Tag: Poverty

The Criminalization of Poverty and Homelessness

Homeless encampment between I-5 and Harborview Medical Center. Photo credit: Josephine Ensign, 2020

As our country edges towards post-pandemic individual and community life, we see clear evidence of deepening economic and racial inequities. Any walk or drive through our urban areas, from Washington, DC to Los Angeles, reveals a steep rise in visible poverty and homelessness, especially for persons of color. With this rise comes an increased push to criminalize people for being homeless. From my nearly forty years as a nurse and researcher working with homeless populations, and my lived experience of homelessness as a young adult, I know that criminalizing poverty and homelessness does not work. It only worsens the problem.

Here in Seattle, which already had one of our nation’s highest rates of homelessness and income disparities before the pandemic, tents and other temporary living structures made of cast-off materials line the hillsides along I-5, appear on sidewalks, and in green spaces such as ravines and city parks. Cars, RVs, and trucks with screened off windows and windshields—the temporary homes of vehicle residents— dot the landscape. A house next door to my own home in a mixed-income neighborhood near the university where I work, has changed from being an informal refuge for homeless squatters to a ‘flipped’ single-family home currently on the market for $1.2 million.

Early in the Covid-19 pandemic, when we were asked to shelter at home and congregate living spaces such as emergency shelters were known to flame the spread of the virus, public health officials locally and nationally moved to limit shelter capacity and placed moratoriums on both evictions from housing and homeless encampment clearances. Motels were turned into Covid isolation and recovery units for unhoused people. Despite the motels and pauses on evictions, visible homelessness increased exponentially.

Eviction moratoriums, an effort to prevent a wave of new homelessness in the economic fallout from the pandemic, although being challenged, appear to have more staying power than the hold on encampment clearances. In February of this year, the city of Mercer Island, one of the highest income ZIP Codes in the Seattle-King County area, enacted legislation to ban camping in public parks. (1) The Auburn City Council recently passed more punitive anti-homelessness legislation, allowing the charging of criminal trespassing for people camping overnight on any city property. (2) People now face a $1,000 fine and/or 90 days in jail if they fail to follow through with individualized plans aimed at either moving them into housing or at least out of the jurisdiction. Council members who voted in favor of this criminal penalty characterize the new law as “compassionate accountability.” In Seattle, a group composed of mainly business people is calling their effort to resume encampment clearances “Compassionate Seattle.” (3) They aim to secure enough signatures to bring to vote a change in the Seattle City Charter requiring the city to provide more permanent, supportive housing and simultaneously to clear parks and other public spaces of homeless encampments by criminalizing them.

Criminalizing homelessness has a long history in our country despite the fact that it has never worked. As the National Law Center on Homelessness and Poverty documents, criminalization worsens homelessness and racial inequities by weighing down already impoverished people with hefty fines, jail sentences, and criminal records. (4, 5) Criminalization diverts money away from supportive housing, and basic health—including mental health and substance use disorder treatment—that are more cost-effective at preventing and addressing homelessness. Communities that criminalize homelessness have higher rates of violence against people living or even appearing to be homeless. (6)

If criminalizing homelessness does not work, why do we keep returning to it? Part of the reason has to do with the fact that it was foundational to our country. Our various state-level poor laws, including vagrancy laws, are based on the Elizabethan Poor Laws adopted by the original thirteen British colonies. British social historian David Hitchcock points out that “Christian charity and proper punishment were delicately connected in English culture,” a connection reflected in the English Poor Laws. (7) English paupers were sent to the colonies as punishment, in what Hitchcock terms “welfare colonialism.” (8)

Benjamin Franklin, the vocal proponent of the “pull yourself up by your bootstraps” American metaphor of personal transformation through hard work, openly despised poor people and advocated for sending them to the western frontier, which at that time was Western Pennsylvania. (9) Franklin viewed this practice as a survival-of-the-fittest sort of endeavor that would simultaneously rid the East Coast cities of urban blight and disease, force the assimilation of immigrants, and improve the character and hardiness of Americans.

