As 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.”
The 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.
Dorothy Day is known for her work in social justice, and especially for her co-founding and longtime work with the Catholic Worker Movement. Earlier in my career I worked with the Richmond, Virginia-based Freedom House, modeled after Day’s houses of hospitality. Freedom House, like Day’s original house of hospitality in the Lower East Side of NYC, included a shelter, soup kitchen, laundry and clothing services, counseling and friendship. The staff members of Freedom House lived in voluntary poverty as a mark of solidarity, and as a way to become un-insulated from the realities of poverty and homelessness.
I also knew that Dorothy Day had been a journalist and had been involved with the women’s suffrage movement. She picketed the White House in 1917 as part of the Silent Sentinels’ nonviolent civil disobedience, and was arrested and jailed for her part in the peaceful protest.
But, I had no idea that Dorothy Day was also a nurse. I discovered that fact recently when I read her autobiography, The Long Loneliness (Harper and Row, 1952). In 1918, as WWI and the influenza pandemic raged on, Dorothy wrote to a friend: ‘I hate being Utopian and trying to escape from reality . (,,,) What good am I doing my fellow men? They are sick and there are not enough nurses to care for them. It’s the poor that are suffering. I’ve got to do something.”
So she went to work as a nurse–or a nurse-in-training– at the Kings County Hospital in Brooklyn. She writes of this time: “From the beginning I enjoyed the work. (…) My experience there reassured me as to the care one received from the city. It was a care given to citizens, not to paupers. And it was all free.”
In her autobiography, she describes specific patients and hospital wards that were particuarly memorable to her. Two female patients dying near each other in a ward, one a woman of fifty and the other a girl of twenty-two. Of the younger patient she writes, “There was the smell of death around her, I kept thinking, and there was no one to bring her flowers to deaden it.” She moved to a fracture ward. ‘This ward broke me, the work was so hard. (…) One afternoon when I had been cleaning up filth all day, and the perverse patient had again thrown her bedpan out on the floor dirtying my shoes and stockings, I left the ward in tears and sat in the washroom weeping uncontrollably at the ugliness and misery of life.” Day claims that she had a sympathetic nursing supervisor who took her off the difficult ward, “… transferring me to medical where there were fifty patients with influenza.” (I’m not so sure I’d call her supervisor sympathetic.)
We forget how devastating the 1918 flu pandemic was: “This was the time of the ‘flu’ epidemic and the wards were filled and the halls too. Many of the nurses became ill and we were very short-handed. Every night before going off duty there were bodies to be wrapped in sheets and wheeled away to the morgue. When we came on duty in the morning, the night nurse was performing the same grim task.(…) It was hard not to be careless at this time when every day ten or twelve new patients were carried in or walked staggeringly only to fall unconscious as soon as their clothes were taken from them.”
Of burnout and emotional numbing in her work a a nurse, Day writes this: “Nursing was like newspaper work. It was impossible to suffer long over the tragedies which took place every day. One was too close to them to have perspective. They happened too continuously. They weighed on you, gave you a still and subdued feeling, but the very fact that you were continually busy left you no time to brood.” She writes of finding solace and peace outside in the hospital grounds: “I just sat for a brief rest and watched the sparrows and starlings looking for crumbs from the apron pockets of the old women. ”
Dorothy Day worked as a nurse at the hospital for a year, until after the influenza epidemic was over. “Then a longing to write, to be pursuing the career of a journalist which I had chosen for myself, swept over me so that even though I loved the work in the hospital, I felt it was a second choice, and not my vocation. My work was to write and there was no time for that where I was.” She concludes this chapter of her life by writing, “…I had been a good and sympathetic nurse. I knew that I loved the work, and that if I had not had the irresistible urge to write, I would have clung to the profession of nursing as the most noble work (…).”
Nurse Dorothy Day, along with suffragist/activist/radical hospitality Dorothy Day: an inspiration.
