How many homeless people die in California annually?
California's biggest failure is killing thousands
One obvious thing that often gets overlooked about unsheltered homelessness is that it’s a death sentence. Maslow’s hierarchy of needs ranks shelter alongside food and water as a basic need for good reason. Living without shelter will kill you, it’s just a matter of when. In cold places like New York, it’ll kill you quickly. In temperate places like San Francisco, it’ll kill you slowly. But it will kill you.
Exposure to high levels of pollution and stress have been found to dramatically increase the development certain chronic diseases, including diabetes, chronic pulmonary disease, and coronary artery disease among unsheltered homeless people.1 The unsheltered are also at much higher risk for contracting infectious diseases such as typhus and hepatitis A; an outbreak of Hepatitis A at several San Diego homeless encampments in 2017 killed 20 people. A study in Los Angeles found that unsheltered Los Angelenos were 26 times more likely to die from alcohol and drug abuse, 11 times more likely to die from transportation-related injuries, 10 times more likely to die from homicide, and five times more likely to die from suicide than their housed counterparts.2 The average age at death for homeless Californians is about 50 years, 38 percent shorter the housed population (81 years).3
~7,214 homeless Californians died in 2022, or about 4.21 deaths for every 100 homeless individuals; 5,940 died in 2021, 3.64 deaths for every 100; and 5,390 deaths in 2020, 3.13 deaths for every 100. Between 2020 and 2022 deaths of homeless Californians increased by about 34 percent.
Homeless deaths in California are tracked unevenly, but ten counties representing about 75% of California’s homeless population have reported annual homeless mortality figures most years since 2020. I used that data to create a deaths-per-100-homeless-individuals figure and extrapolated it out to that year’s statewide population estimate from the Point-in-Time count. Using this method, I think it’s reasonable to estimate 7,214 homeless Californians died in 2022, or about 4.21 deaths for every 100 homeless individuals; 5,940 died in 2021, 3.64 deaths for every 100; and 5,390 deaths in 2020, 3.13 deaths for every 100. Between 2020 and 2022 deaths of homeless Californians increased by about 34 percent, nearly all of it explained by surging overdose deaths (primarily from fentanyl).
Several large jurisdictions in Southern California and the Bay Area have tracked homeless mortality in greater detail over several years. Using this data, it becomes apparent that many, possibly most, deaths could be avoided simply by bringing people indoors. For example, of the nearly 10,000 deaths tracked across these counties, 12 percent (1,227) were caused by traffic accidents. It’s pretty easy to understand how camping along sidewalks and alleyways and beneath underpasses increases your chance of being killed by a car. Shockingly, eight percent (762) were homicides. When talking about unsheltered homelessness being unsafe, it must be emphasized that the biggest safety risk is for the unsheltered residents themselves because they’re literally being murdered out there in huge numbers. Twenty-six percent of deaths were from natural causes including from chronic diseases and infections, which, as discussed above, unsheltered homelessness has been known to greatly exacerbate. When it comes to overdose deaths (the single largest cause of homeless mortality), it’s unclear what impact shelter would have. On the one hand, overdose deaths continued apace among homeless San Franciscans in the shelter-in-place hotels during COVID. On the other hand, many service workers report how the toxic incentives within encampments push people towards using.
If you needed more anecdotes, just look at this past winter. From freezing temperatures to trees knocked by high winds onto tents, weather contributed to the deaths of at least 18 people experiencing homelessness in San Jose, Saratoga, Oakland, South San Francisco, and Sacramento during the winter of 2022-23. These lives would almost certainly not have been taken had they been in a shelter the night they succumbed to the elements. Inexcusably, more homeless residents die of hypothermia in Los Angeles each year than New York City, even as heat-related deaths continue to rise.
You might think that bringing people indoors and saving lives would be the top priority for California. Strangely, tragically, infuriatingly, it’s not. California jurisdictions are incentivized to end homelessness, not end unsheltered homelessness. That sounds good, but it creates an obvious math problem. Solving homelessness typically requires building a $600,000 unit of permanent supportive housing, which then needs about $40k in annual subsidies to operate. But because California has so many homeless people (due primarily to high housing costs resulting from a supply shortage), 171,000 at last count or 44 for every 10,000 residents, housing them all would cost about $70 billion in one time construction costs and about $7 billion in annual operating expenditures. There is simply no feasible plan to raise that kind of money. The result is that local jurisdictions “end homelessness” at a far slower pace than California’s broken housing market creates it, resulting in 115,000 Californians spilling onto the streets with nowhere else to go but deadly encampments.
