Public Health Policy Analysis: AB , as amended -- Homeless Shelters: Safety Regulations.

Today, there are more than 5.5 million homeless people in the United States (The state of homelessness in America, 2021), and tens of thousands of these homeless people are living on the streets in California despite increasingly aggressive attempts by the state government to provide effective solutions to this chronic problem. The purpose of this paper is to provide an overview of a current health problem affecting the State of California that is being addressed by a proposed law, AB 362 and how this new law would address the problem of homelessness in the state today and in the future. In addition, an assessment concerning the severity of the health problems that are associated with Californias homeless problem is followed by an overview of AB 363, as amended (hereinafter alternatively the bill) and the respective stakeholders that will be potentially affected by it should it become law. Further, an examination of the promises included in the bill and its corresponding expected outcomes is followed by a discussion of the multiple problems that are arrayed against the bills passage and implementation and a description of potential unexpected consequences as a result of the bill becoming law from a public health perspective. Finally, the paper concludes with a series of recommendations that are based on the foregoing research and the findings that emerged.

Overview of the health problem:

Although precise figures are unavailable, most current estimates indicate that Californias homeless problem is amongst the most severe in the United States today, accounting for a significant percentage of the nations total homeless population. For example, according to Elias (2021), No one knows precisely how many of the states approximately 161,000 homeless prefer to keep sleeping in tents and under tarps, as about two-thirds of the California homeless do each night (para. 3). As noted above, Californias mild climate allows this type of homelessness to proliferate even when there are local ordinances against these shelters.

Not surprisingly, Californias homeless population suffers from many if not all of the same health problems as the homeless populations in other states, including most especially respiratory ailments, poor nutrition, dermatological conditions, mental health issues and substance abuse problems (Alarcon & Tipu, 2020), some of which are moderated only in part perhaps by the states more temperate climate compared to most other states in the country. Notwithstanding this mediating factor, though, the homeless people living in California are faced with a wide range of health problems that have a severe effect on their well-being as discussed further below.

Severity of the health problem:

In reality, living on the streets with little or no ready access to hygienic facilities, poor nutrition, and exposure to the elements will likely exacerbate any preexisting health problems as well as cause a multitude of others. In this regard, Alarcon and Tipu (2020) emphasize that, People experiencing homelessness suffer from a risk of mortality three to four times that of the general population and are at high risk for contracting severe acute respiratory syndrome coronavirus 2 and for developing Covid-19 because of underlying comorbidities [including] include lung disease and immunocompromised states (p. 37). In other words, there are virtually no health problems that homelessness does not exacerbate, and the harsh condition of homelessness can cause a wide array of physical and mental health conditions that were not already present. Against this backdrop, it might appear reasonable to suggest that anything that can be done to alleviate this suffering would receive widespread public support, but this is not exactly the case with the bill as noted below.

Overview of the bill and stakeholders:

In the...

Indeed, Californias multi-trillion- dollar budget is the largest in the country and it is reasonable to posit that tremors in the states budget for any reason will have nationwide and even global implications. These issues also mean that California lawmakers are already hard-pressed to identify viable and timely solutions to the states homelessness problem, but more than two-thirds (66%) of California taxpayers believe that the hundreds of millions of dollars already being spent on this problem have been used ineffectively (Roberts, 2019).

At present, California maintains a network of 691 homeless shelters that employ around 15,000 people that earn in excess of $1 billion with assets of about $2 billion (California homeless shelters, 2021). The network of homeless shelters are primarily based in major urban areas as set forth in Table 1 below.

Table 1

Five most populated homeless shelters in California by city

Metro area

# Nonprofits

Employees

Revenues

Assets

Los Angeles

270

5,162

$357,564,446

$565,080,650

San Francisco

86

4,311

$390,482,213

$400,396,825

Riverside

77

606

$32,439,448

$32.883,063

Sacramento

42

421

$19,158,045

$17,490,049

San Diego

22

327

$44,619,339

$204,208,692

Source: California homeless shelters, 2021

It is noteworthy that there are some significant differences in the revenues generated by San Franciscos 86 shelters compared to Los Angeless 270 shelters, with the former earning about $33 million more than the latter despite having just around 32% as many homeless facilities. Irrespective of the metro area involved, though, it is clear that the stakes are high for lawmakers, taxpayers and the homeless alike in California today. It is little wonder, then, that a majority of California taxpayers have become increasingly frustrated with the states efforts to address this problem from a humanitarian perspective.

On a far more superficial and inhumane nte, however, anecdotal reports indicate that the states homelessness problem is also driving many of the more affluent taxpayers to other states simply because they dont like looking at them. For instance, former Olympian gold medalist, former reality television star and current candidate in Californias gubernatorial race, Caitlyn Jenner, recently noted in a televised interview with Fox News Sean Hannity: My friends are leaving California. I said, 'Where are you going?' And he says, 'Im moving to Sedona, Arizona, I cant take it here anymore. I cant walk down the street and see the homeless' (as cited in Pitofsky, 2021, para. 4). Notwithstanding the fact that this interview took place in a private airplane hangar that is mainly reserved for the ultrawealthy, these sentiments are likely also echoed throughout much of the states taxpaying population that is weary of spending even more money on a problem that just seems to get worse.

The main provisions of the bill are broad-based but all have a primary focus on the various health and safety standards that are used for homeless facilities in the state. In sum, if passed, the bill would:

Establish minimum health and safety standards for homeless shelters, as defined, including, but not limited to, minimum standards for homeless shelter maintenance, interior air quality, sleeping rooms, and laundries.

Require the housing, building, or health department of a local agency to serve as the enforcement agency and enforce the minimum health and safety standards within their jurisdiction, unless the local agency enters an agreement with the Business,…