Seattle is a boom or bust town. Boom times: The timber/logging industry of its early days. The jumping off point for people drawn to the Klondike Gold Rush in the Yukon. The Boeing surge during WWII. And, since the 1990s and accelerating over the past four or so years, the technology boom with Microsoft and now Amazon leading the way. The bust times in between, including the Boeing Bust of the early 1970s, spurring the famous billboard near the Sea-Tac airport reading, “Will the last person leaving Seattle turn out the lights.”
Since its early days Seattle has been a socially progressive place. King County, which includes the City of Seattle, was formed by the Oregon Territorial legislature in 1852. From the beginning, the King County Commissioners were responsible for such things as constructing and maintaining public buildings, collecting taxes, and supporting ‘indigents, paupers, ill, insane, and homeless people living in the county.’ Today, while there is a robust safety net in our community, it is not strong enough. Homelessness in the Seattle area is increasing, with tent cities sprouting up wherever they can, including along the original Skid Road (Yesler Way) in the shadows of Harborview Medical Center as shown in this photo taken late last fall.
Homeless encampment near Harborview in downtown Seattle. Photo credit: Josephine Ensign/2014.
As the bumperstickers at the beginning of this post proclaim: Healthcare is a human right; housing is health care. They were produced by the National Health Care for the Homeless Council, of which I am a member. The Council recently issued this timely and hopefully provocative-in-a-good way justice statement entitled Standing in Solidarity: In Support of the Movement for Social Justice. It reads:
“The National Health Care for the Homeless Council recognizes that the significant health disparities associated with homelessness are part of a much larger pattern of injustice in the United States. Poverty and structural racism too often are perpetuated and upheld by poor public policies and narrow social opinion, leaving millions of men, women, children, and youth unable to achieve their potential for well-being and success. We stand in solidarity with the growing social movements and supportive jurisdictions that seek to correct underlying social and economic inequities. We understand that our work as health care providers is part of a much larger struggle to attain human and civil rights, to include the rights to housing and health care.
Numerous recent events involving police violence and community responses have reawakened the national consciousness around the failures of our public systems. Rather than focusing on sensationalized moments and ignoring the daily traumatic violence experienced by those living in poverty, we ask that media outlets instead continue to highlight the root causes of these incidents—social disinvestment, racism, and the ongoing, profound inequities in opportunities, as evidenced by the following:
Incarceration: The U.S. has the highest rate of incarceration in the world, disproportionately among people of color commonly convicted of nonviolent drug offenses. In 2013, nearly 7 million people were in the adult correctional system (4 million on probation, 1.5 million in prison, 850,000 on parole, and 731,000 in jails). People without homes are routinely criminalized for sleeping or sitting in public spaces, as are people struggling with mental illness and addictions. This leaves millions with criminal records that often preclude employment and housing.
Public policies created current conditions, but the policy-making process can also promote a robust and inclusive society. We call for measures to establish for everyone in our country the rights to health care, housing, and livable incomes. We also call for those in the Health Care for the Homeless community—and others allied with this cause—to continue our work toward public policies that achieve social justice.”
This was the first in my summer reading challenge (with a health humanities/social justice slant): Just Like Us: The True Story of Four Mexican Girls Coming of Age in America, by Helen Thorpe (Scribner, 2009). I ran across this book last month at Denver’s lovely downtown ‘LoDo’ Tattered Cover Bookstore (a highly recommended indie bookstore). I asked the helpful information desk woman to direct me to books by local authors, and this was one she recommended.
I give it a one (sunny peace symbol) out of five–also known as ‘I did not like it.’ While it is generally well written, I found it to be too superficial in its treatment of the complex issue of immigration. At one point in the book, Thorpe likens her struggles to be taken seriously as a journalist (while being known mainly as the wife of the Mayor of Denver) with the Mexican young women’s struggles to assimilate to life in the United States. Really? How did that statement get past the book’s editors? In addition, the author lost credibility to me when she admitted to not speaking or understanding Spanish, when the families of the four girls she highlights in the book are mono-lingual Spanish-speaking.
