As the nationwide crisis in the housing and credit markets unfolds, a community-based coalition of health care and social service providers, affordable housing developers, and community organizers convened on October 10, 2008 to highlight human rights-based solutions to the crisis in one of America’s hardest-hit communities, South Los Angeles.
Their call to action, Taming the Perfect Storm, is a unique, ambitious, and pragmatic example of “Health and Human Rights in Practice.” Beginning with the recognition that fundamental rights for individuals who are either homeless or at-risk for homelessness are not being fulfilled by the nation these residents call home, this collaborative report uses a human rights framework to its full advantage. The report moves from a broad understanding and comprehensive analysis of the problems faced by residents of South Los Angeles to specific recommendations to address the health – and human rights – needs of a vulnerable population.
The methods used in this report – analysis of interactions between local laws, economic policy, policing efforts, and other social determinants of health; extensive interviews and ethnography listening deeply to those in need; and clear recommendations based on a human rights approach – can be used by communities anywhere.
We hope you will read the full report (by clicking on the cover above), not only for what it specifically reveals but also for the methods and analytic approach used by the South Los Angeles Homelessness Prevention and Intervention Collaborative. This model can be used to understand and begin to address a wide range of problems, wherever human rights are a concern. As stated in the report, “Combining the treetops of international declarations and human rights law with grassroots advocacy and know-how, a South Los Angeles Human Rights Approach to Health can be transformative.”
We would like to draw particular attention to a novel advocacy tool, the South Los Angeles Declaration of Health and Human Rights. It is exciting to imagine human rights declarations coming from communities around the United States – indeed around the world – as they will come from South Los Angeles.
Rishi Manchanda, MD, MPH and Evan Lyon, MD
From the Executive Summary
This report is the product of a unique South Los Angeles-based coalition of health service providers, community health workers/promotoras, tenant organizers, and affordable housing and civil rights advocates. The complex problem of homelessness and poor health in South Los Angeles is shaped by key local housing, health and law enforcement policies and conditions, some of which we have identified in prior work and continue to address.
Service providers, organizers and advocates in our collaborative have all witnessed the deleterious health and human rights impact of a recent series of public ordinances and law enforcement initiatives in South Los Angeles and Skid Row which disproportionately and often unjustly affect extremely poor and homeless persons. These programs have combined with other powerful trends, including the scarcity of local permanent supportive and affordable housing, the displacement of homeless and low-income residents due to gentrification downtown and along the Figueroa Corridor, evictions and the foreclosure crisis, the closing of Martin Luther King Jr.-Harbor Hospital, the historic underfunding of South Los Angeles community clinics by the Los Angeles County Department of Health Services, and the weakening of the local public health safety-net. Together, these forces have created a perfect storm for the homelessness and health crisis in South Los Angeles. Now, as the federal banking and credit crisis unfolds, South Los Angeles has become a bellwether for the nation, highlighting the fundamental challenges facing America’s increasingly stressed communities.
We conducted surveys of homeless individuals and service providers to document and define this perfect storm more clearly. Results from our work highlight the direct impact of damaging policies and trends on the health of homeless persons living in South Los Angeles.
Of the homeless persons we surveyed in South Los Angeles:
- Only 28% indicated that they had a usual source of medical care.
- 38% reported having a mental health condition.
- Nearly half (46%) reported a need for dental care in the past year. However, 59% of those who needed dental care did not receive it.
- 32% of those who reported receiving medical care at Martin Luther King Jr.-Harbor Hospital within the past two years indicated that the hospital’s closure decreased their ability to get medical care.
- An astonishing 42% of those who rented in the last five years became homeless because they were unable to afford a rent increase.
- Nearly 3 in 10 homeless individuals have experienced an eviction (27%).
- 1 out of every 3 (34%) homeless individuals reported having had an interaction with law enforcement in the past year.
This report from the South Los Angeles Homelessness Prevention and Intervention Collaborative (HPIC):
- Develops a common language to understand the health impact of current trends in housing availability, displacement, law enforcement policy, and health services in South Los Angeles
- Provides important evidence of the health needs and experiences of homeless individuals and service providers in South Los Angeles based on original community-based participatory research
- Offers a human rights approach to health to equip advocates, service providers, policymakers, and media to better address poor health and homelessness in South Los Angeles
- Offers specific recommendations to improve health and homelessness in South Los Angeles
From Solutions, concluding “Taming the Perfect Storm”
The perfect storm of homelessness and poor health in South Los Angeles requires a powerful human right to health approach that can engender the broad-based support and political will necessary to implement long overdue, desperately needed solutions. Using this rights-based framework, we highlight key policy changes, outlined below, that target each major element of the perfect storm. These changes must occur if health and human rights are to be protected in South Los Angeles.
Shift the Policy Debate and Generate Political Will to Tame the Perfect Storm in South Los Angeles
Outlining policy prescriptives alone is not sufficient for the pressing task of preserving and restoring a healthy community in South Los Angeles. If we hope to leverage our voices to implement these policies effectively and equitably, our collective approach to homelessness and poor health in South Los Angeles will require a catalyst to shift the policy debate.
Adopt a Human Rights Approach to Health
As our community of service providers, advocates, policymakers and patients begins to understand the determinants of health and homelessness outlined in this report, the human rights approach to health described in this report offers a powerful method to turn awareness into political will and take specific, much-needed action. Combining the treetops of international declarations and human rights law with grassroots advocacy and know-how, a South Los Angeles Human Rights Approach to Health can be transformative. Such an approach demands that stakeholders shatter stereotyped, dehumanizing views of poor and homeless persons and unproductive and unhealthy silo-based approaches and, in their place, construct sound health, housing and law enforcement policies that respect our shared rights and responsibilities.
Share and use a common language
Innovative and powerful strategies to accelerate current efforts to tame the perfect storm of homelessness and poor health in South Los Angeles are required. Our collaborative believes that the first step of any local strategy involves the building of a common language among varied South Los Angeles constituents. As outlined earlier in our report, providers, patients, policymakers, and advocates can begin by using the vocabulary of “social determinants of health” to address the economic and social conditions which determine health in South Los Angeles.
The South Los Angeles Declaration of Health and Human Rights
We propose that one of the first grassroots advocacy efforts of the Human Rights to Health Approach be the development of the South Los Angeles Declaration of Health and Human Rights. Loosely adapted from the Universal Declaration of Human Rights, we envision that the South Los Angeles version will be developed in a participatory process, informed by patient and client experiences and endorsed by local service providers, advocates, and policymakers. This process will help build a broad coalition to address homelessness and health in South Los Angeles and generate needed fresh political will, media attention, and broader support.
In the nation as a whole, persistent widespread homelessness and the health care crisis offer compelling evidence of a collective disregard for human rights. Few places exhibit the ill effects of this disregard like South Los Angeles. Conversely, no other community stands to benefit as much from a community-based human rights approach to health. With a firm understanding of the links between critical determinants of health like housing, public and community health resources, and law enforcement policy, we commit to build the political will and skills needed to tame this perfect storm of homelessness and poor health. In short, we commit to reclaim and redefine our community guided by the practical application of fundamental human rights principles. As an important stage of community dialogue on the right to health, housing, and security begins, we welcome all constructive comments and critiques of this report.