The solution, I think, is twofold. First, California has to get out of its own way and build, to borrow a phrase from a senior Newsom staffer, a metric shit ton of new housing. Doing so will bring down per-unit costs so that the roughly 50% of all homeless Californians that suffer from neither a substance abuse nor a psychological disorder can self-resolve in naturally affordable housing so that scarce public resources can be focused on those for whom the housing market will never reach. Second, California has to prioritize saving lives—and that means bringing people indoors. Interim, non-congregate housing like those provided by DignityMoves (full transparency, DM is a member of my employer organization) options are now available that can be scaled at 1/15 the cost of permanent housing while still—crucially—qualifying for federal operating subsidies. Unlike stack and pack congregate shelters, these interim options are widely popular among homeless residents, ensuring higher rates of uptake. Some homeless Californians will inevitably resist moving indoors, but I suspect most of these individuals suffer from an extreme psychiatric or substance abuse disorder and will qualify for compulsory health and housing assistance under Governor Newsom’s CARE Court.
I know this can be done because most other states already do it. California cities provide only about .32 shelter beds for every homeless resident while the national average outside California is .86 beds for every resident. New York, whose homeless population is about the same size as California’s relative to its overall population, provides shelter to basically everyone. It’s sometimes pointed out that New York and other cold states made a policy decision to invest in shelters rather than housing because otherwise their homeless residents would die. To which I reply yes, that’s precisely the point.
Mortality data sources
San Diego County: https://www.sandiegouniontribune.com/news/homelessness/story/2022-12-21/vigil-remembers-500-homeless-deaths-in-2022
Ventura County: https://www.vcstar.com/story/news/local/2022/12/15/longest-night-memorial-vigils-homeless-deaths-ventura-oxnard-california-2022/69732092007/
Orange County: https://voiceofoc.org/2023/01/kriz-another-45-people-died-homeless-in-oc-in-december-488-for-the-year-now-after-2-weeks-of-rain-whats-next/; https://www.ocsheriff.gov/sites/ocsd/files/2023-02/Homeless%20Death%20Review%20paper_FINAL.pdf
San Francisco City & County: https://www.sfchronicle.com/bayarea/article/Names-read-during-vigil-of-homeless-people-who-17657993.php; https://nhchc.org/wp-content/uploads/2022/08/Homeless-Deaths-in-San-Francisco-for-NHCHC-2022-cleaned.pdf
Santa Clara County: https://sanjosespotlight.com/tombstones-honor-196-homeless-people-who-died-in-silicon-valley/#:~:text=According%20to%20the%20Santa%20Clara,87%20seniors%20and%20an%20infant; https://sanjosespotlight.com/hundreds-of-homeless-people-died-on-silicon-valley-santa-clara-county-san-jose-streets-in-2022/#:~:text=Santa%20Clara%20County%20saw%20246,of%20250%20deaths%20in%202021
Alameda County: https://oaklandside.org/2022/12/22/homeless-persons-memorial-alameda-county-oakland/; https://www.achch.org/uploads/7/2/5/4/72547769/2018-2020_ac_homeless_mortality_report_final_4.11.2022.pdf
Santa Barbara County: https://santabarbara.legistar.com/gateway.aspx?m=l&id=/matter.aspx?key=25362
Los Angeles County: http://publichealth.lacounty.gov/chie/reports/Homeless_Mortality_Report_2023.pdf
Sacramento County: https://www.capradio.org/articles/2021/09/21/winter-was-the-deadliest-season-report-shows-137-homeless-residents-died-in-sacramento-county-in-2020/; https://www.capradio.org/articles/2022/09/12/a-record-199-unhoused-sacramento-county-residents-died-in-2021-report-finds/; https://www.abc10.com/article/news/local/candlelight-vigil-sacramento-homeless/103-79b549bb-567e-4a07-9470-0a5033e511e7#:~:text=Sacramento%20group%20holds%20candlelight%20vigil,two%20days%20in%20the%20county.&text=SACRAMENTO%20COUNTY%2C%20Calif.
https://www.sciencedirect.com/science/article/pii/S2773065422000414
Los Angeles County Department of Public Health. Recent trends in mortality rates and causes of death among people experiencing homelessness in Los Angeles County. Center for Health Impact Evaluation. October 2019. http://publichealth.lacounty.gov/chie/ reports/HomelessMortality_CHIEBrief_Final.pdf
The US Burden of Disease Collaborators. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444–1472. doi:10.1001/ jama.2018.0158; Los Angeles County 51 years, San Francisco City & County 51 years; Santa Clara County 52 years; Orange County 48 years.