A reporter looks at why one town's homeless residents die so young

The first time Kenzie spent the night outside, she was 5 years old.

She was with her mother and siblings — six people in a five-seat station wagon parked on the second story of a downtown Santa Cruz parking garage. They stayed up listening to the radio until the car battery died.

“It was cold, and we were definitely hungry, and it was definitely difficult on my mom,” remembers Kenzie, who asked Good Times to withhold her last name to protect her privacy. 

Kenzie’s experience is one of many stories of heartbreak I heard firsthand during my monthslong investigation into the health impacts of homelessness in California’s Santa Cruz County, with support from the Center for Health Journalism’s 2020 California Fellowship.

Standing near her tent by the shoulder of Highway 1, Kenzie wore a leopard-print top and a knit 7-Eleven beanie with her hair in a ponytail. She hadn’t been able to shower lately, and her hair was dirty, so she wanted to keep it out of her face, she said.

Kenzie, a 29-year-old ovarian cancer survivor, has had a number of bouts of homelessness and a host of health problems to go along with them — including sciatica and blood clots, both of which she partially attributes to sleeping in awkward positions in her car in recent years.

“On top of that, the lack of sleep, having to be outdoors. And dude, this is not any life for a woman out here,” she said. “It is scary and sketchy and fucked in every way. It’s exhausting. You can’t get very healthy food very often. You can’t get support to stay safe from any abusers.”

Being homeless is a huge health risk. Statistics compiled by Santa Cruz County routinely show that local homeless residents die at least 22 years earlier on average than the county’s housed residents do. Housing Matters and the Santa Cruz County Homeless Persons’ Health Project (HPHP) hosted the county’s 22nd annual Homeless Memorial on Friday, Dec. 18. In compiling figures for the 2020 report, HPHP found 77 confirmed homeless deaths, more than in any year in the past 22 years.

The official causes of death include factors like suicide, substance abuse and heart attack.

But Joey Crottogini, the health center manager for HPHP, says many of the biggest health risks are more basic. They include things like not having a phone or not getting daily mail, and not having a stable address where friends or social workers are able to follow up with them.

“Those are just critical needs for someone to survive in 2020,” he says. “A lot of folks we see have had a lot of trauma in their lives, and so being able to build rapport and build relationships with them is the most important thing, so we can provide care to them. Once we provide that trust, we can provide that care. A lot of times, it’s difficult. If you’re living outside and you’re constantly moving around, it takes a certain service provider to be able to provide you.”

A brutal year in Santa Cruz

For the first part of my series, I wrote about an aspect of homeless health that I had some background on and that would be relatively timely.

Part one explored an application from the Harm Reduction Coalition of Santa Cruz County to the state to become a certified secondary exchange program that distributes syringes. The program, which reduces the health risks associated with drug use, had been waiting to hear back from the California Department of Public Health for months. I was able to shine a light on the issues.

But the challenges facing Santa Cruz County around homelessness have been enormous this past year. 

The COVID-19 pandemic increased housing insecurity across Santa Cruz County and deepened the risks the county’s homeless residents experience, all while expanding the need for services. Additionally, this past summer, wildfires destroyed more than 900 homes, amounting to likely the most devastating natural disaster in county history.

Service providers and politicians worry that the drop in the community’s housing supply will have lasting impacts. For the sake of context, Butte County, home to the town of Paradise, still has a burgeoning population of relatively new homeless residents — people camping in RVs and tents, more than two years after the Camp Fire ravaged the region.

The state of the pandemic and the damage done by the fires changed the scope and trajectory of my reporting project. I ended up using my CHJ fellowship to essentially expand my beat reporting on homelessness. For that reporting, I mostly relied on public meetings and in-depth interviews. Over the course of my fellowship, I covered harm reduction, the findings from a new committee on homelessness, the management of encampments, and the challenges created by the wildfires. I also offered a closer look at some of the major health risks that accompany homelessness.

Homelessness shortens lives

For people who don’t have a place to call home, a number of factors can take decades off their lives. 

Some of the health risks stem from substance abuse. Those who don’t become homeless because of an addiction pick up the habit on the streets in order to cope.

The Harm Reduction Coalition of Santa Cruz County offers a number of services to reverse overdoses and to reduce the risks posed by injection drug use. Despite opposition from the county Board of Supervisors and law enforcement leaders, the state approved an application from the Harm Reduction Coalition to become a certified secondary exchange program. Volunteers say this will allow the group to save lives and keep people out of the hospital.

Other services are expanding as well. By leveraging coronavirus relief dollars, the county added new services, including a managed homeless encampment. The winter rains, however, threw much of the new program into question and forced the county to rethink the location of the camp, which was in a floodplain. 

A newer unmanaged camp popped up at the edge of the county-run encampment, and it began to grow. As it expanded, it incited new controversies as residents complained of blight, trash, and even reported increases in some kinds of criminal activity, according to the city. Soon, both the city and Santa Cruz County were asking for more resources from the state of California and from the federal government. 

The back-and-forth prompted concerns that maybe local governments were too busy squabbling to think proactively about the important task of providing services and housing people. In a statement to Good Times, Phil Kramer, executive director of the Housing Matters shelter and services campus, said what’s clear is that people who live outside are struggling.

Kramer explained that he sometimes wonders if a lack of community or political will is limiting the rollout of further services. 

In any case, he says it’s time for everyone to step up and pitch in.   

“All I know is that we have hundreds of people sleeping outside right now all over town and winter is coming and everyone needs to step up and do more. Every agency, every community member, everyone,” he said. “The status quo is so harmful to both the people sleeping outside and to the community dealing with the impacts of so many people sleeping rough all around the community. Write to elected officials and tell them that you don’t want unmanaged camping scattered all over the place. Tell them you want people sleeping outside to have a safe, healthy, managed place to go — and that you want the safe, managed sites to be in thoughtfully-selected sites that will work for the housed and unsheltered residents in our community. And then, when a site is proposed in your neighborhood, say, ‘Let’s manage it well and make it work.’”