Solving homelessness: What will it take?
By Vivienne Aguilar/ California Health Journalism Fellow
The lead researcher of California’s most inclusive study on homelessness in nearly three decades, advised journalists at HJ25 to focus their reporting on the policy failures at every level of government, instead of highlighting the personal failures of those living on the streets.
“People are really trying to balance food money and rent money, so any destabilization of federal funds is just going to lead to an increase in homelessness,” said Margot Kushel, M.D., professor of Medicine and director of Benioff Homelessness and Housing Initiative at University of California San Francisco.
Kushel is the principal investigator of the California Statewide Study of People Experiencing Homelessness (CASPEH), published in 2023.
Portland-based journalist and mental health correspondent for National Public Radio, Katia Riddle, spoke with Kushel about the barriers within the health care system, uncertainty brought on by the Grants Pass v. Johnson ruling last summer, and national confusion caused by the Trump Administration’s pausing of housing assistance vouchers.
Kushel said in many ways, leaders are “going backwards.”
For example, instead of pushing resources towards housing-first programs, which research shows is the most effective way to prevent physical and mental health issues from compounding after someone is homeless, she said many politicians are leaning into the criminalization of homelessness.
“When you’re talking to people, you tell the story of individuals, and it’s hard to write the structural problems into it,” she told journalists. “I encourage you to tell the story of the individual, but to write into the story the structural issues.”
For the study, Kushel and her team interviewed nearly 3,200 people experiencing homelessness across the state in rural, urban and suburban areas between fall 2021 and 2022. They then analyzed the causes and consequences of homelessness and used the findings to recommend policy changes and effective programs models.
One major take away from the study: nearly half (48%) of the homeless population in California are 50 years old and older; 41% had never been homeless until age 50.
While city and county governments can make life difficult for their homeless populations by arresting people without providing emergency shelter, Kushel said holding local leaders accountable can only move the nation so far in the right direction.
“The federal government has the largest role to play, and we’re in a time of deep, deep uncertainty,” Kushel said.
Throughout her research, Kushel documented many of the systemic problems facing homeless Americans and their advocates existed in both Democratic and Republican administrations, but stressed that the most recent and devastating cuts to federal social programs under Donald Trump means “we’re really a mess.”
Vivienne Aguilar is a health equity reporter for the nonprofit California news group the Central Valley Journalism Collaborative, which publishes The Intersection. She was a 2025 AHCJ-California Health Journalism Fellow.