Time for some serious summertime reading. Time to join in on the ‘summer reading challenge’ as posted by one of our PNW writers, Oliver de la Paz (a wonderful poet). He has the full list of reading challenge criteria on his blog post, along with his own summer reading list. And for more ideas, one of my current writing teachers/mentors, Wendy Call, has her summer reading list posted here. My own list is slanted towards topics having to do with health humanities and social justice. I realize they aren’t exactly ‘light’ summertime reading, but what can I say…Here is my current reading list (with the last three books being ‘borrowed’ from his list):
The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander (This is our University of Washington Health Sciences Common Book for academic year 2015/16).
The Politics of Aesthetics, by Jacques Ranciere
Capital in the 21st Century, by Thomas Piketty
The Aesthetics of Resistance, by Peter Weiss
Raw Data is an Oxymoron, by Lisa Gitelman
On Such a Full Sea, by Chang-rae Lee
The Bladerunner (book–not the movie one) by Alan Nouse
Intern, by Doctor X (Alan Nouse)
Urban Alchemy: Restoring Joy in America’s Sorted-Out Cities, by Mindy Thompson Fullilove (lovely last name!)
Just Like Us: The True Story of Four Mexican Girls Coming of Age in America, by Helen Thorpe (currently reading this one)
Graphic Medicine Manifesto, by MK Czerwiec, et al.
Mirrors: Stories of Almost Everyone, by Eduardo Galeano
Words, and especially metaphors, fascinate me. They are powerful and oftentimes unexamined. Take cliff for example. The OED definition of cliff is: “a perpendicular or steep face of rock of considerable height.” Cliffs are both dangerous and exhilarating-seductive. Think of the aptly named Heathcliff (Emily Bronte’s in Wuthering Heights that is, not the rather insipid comic-strip cat). Cliffs represent the edge of the known and comfortable world. Cliffs are good places to gain some perspective.
Cliff, as a metaphor in the health policy world, is used in various ways. First, there is the ‘funding cliff,’ and specifically the current ‘primary care funding cliff,’ also called the ‘community health center funding cliff.’ Community Health Centers across the U.S. are facing a potential federal funding cut of up to %70 this coming fall (for a good and brief article on it, see the Commonwealth Fund’s Washington Health Week in Review, “Health Centers Push for Remedy to Avoid the Funding ‘Cliff,” by John Reichard, 11-3-14). The National Association of Community Health Centers has a policy issues website on the primary care funding cliff with more information and links to policy advocacy that individuals and groups can get involved in. And here is the RCHN Community Health Foundation’s infographic on the primary care funding cliff.
I am a big fan of community health centers (CHCs) and have worked at three different CHCs in the Seattle area over a period of fifteen years. They typically have very passionate, social-justice oriented people working for them, and they emphasize the use of interdisciplinary teams. CHCs provide comprehensive community-based health care for over 25 million people living in poverty, people who are homeless, as well as immigrant/refugee, and migrant farm workers in urban and rural areas throughout the U.S. CHCs are far from the ‘perfect’ model of care–they are high professional burnout workplaces and they often have much more ‘heart’ than ‘head’ (as in sometimes struggling with good leadership/administration). But they are as close to perfect that I’ve experienced in our country. Not surprising to me is the fact that one of our earliest models of CHCs was the Frontier Nursing Service, started by nurse midwife Mary Breckinridge in 1925 (and still in existence) to provide primary health care in an impoverished rural area of Kentucky.
But to return to the cliff metaphor, a second and important use of ‘cliff’ in the health policy arena is Dr. Camara Jones‘ ‘Cliff Analogy’ framework for levels of health prevention at a population level. Dr. Jones is a family physician and epidemiologist, and currently Research Director on social determinants of health and equity at the Centers for Disease Control. She distills down and illustrates complex health policy/health systems issues through the use of stories and metaphor–the Gardener’s Tale for levels of racism, and the Cliff Analogy for the social determinants of health and of health equity.