This westering, frontier mentality has reverberations today in Seattle, from the increase in Tiny House Villages looking eerily like the shacktown Hoovervilles of the Great Depression, to the burgeoning vehicle residents similar to the Dust Bowl’s Rubber Tramps who lined city parks, as well as the RV residents depicted in “Nomadland.” Recently, a team of human rights lawyers invoked the frontier-era Homestead Act of 1862 in King County Superior Court. (10) They were representing a homeless construction worker who lived in his truck against the city of Seattle for impounding his truck and charging him $557 in impound fees. (The city of Seattle appealed the ruling to the Washington Supreme Court, which heard arguments on March 16, with a ruling expected within a few months.)

Punishing people for being down and out and homeless is not the answer. Increased and sustained funding for safe, affordable, supportive housing, well-connected with primary health care that is inclusive of mental health and substance use treatment, is what works to address homelessness. Policies and programs led by people with the lived experience of homelessness make them more innovative and effective.

Sources:

1. Sydney Brownstone, “Auburn City Council votes to create criminal penalty for camping on city property,” The Seattle Times, April 19, 2021, https://www.seattletimes.com/seattle-news/homeless/auburn-city-council-creates-criminal-penalty-for-camping-on-city-property/.

2.Paige Cornwell, “Mercer Island restricts camping on public property in near-unanimous vote,” The Seattle Times, February 16, 2021, https://www.seattletimes.com/seattle-news/eastside/in-near-unanimous-vote-mercer-island-restricts-camping-on-public-property/.

3. Daniel Beekman and Scott Greenstone, “Proposal to address homelessness in Seattle city charter met with intrigue, skepticism,” The Seattle Times, April 13 2021, https://www.seattletimes.com/seattle-news/politics/seattle-begins-to-digest-proposal-that-would-change-city-charter-to-address-homelessness/.

4. National Law Center on Homelessness and Poverty, “Housing Not Handcuffs: What is Criminalization of Homelessness?” https://nlchp.org/wp-content/uploads/2018/10/criminalization-one-pager.pdf, accessed 4-29-21.

5. Joseph W. Mead and Sara Rankin, “Why turning homelessness into a crime is cruel and costly,” The Conversation, June 20, 2018, https://theconversation.com/why-turning-homelessness-into-a-crime-is-cruel-and-costly-97290

6.National Coalition for the Homeless, “No Safe Street: A Survey of Violence Committed Against Homeless People,” https://nationalhomeless.org/no-safe-place/, accessed 4-29-21.

7. David Hitchcock, “’Punishment Is All the Charity That the Law Affordith Them’: Penal Transportation, Vagrancy, and the Charitable Impulse in the British Atlantic, c. 1600-1750,” New Global Studies 12, no. 2 (2018): 195-215 (quote, 200), https//doi.org/10.1515/ngs-2018-0029.

8. Hitchcock.

9. Nancy Isenberg, White Trash: The 400-year Untold History of Class in America, (New York: Viking, 2016)

10. Ann LoGerfo and Ali Bilow, “Washington Supreme Court to Hear Oral Argument March 16 in Case Concerning Seattle’s Practice of Impounding Vehicles Used as Homes,” Columbia Legal Services, https://columbialegal.org/impact_litigations/city-of-seattle-v-steven-long-2/.

Reflections on the Poor Laws

P1020893.JPGWater of Leith, Edinburgh, bench beside Saint Bernard’s well with a statue of Hygieia, goddess of health

The largely impenetrable layers of history and how we humans are so prone to repeat past mistakes.

