health, and outreach services to a population that is literally depending on these for their very lives.
We must not buy into the politics of scarcity, and resign ourselves to expecting less and less each year from the community and City we live in for our survival and well-being. We can and must demand that the power brokers of this city bring something to the table now before we descend further into chaos and hopeless self destruction.
Andrew