Margot Kushel MD Profile picture
Jul 7, 2020 26 tweets 11 min read Read on X
Thrilled to be listening to @nhannahjones & Marla Newman, Chair BOD @NLIHC on #RacialEquityAndCOVID from lens of housing/homelessness!
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& @nhannahjones spelling out how control of housing was mechanism of social control in North (racial covenants, redlining)."You don't have to pass laws saying Black ppl couldn't go to school with White ppl if you control where they live--& create neighborhood schools"
Midwestern & Northern cities most segregated--not just housing, but also schools. #RacialEquityAndCOVID
"Fair Housing Act is Civil Rights Law of the North"--not passed until after 1968, after Rev Dr King assassinated. Resistance to passage of law foreshadowed hesitancy to enforce Fair Housing Act. #RacialEquityAndCOVID Lack of enforcement has continued since its inception.
Housing is lynchpin of opportunity @nhannahjones #RacialEquityAndCOVID @NLIHC
White ppl moved out of integrated neighborhoods through redlining. Inequality created w government policy--it has to be undone through govt policy #RacialEquityAndCOVID
How do you undo generations of disadvantage & racial hierarchy--if White ppl control levers of power & White Americans don't want to undo anti-Black racism/segregation? Unfair to ask Black ppl how do we get White ppl do what is just! #RacialEquityAndCOVID
Wealth gap even more detrimental than income gap--Black households have 10 cents of wealth for every $1 White Americans (Black families w kids--1 Cent for every 1$)--biggest generator of this is HOUSING. Post WWII--Fed Govt said only needed to put down 20% to buy home
But Fed policies kept Black Americans from buying homes. Black ppl left out of "generational affirmative action" of mortgage/housing policy. AND redlining artificially inflated values in White areas & ⬇️in Black areas. W Fair Housing Act--didn't equalize home values.
Black incomes about half that of White--but also had no way to accumulate wealth over time. During #COVID--w/o wealth--no cushion with economic shock (loss of income during COVID). More than 1/4 Black Americans have missed rent payment since COVID. #RacialEquityAndCOVID
If you are Black & lose your job--you can be homeless w/in 2 months--you have NO safety net. Manufactured disadvantage since chattel slavery. #RacialEquityAndCOVID
White person w HS degree than Black person w graduate degree--effects of generational wealth inequities. Only way to build wealth is to transfer wealth to Black communities. #RacialEquityAndCOVID
Why do (White) Americans have a visceral rejection of the idea of repair? What would it look like?Targeted investment into Black neighborhoods/schools to make up for disenvestment.Vigorous enforcement civil right laws & individual cash payments @nhannahjones #RacialEquityAndCOVID
Black & Latinx ppl blamed for housing crisis in 2008--This is how racism works. Entire communities unbanked w/o access to capital were targetted--vulnerable communities made vulnerable by policies. #RacialEquityANDCOVID
Once face of social issue becomes Black person--society stops caring--we are seeing this w #COVID19. (and homelessness!). #RacialEquityAndCOVID
Most low income housing in this country for elderly White ppl--but once face becomes Black ppl, you get opposition. #RacialEquityAndCOVID
Did we learn any lessons from 2008 that could inform how we move forward in #COVID housing crisis. @nhannahjones says: Alot did learn, but not the ppl who are in power.
Watch messages of personal responsibility--has been our default--language White supremacy. Lots of White Americans get hurt by these policies--White ppl willing to hurt their own interests if they think larger #s Black and Brown ppl will benefit. #RacialEquityAndCOVID
What has pandemic taught us about political will & social policies? @nhannahjones pandemic has exposed all the excuses why we can't afford social safety net etc as just that--excuses. Exposed idea of ppl undeserving of help--
circumstances outside your control can dictate whether you can pay the rent. "Can't put that genie back in the bottle." Many of these policies sunsetting now. Will there be retrenchment? The thing to do is call your congressppl--we have to pass programs to help fellow Americans.
Individual Americans can't forestall rent and eviction crisis--that is the role of government. There are things only govt can & should do. @nhannahjones #RacialEquityAndCOVID
Due to redlining/segregation--Housing hasn't been as good an investment for Black Americans. @nhannahjones why are discussions about reparations (when they happen) about everything other than $ --"freedom is being able to spend $ as you want." #RacialEquityAndCOVID
Most Black voucher holders have to use them in segregated communities, Fair Housing Act not enforced. Tension bw low-income housing $ Fair Housing. To house the most ppl, don't want to spend $ in affluent areas (or manage battles). #RacialEquityAndCOVID.
Need to resolve this tension--control at municipal level--of where low-income housing built to make allotment of housing more fair! #RacialEquityAndCOVID
Thank you @nhannahjones & @NLIHC for amazing discussion on #RacialEquityAndCOVID