That is what occurs to me today as I walk these ancient paths and sit beside an ancient, pagan well of healing—mineral waters—overlaid, of course, by Christian (Saint Bernard) and ancient Greek (Hygieia) symbols. After a morning of reading ancient British Poor Laws—weeks of researching them and tracing their repercussions today, not only in the U.K. but also in the U.S. and in Seattle/Washington State. The worthy and unworthy poor. The deserving and underserving poor. The impotent poor. Paupers. Vagrants. Ruffians. Charity and its attendant ills. Solidarity and its limitations.

Beige mud puddles surround me here as I sit on this bench, barely staying dry underneath my umbrella. What sort of stone is all this beige-ness? (note: ancient sandstone, over 300 million years old.) The entire city of Edinburgh is composed of beige stone. And what minerals are in this water? (note: Sulphur, magnesium, and iron it seems.)

A soft purple Scottish thistle—late blooming ones in the midst of a large patch of blackened, dried up plants with thistle heads. There seems to be a prickly and a not so prickly version of thistles here. Why is the thistle the national flower of Scotland? (note: no one seems to know although there is a story about it that involves Norwegian invaders by sea who stepped on the thistles and alerted the Scots to their presence.)

Why aren’t nurses taught more about the history of social welfare and of the legacies of ancient pauper laws? Are they taught that at all here in Scotland or elsewhere in the U.K.? How much of it are even social workers taught either here in the U.K. or back home in the U.S.? It seems so important and puts many things in perspective, especially in terms of addressing the current thorny question, “What to do about the homeless?” And my own ongoing work in the vicinity of that question. I almost feel cheated in not having known about it much earlier in my life and my career as a nurse.

The deep layers of the histories of places and peoples are important to acknowledge, to know, at least at some more than superficial level. Is this something that can only be appreciated as one ages and takes on a proper sense of time?

A beechnut exploded, scattered on the ground along the river walk path wending its way beneath an old tree. They look like flowers but are hard. I try to press one between these pages and it breaks through the paper. Only the seeds remain.

 

Body, Soul, Survival

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University of Washington, Seattle. Photo credit: Josephine Ensign/2017

“Health is politics by other means,” asserts Columbia University professor of sociology Alondra Nelson in her fascinating book Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (Minneapolis: University of Minnesota Press, 2011). Nelson acknowledges that her statement is inspired by French philosopher and scientist Bruno Latour’s assertion that science is politics by other means. For anyone who ever doubted either of these assertions—or thought they were alternative facts—you must live in the Land of Narnia.

Before reading Nelson’s book I knew that Black Panther Party for Self Defense had created community-based primary care health clinics in many major U.S. urban areas in the late 1960s/early 1970s. But I did not understand the true breadth of their healthcare activism. I worked as a nurse practitioner for about six years at Seattle’s Carolyn Downs Family Medical Clinic , originally formed in 1968 as a Black Panther clinic. It is located in the Central District of Seattle, a traditionally black neighborhood that is now significantly gentrifying. It is named after an early Black Panther community organizer, Carolyn Downs, who died at an early age of breast cancer—something that most likely could have been detected and more effectively treated if she had had better access to the primary care now provided by the clinic she helped develop. A highlight for me of working at Carolyn Downs Clinic was being able to care for one of Carolyn’s granddaughters.

The Black Panther Party for Self Defense was formed in Oakland in 1966 as a survival tactic “to afford protection for poor blacks from police brutality and to offer varied other services to these same communities.” (pp. 5-6) These services included the establishment of no-cost community-based primary care clinics, sickle-cell and blood pressure screenings, free breakfast programs for children, and after-school and summer tutoring programs. They also formed teams of patient advocates who accompanied their patients to hospitals or specialty care, heralding our current system of patient navigators. The Black Panthers were also instrumental in challenging the formation of the Center for the Study and Reduction of Violence at UCLA, a research center backed by the California governor Ronald Reagan, and which promised to find the origins of violence. It was to be headed by psychiatrist Louis Jolyon West, whose previous research included experiments with sleep deprivation, LSD, and correlating the era’s student activism with antisocial behavior. (pp. 153-154) The Black Panthers contended that aggression for people within marginalized communities was a legitimate response to oppression. They, along with many other activists, were successful in blocking funding for this center.