In a recent journal article/commentary, Dr. Jones states, “The social determinants of health equity differ from the social determinants of health. While the social determinants of health are the conditions in which people are born, grow, live, work, and age, the social determinants of equity are systems of power. (…) The social determinants of equity govern the distribution of resources and populations through decision-making structures, practices, norms, and values, and too often operate as social determinants of in-equity by differentially distributing resources and populations.” (“Systems of Power, Axes of Inequity” in Medical Care, October 2014, 52(10): S71-S75). In a graphic depiction of these concepts included in her ‘Cliff Analogy,” she shows that the cliff is not a flat, 2-dimensional cliff (as in the infographic above), but is 3-dimensional–differing in how resources, populations, (and, I would add, even the cliff’s physical contours/environment) are distributed.
So on this official President’s Day in the U.S., or Washington’s Birthday for all federal workers, take some time away from the shoe and cars sales and school holiday to consider what actions you can take to make our communities healthier and more equitable places.
Amidst all the Year in Reviews and New Years Resolutions and post Christmas/Hanukkah/Kwanzaa/Festivus consumerism hangovers, I’m thinking a lot about the power of hope. The power of dreaming a better world. The power of dreaming and then doing something concrete to help bring about a better world. Direct service, political advocacy, and activism: we need a healthy combination of people involved in all three areas of civic engagement. And just because we might be drawn to one area (like direct service) and repelled by another (like in-your-face activism) doesn’t mean that they aren’t all equally as important.
Art and writing as activism. The living writer who best exemplifies what it means to dream a better world (and to write great literature about it) is science-fiction writer Ursula Le Guin. This year at the National Book Awards, Le Guin received the Medal for Distinguished Contribution to American Letters. In her powerful acceptance speech (YouTube video of it here), she states:
“Hard times are coming, when we’ll be wanting the voices of writers who can see alternatives to how we live now, can see through our fear-stricken society and its obsessive technologies to other ways of being, and even imagine real grounds for hope. We’ll need writers who can remember freedom — poets, visionaries — realists of a larger reality”
Health and Homelessness in Richmond, Virginia in the 1980s: Although I was intimidated by her when I first started working at the Richmond Street Center in 1986, I quickly came to view Sheila Crowley as a valuable mentor.
Sheila Crowley was the Executive Director of the Daily Planet (the lead agency of the Richmond Street Center) from 1984-1992. She left the Daily Planet in 1992 to work on her doctorate in social work, focusing on housing policy. As part of her doctorate, she did a yearlong housing policy fellowship on Capitol Hill. Since 1998 she has been President and CEO of the National Low Income Housing Coalition (NLIHC), based in Washington, DC. The NLIHC works on socially just national housing policy issues, public education, and research. They publish the annual Housing Wage/ Out of Reach Report, which shows side-by-side comparison of wages and rents for all U.S. counties, metropolitan areas, and states.
In my telephone conversation with Sheila several years ago, she characterized the national policy climate as “a disconnect between the response to homelessness and the response to the housing shortage.” She commented on how homelessness has become institutionalized and taken for granted, with so many more people working within the homelessness industry than when it originated in the 1980s, and with even more displacement of low income people from housing.
I had been thinking about similar things. After more than a quarter of a century working with homeless people in the U.S., it disturbs me that there are more, not less people experiencing homelessness, illness, and lack of access to basic health care. There are more specialized services for homeless people in our country than there were three decades ago: homelessness as a problem has become institutionalized. Within the federal government, the Interagency Council on Homelessness includes representatives from fifteen different federal agencies related to homelessness. Homelessness has become an industry. There are currently at least 1 million people working directly with homeless-focused agencies. Homelessness is an assumed aspect of modern American urban life, often portrayed in Hollywood movies as part of a gritty, authentic urban backdrop. I had been asking myself whether by working in the ‘homelessness industry’ I was doing more harm than good: harm in that I helped make homelessness more palatable to people experiencing homelessness, as well as to our housed community members (and yes, even to myself: a literal “I gave at the office” sort of a thing). I haven’t found an answer to my question, but I continue to think it’s an important one to ask.