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More from @MKushel

Mar 25, 2022
Housing First works. We have tons of evidence to support it. The problem is--we don't have the housing. The soln: we need to preserve, protect, produce housing for the lowest income renters. Happy to talk to @BigadShaban @nbcbayarea about the evidence. 1/x
Discussed our eval study w @mravenEM @DSTNHome @SCCgov @abode_services @ucsfbhhi which showed that even the "hardest to house" ppl could be housed FOR YEARS w/o preconditions 2/x

hsr.org/node/664701
We gave Abode, SCC a list of the folks who were homeless who faced the most challenges (⬆️use of hospitals, ED, jail, psych, etc)--and randomly assigned folks to Housing First Permanent Supportive Housing w "intensive case management"--a master's trained counselor (e.g. LCSW) 3/x
Read 16 tweets
Jul 14, 2021
A🧵about #COVID vaccines. The @ucsfbhhi has spent last several mos working w great partners to provide vax to folks in the Tenderloin--including those who are homeless/formerly homeless. After providing 2500+vax to folks who face many barriers to vaccines--some thoughts: 1/x Bright mural on wall, tree holding homes with inscription: E
We talk alot about vax "hesitancy" but--we found, access>>>hesitancy. We had small, local sites (@GLIDEsf & Boeddeker Park)--with great outreach/ no appts needed. Helpful for those who couldn't get to mass vax sites. Reached 100s of folx, but not enough: So, what worked? 2/X Sunny day, blue topped tends on city street with ppl in them
Mobile teams! Teams, led by the incredible @codetenderloin --ppl w deep roots in community, lived expertise--w MD/NP or RN & "scribe." Teams walked around neighborhood and vaccinated folks wherever we found them. We answered ?s, supported ppls' choices--& when ready--vaxxed 3/X Ppl. casually dressed, masks--cart with bright pink sign &qu
Read 9 tweets
Oct 19, 2020
This policy change is v problematic. Don't be fooled by talk of ⬆️mental health. The reason homelessness has ⬆️ is bc the fundamental drivers of homelessness: income inequality, lack of deeply affordable ("ELI") housing & racism-- have worsened. A 🧵 1/x
bit.ly/3dF5Sdn
Housing First has a strong evidence base. Our recent study showed it successfully housed 86% of the "most difficult" to house chronically homeless ppl w high rates of substance use and mental health disabilities. hsr.org/node/664701 2/x
Read 12 tweets
Sep 25, 2020
Our paper, RCT on PSH for the highest user of healthcare is out @HSR_HRET. PSH w/ intensive case management ends homelessness for 86% of the highest users of multiple services. A lot of subtlety here. A 🧵@mravenEM @ucsfcvp @ucsfbhhi @ucsf onlinelibrary.wiley.com/doi/full/10.11… 1/x
Multi-year RCT comparing PSH (subsidized housing, mostly scattered site; ICM 1:15 master’s trained led team by @abode_services) vs usual care for chronically homeless ppl who were highest users of acute healthcare/jail in @sccgov 423 participants (199 intervent/224 control). 2x
Inclusions: chronic homelessness; highest users of services. Ineligible: engagement other program, req nursing home, hospice eligible. We created risk score/triage tool to calculate highest users (mult criteria). Triage tool calculated continuously & flagged in records. 3/x
Read 20 tweets
May 15, 2020
Must read editorial in @nytimes on #homelessness that lays out the problem, where blame lays, & solution--"The fed govt could render homelessness rare, brief & nonrecurring. The cure for homelessness is housing." (YES!) A thread 1/x @BCAppelbaum

nytimes.com/2020/05/15/opi…
1. Problem is housing (not individual vulnerabilities) 2. Federal govt (& realistically, only Fed) could solve it 3. Instead, feds heavily subsidize wealthy homeowners, instead of low-income (mortgage interest tax deduction means homeowners live in deeply subsidized housing) 2/x
4. We spend $12 Billion a yr on shelters (shelters are dangerous, difficult places (#COVID19 has made this more evident cdc.gov/mmwr/volumes/6… , but as CA Gov @GavinNewsom says: "shelters solve sleep, housing solves homelessness) & 1/3 (in CA 2/3) unsheltered) despite $12B 3/x
Read 12 tweets
Mar 28, 2020
CA guidance on ⬇️ risk to homeless pops during #COVID19. Urgent need for private spaces (i.e. hotels) to ⬇️ risk. Can cohort those w infxn who don't require hospitalization (need tests!) in order to provide medical care. (Thread) 1/X

cdph.ca.gov/Programs/CID/D…
Ideally, would have private room for all, but unlikely. So, a prioritization scheme. 1) need social distancing (& hygiene)/encampment in shelters & aggressive syndromic screening in shelters & encampments 2) prioritize ppl likely to have ⬆️risk complications for hotels 2/X
(⬆️ age, underlying conditions) 3) PUI (+screens) to hotels for isolation (NEED TESTS!) 4) ppl COVID+who don't req hospital, either in hotels or cohorted (some + to cohort to be able to provide medical/behavioral health care) [Need PPE!] 3/X
Read 9 tweets

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