The American Journal of Public Health (AJPH) dedicated its entire October 2016 special edition issue to the public health work and legacies of the Black Panther Party. As physician and AJPH editor-in-chief Alfredo Morabia writes:

“Now that a new generation is carrying on the ideals of the health activists of the 1960s, it is time to revisit this history, understand the strengths and weaknesses of the BPP public health initiatives, and have a frank debate about what really happened. The stakes are huge for an emerging generation unwilling to accept that certain lives matter less than others, and that, as the recent massive lead contamination of the Flint, Michigan, water system shows, many poor (and Black) communities still remain defenseless against such overtly aggressive assaults to their health in a context in which, as Angus Deaton puts it, the infamous one percent is not only richer but much healthier.”

Read more in this AJPH special issue: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303405

Additional resources:

The Seattle Black Panther Party History and Memory Project, part of the University of Washington’s Seattle’s Civil Rights and Labor History Project, led by UW professor of history James Gregory—contains videotaped oral histories, historical photographs and news coverage and more.

 

High Art, High Medicine, High Lead

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Woman looking at art, Cleveland Museum of Art. Photo credit: Josephine Ensign/2016

Cleveland: the city of high art, high medicine, and high lead levels. Home of the amazing Cleveland Museum of Art, with its recent $350 million renovation, including a glass-enclosed atrium, the city’s largest free public space (at 39,000 square feet).

I spent the past week living in Cleveland, Ohio, in a hotel next to the Cleveland Clinic Hospital, one of our country’s premier high-end, high-tech medical complexes. It is, of course, a private health care entity. The last time I visited the Cleveland Clinic was in 1979 when I was a (blessedly only briefly) ‘cardiac patient,’ referred there by my Oberlin College clinic physician for a bothersome heart rhythm problem–probably precipitated by too much caffeine and studying of medical ethics. I remember being inside a dark brick building, and if the clinic space back then had any artwork to speak of, I certainly don’t remember it.

A few days ago, touring the art collection in the main Cleveland Clinic Hospital and guided by one of their art program curators, I was struck by how much of it is cold, clinical, and high-tech–matching, I was told, the overall branding image of the hospital system. I was standing inside the hospital space where surgeons recently had performed the first U.S.-based uterus transplant (significantly, I believe, in a married, Christian white woman and mother of adopted sons). Here are a few examples of the hospital’s prickly artwork:IMG_6708

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‘The Ineffable Gardener and the Developed Seed” 2013, Stainless steel modules, by Lois Cacchini.

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Untitled (Rooftop View) oil on masonite, 1957, by Hughie Lee-Smith. Cleveland Art Museum. 

Cleveland is part of the Rust Belt now, and the town’s numerous boarded-up, crumbling factory buildings and houses are testament to the city’s economic decline. Cleveland is a city of 389,524 residents, the vast majority are African-American, and 39.2 of all residents live in poverty (the median household income is $24,701). Not surprisingly, the health care sector is Cleveland’s largest employer, with the arts also being a leading industry. (Source: Data USA from the MIT Media Lab–a great source of up-to-date and easy-to-use data visualization based on US government databases.)

When I checked into the Cleveland hotel at the start of my health humanities conference, a middle-aged white man from Germany was carrying a large container of bottled water. When I asked him about it he told me he’d read that Cleveland’s water supply was not safe and contained high lead levels, so he was buying his own water. He also told me he had flown in to be treated at the Cleveland Clinic.