Sheila gave me broad-brush characterizations of the Clinton, Bush, and Obama administrations’ approaches to housing and homelessness. Under Clinton there was emphasis placed on de-concentration of low-income housing, with the unintended consequence of a net loss of low-income housing units. The Bush administration placed emphasis on increasing home ownership rates, with some funding going to McKinney Homeless Assistance for housing programs. Obama appointed a great Housing and Urban Development (HUD) director, Shaun Donovan, and Sheila had high hopes, but at the time of our interview she felt that not much had been done. The Homelessness Prevention and Rapid Re-housing Program funded through the American Recovery and Reinvestment Act of 2009 appears to have been effective at preventing the worst of recession-related increase in homelessness, although the numbers of unsheltered and doubled-up homeless increased during the 2009-2011 time period.
Sheila and I talked about how even the term ‘homeless’ is problematic on many levels. In the U.S. there have been different official federal definitions for homeless. Until recently the Department of Housing and Urban Development only included the visible or literal homeless—those living on the streets or in emergency shelters. Other federal definitions, such as those necessary for receiving health benefits, have had broader definitions that included people temporarily doubled-up with friends or family, people living episodically in cheap hotels, and people living in cars or other places not intended for human habitation. This definition encompasses people in many different variations of being marginally or precariously housed—as I had been as a young adult. The HUD definition was amended in December 2011 to be more in line with this broader definition of homeless.
Sheila described being at a Homeless Advocates Group (HAG) national meeting recently. HAG is composed of leaders of all the major groups working on homelessness at the national level, including the NLIHC, the National Health Care for the Homeless Council, and the National Alliance to End Homelessness. She looked around the meeting room and realized that all of the leaders of the represented agencies and coalitions were now in their fifties and sixties and had gotten their start in homelessness work in the 1980s. She thought to herself, “Here we go again,” with the increase in the number of homeless, this time due to the national foreclosure crisis and effects of the prolonged recession.
She was quick to highlight success stories, communities that are pulling together coordinated responses to homelessness with a Housing First emphasis—working to maintain people in adequate affordable housing and to quickly re-house people—and a Housing Plus approach of providing supportive housing for people with mental or physical health or substance abuse issues complicating their homelessness. People cannot be healthy unless they have safe and healthy housing. She mentioned Columbus, Ohio and Worcester, Massachusetts as two examples of successful community responses, and added that my new hometown of Seattle has done pretty well with a significant decrease in the chronically homeless population. Across the country, there’s been resistance from emergency shelter providers and church-sponsored programs who see funding and support moving away from their services. But the Housing First movement has had broad bipartisan support since it cuts across different political ideologies.
When I mentioned to Sheila what now stands at the corner of Belvidere and Canal Streets where the Richmond Street Center had been (it is now a VCU college dorm building and a Starbucks), she immediately said, “The only thing I regret about the Street Center building being torn down was the elevator.” This surprised me until I remembered what a practical woman Sheila is—a common character trait of many of the social workers, as well as of public health nurses I have known. She reminded me that the city inspectors had insisted she fund and install a $30,000 elevator in the Street Center building before it could open. She hopes they were at least able to re-use the elevator for another building. She also recounted the construction of the addition on the back of the Street Center for the expanded clinic space I worked in. A sinkhole opened up in the parking lot while they were preparing the foundation. That’s when they discovered that the Street Center was built on land that had been the city dump. Sheila said she went back to where the workmen were standing around looking at the hole, rubbing their chins, exclaiming, “It’s the darndest thing,” and she responded, “Well don’t just stand there, do something about it!”
We need more people like Sheila who don’t just stand around contemplating problems, but who roll up their sleeves and try to solve them.
The State of Homelessness in America 2014 report from the National Alliance to End Homelessness. The overall rate of homelessness in the U.S. decreased by 3.7% for the time period 2012-2013, although it increased in 20 states.
As 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).
The 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.
