Commentary: Solutions Over Sweeps

A humanitarian crisis is unfolding on the streets of Denver, where homelessness serves as a poignant reflection of systemic failures that permeate all sectors of public policy. Instead of addressing the underlying causes of homelessness, cities like Denver and Aurora have opted to veil the growing homelessness crisis through “Band-Aid solutions” like encampment “sweeps.” Sadly, the discussion has focused more on what to do with "the homeless" and less on what to do for them.

In May 2012, Denver instituted its urban camping ban. To enforce this ban, Denver police and other service workers have forcibly displaced people experiencing homelessness, a not uncommon practice in cities throughout the U.S. Against the backdrop of diminishing affordable housing, the Denver metro area homeless population has swelled. How has this been addressed? An increased frequency of encampment sweeps that occur largely at times hidden from public view. The frequency of sweeps doubled from 2020 to 2021, and they usually occur between 10 p.m. to midnight or 6 to 8 a.m. Furthermore, only 4 percent of the individuals displaced in these encampment sweeps are subsequently connected to shelters. In essence, we tell them that they can’t stay here but give them no other options.

As public health professionals, we have a responsibility to critically assess the impacts of encampment sweeps on the health and well-being of those affected. This critical assessment necessitates utilizing evidence to inform policy discussion through a scientifically rigorous lens. Despite city officials’ claims that encampment sweeps are necessary for addressing public health and safety concerns, research, including a recent study published in the Journal of the American Medical Association (JAMA), paints a different picture. Sweeps are cruel, ineffective and costly, and are likely worsening the health of people experiencing homelessness. The ongoing enforcement of these sweeps exacerbates cycles of violence against the population and further compromises their health outcomes. Moreover, sweeps are a demonstration in fiscal irresponsibility, as they siphon taxpayer money toward ineffective measures that fail to address the root causes of homelessness or provide sustainable solutions. The JAMA study that emerged from our research lab modeled the health and economic impacts of forcibly displacing people experiencing homelessness in cities across the United States, including Denver. The results underscore that sweeps not only lack efficacy, but also impose detrimental effects on both displaced individuals and the larger community.

The study used a model to estimate the effects of sweeps on health outcomes associated with injection drug use, including overdose and hospitalizations for serious injection-related infections, by simulating the natural history of injection drug use in hypothetical cohorts of people experiencing homelessness in different cities.

Here’s how it works: Based on each (simulated) individual’s unique demographic and behavior profile, and the risk environment of the city being modeled, researchers estimated the chances of experiencing an overdose, developing an infection, linking to care, initiating medication for opioid use disorder (MOUD), changing behaviors, and death in the absence of involuntary displacement. The inputs were informed by more than thirty peer-reviewed studies that largely comprise the bulk of recent research on this subject. The team then used other published studies to calculate how displacement might impact access to vital services, and ran the model again under the conditions of involuntary displacement. Same population; the only thing that changed was access to services.

When the model simulated the Denver population hundreds of times over a ten-year period, it found that, across the board, continuing to sweep unsheltered people without accompanying services or housing leads to worsened health outcomes. Period.

Why? Because when people experiencing homelessness are displaced — even by just a few blocks — they can be cut off from critical social support, medical care like methadone, and harm reduction services, not to mention losing their personal belongings and even medication.

This matters, because if Denver’s next mayor continues to enforce the camping bans by involuntarily displacing people, we can expect a 189 percent increase in overdose mortality and a one-year decrease in an already depressing life expectancy among unsheltered people who use drugs (7.42 years to 6.34 years out of a possible 10). We would also expect to see dramatic increases in hospitalizations — overburdening an already burned-out health-care system and burdening taxpayers with increased Medicaid and law enforcement costs that could be mitigated by prioritizing housing, preventive care and harm reduction.

In addition to the compelling evidence presented in the JAMA study, there is a wealth of research that not only suggests but unequivocally demonstrates that incarcerating and mandating substance-use disorder treatment for people experiencing homelessness fails to address homelessness and further worsens health outcomes. So, what does work?
Housing First. Housing First is a cost-effective approach that prioritizes providing immediate access to stable, permanent housing to individuals and families experiencing homelessness. This approach recognizes that having a safe and stable place to live is a fundamental human right and necessary foundation for individuals to address other challenges they may face, such as mental health, substance use and employment. Denver has already been a national leader in testing the housing first initiative through Social Impact Bonds. We need to scale this now — because it works.

Wraparound Supportive Services. Wraparound supportive health services have been shown to reduce health-care costs and improve health outcomes for individuals experiencing homelessness. When utilized in conjunction with supportive housing, improved health outcomes are amplified, as supportive housing can serve as a locus for health-care providers to implement customized-care strategies for people experiencing homelessness. To be clear, though, sobriety and acceptance of these services should not be a condition of housing.

Decrease health hazards of the encampments. Housing with supportive services is the goal, but is a long way off — no matter what mayoral candidates may promise. There are thousands of people experiencing homelessness in the Denver metro area — we simply can’t build enough homes in one year. Stopping encampment sweeps is literally the bare minimum that we can do. But what if, while sweeps are stopped and housing is being built, we decrease the hazards of living in an encampment? Providing basic amenities such as sanitation facilities, waste disposal and access to clean water could offer a safe and organized environment for people experiencing homelessness and surrounding communities (temporary as it might be). Encampments also offer a locus for facilitating connections to other systems of care, such as mental health support, housing resources, substance-use disorder treatment and other social services. When we routinely move people, it makes it harder for outreach teams to find them — thus delaying vital preventive care and social services. By adding basic services for unsheltered populations like what has been done in Oakland, we would improve health in the short term and increase the chances of getting people into long-term housing. While this is not a sustainable solution, it might be an intermediate step as long-term solutions are developed.

We, all of us, have a moral obligation to advocate for policies that prioritize the health and well-being of the entire public, not just the well-resourced, well-connected public. Involuntary displacement not only fails to address the root causes of homelessness, but also exacerbates the health and social disparities experienced by unhoused individuals. By adopting evidence-based policies that prioritize housing and supportive services, we can work toward ending the crisis of homelessness and upholding the basic human rights of all individuals, regardless of their housing status. It is time for policymakers to recognize the evidence and take action toward more effective solutions for individuals experiencing homelessness in Denver and beyond.

Cole Jurecka and Pranav Padmanabhan are public health researchers and Denver residents.

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