Indeed, Cleveland has one of our nation’s worst problems with lead ‘poisoning’ but mainly from lead paint in deteriorating inner-city housing. The Cleveland neighborhood of Glenville, only blocks north of the Cleveland Clinic, had a 2014 study of lead levels in children under age 6 showing that 26.5% had levels exceeding the current CDC threshold of 5 micrograms per deciliter. (Source: NYT article “Flint is in the news, but lead poisoning is even worse in Cleveland” by Michael Wines, March 3, 2016.)  Lead, as we know quite well by now, at any level is a brain poison that permanently decreases IQ and interferes with a person’s ability to control impulses. A different spin on the “No Child Left Behind Act.”

This photograph, taken from the top floor of the Cleveland Clinic Hospital and looking north towards Lake Erie, shows the downtown skyline to the left, and to the right (the darker, low-lying area) is the Glenville neighborhood. As I stood gazing at the Cleveland skyline from atop this very antiseptic and removed private hospital, I couldn’t help but wonder how anyone can possibly believe in trickle-down economics. To me it is the ultimate of self-serving delusions. IMG_6715

Framing Homelessness

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Rough sleeping in the U-District. Photo credit: Josephine Ensign/2016

Homelessness is in the news almost every day here in my hometown of Seattle. Unless you happen to live in a gated community and never go outside your protected home, there is scarcely a city block you walk without distinct signs of people living rough outside or in cars or RVs. It is no surprise then that our One Night Count of homelessness by the Seattle/King County Coalition on Homelessness last week found 4,505 people homeless/without shelter, a 19% increase from the One Night Count in January 2015. And this is despite the fact that the One Night Count volunteers (including a group of our UW Seattle nursing students) being unable to enter and count homeless people in ‘The Jungle,’ a longtime homeless encampment area in an I-5 greenbelt area of Seattle–and the location of our impressive Depression Era Hooverville. There had been a mass shooting in The Jungle the night before, resulting in the death of two homeless people and the hospitalization of three others.

Just two months ago, in November 2015, Seattle Mayor Ed Murray declared a state of emergency over homelessness, saying this in the official notice: “The City of Seattle, like many other cities across the country, is facing a homelessness crisis. The region’s current needs outweigh shelter capacity, leaving too many seniors, families and individuals sleeping on the street. More than 45 individuals have died while homeless on Seattle streets in 2015 alone.” His declaration of a state of emergency supposedly helps “deploy critical resources more quickly to those in need.”

Suddenly it begins to feel like we’ve entered a 1980s time-warp, with so many people weighing in with competing viewpoints, priorities, and proposed ‘fixes’ for our homelessness problem. I, of course, could add my own voice to the rising cacophony surrounding this latest round of the homelessness crisis. Instead, I offer these words of wisdom and perspective from some of my favorite deep and critical thinkers on the topic of the ‘first wave’ of modern homelessness in the 1980s:

  • “The scandal of homelessness looked as though it could harness a new politics of compassion and shame–compassion for the plight of the dispossessed and shame at the inhumanity of national and local policies toward them. Homelessness, in sum, had political appeal.” pp 132-133, in Donald Schon and Martin Rein’s excellent book, Frame Reflection: Toward the Resolution of Intractable Policy Controversies. Basic Books, 1994.
  • Put plainly, the opposite of homelessness is not shelter, but home. Understood culturally, ‘home’ must entail some claim to inclusion. The principled question underlying homelessness policy, then, is not, what does charity demand? but rather, what does solidarity require? And so it no longer suffices (if it ever did) to ask what it is about the homeless poor that accounts for their dispossession. One must also ask what it is about ‘the rest of us’ that has learned to ignore, then tolerate, only to grow weary of, and now seeks to banish from sight the ugly evidence of a social order gone badly awry.” p. 214 of Kim Hopper’s now classic book, Reckoning With Homelessness. Cornell UP, 2003.

The Kiwi ‘Can Do’ Community Cafe

IMG_5776As I prepare to leave New Zealand to return to my hometown of Seattle, I reflect on some of  the innovative programs and people working to address the growing problem of homelessness here in the land of milk and honey (and insanely good chocolate).

Yesterday I had lunch, a terrific soy latte, and community fellowship at Auckland’s Lifewise Merge Cafe on Karangahape (‘K’) Road. Lifewise is an Auckland-based community and social development agency that works on issues such as child abuse, domestic violence, addictions, disabilities, poverty, and homelessness. They provide direct services and also lead advocacy activities. One of their current advocacy campaigns is to urge the New Zealand government to change the age of ‘aging out’ of foster care. Currently, foster care ends on a young person’s 17th birthday; Lifewise is advocating that age to be increased to 21. They have ample evidence to show that this policy change would help many young people avoid ending up living on the streets.

Lifewise operated a soup kitchen for homeless people in Auckland since 1885. By the early part of this century they were serving over 40,000 meals a year. They realized that their soup kitchen was effectively maintaining rather than solving the issue of homelessness. So in late 2012 they closed the soup kitchen and opened the Merge Cafe on K-Road. The Merge Cafe is one of the few community cafes in the world. They say this of the cafe:

“The café aims to support Lifewise’s one-stop-shop approach to tackling homelessness by connecting patrons with wrap around support services that would in turn provide pathways out of homelessness. Secondly, the café aims to provide both the homeless and the housed alike, the opportunity to enjoy meals alongside each other, in an environment that embraced choice, dignity and respect.”

From what I saw, heard, and experienced there yesterday, the Merge Cafe is a success on all these fronts. They have tables set up to be longer community tables, not the typical isolating small tables. I sat next to a Maori middle-aged man, who told me that he had become homeless at age 16 when he ran away from an abusive home in a rural part of the North Island. He then became involved with a gang–“They gave me a sense of family that I didn’t have growing up”–but through outreach from Lifewise workers he got a “real job” and an apartment ten years ago. “I come back here to this cafe because it’s friendly and I remember what it’s like to be homeless.”

IMG_5777The cafe had a cozy corner ‘book nook’ lined with bookshelves full of paperback books and magazines to read in their comfy-looking chairs. A hot lunch consisting of an entree and a vegetable and roll cost $4 NZ ($2.50 US). The cafe was full of people eating and talking and seeming to be from a cross-spectrum of race/ethnicities, and socio-economic levels. People in the all black business suits so common in New Zealand. People in ‘high-viz’ orange vests of the road crews taking their lunch breaks. Flamboyant, paint-splattered artist-types. Jeans-wearing ‘suspiciously social worker-looking’ but laid back staff mingling around. And many familiar faces of the many rough sleepers I’ve seen around downtown Auckland.

The community cafe. What a great concept. Perhaps we should try to create one in the University District in Seattle? A worthwhile Kiwi can-do spirit souvenir to pack in my suitcase and take back home.

More Babies! Nurse-Family Partnership

Happy
Image via Wikipedia

Babies
Image via Wikipedia

To continue the baby theme and to remind myself–and all of you–about the good stuff of life and of nursing, I want to highlight the Nurse-Family Partnership Program. As they state on their website, the Nurse-Family Partnership Program “is an evidence-based community healthcare program that empowers low-income, first-time mothers to become confident parents and strong women by partnering with nurse home visits.” Based on independent research, for every public health dollar a community invests in the Nurse-Family Partnership Program, the community gets at least five dollars in return from savings in social services, criminal justice and healthcare costs. The program has now been adopted by over 400 countries and 29 states in the US–and is growing due to its wide-spread appeal and proven cost-effectiveness.

I have the good fortune of working with two local nurses involved with the Nurse Family Partnership in Seattle–King County. It should come as no surprise that they are some of the happiest and seemingly healthiest most grounded of all nurses. They always make my day and remind me of the good stuff of nursing.

Here’s a link to my favorite video of the Nurse-Family Partnership–from New York City. Healthy happy babies and moms and nurses! What’s not to like?

OK–the puppies snuck in here and the kittens are close behind….