decampment as a moral failing
This post is in partnership with Changing the Conversation, a project on housing insecurity with Douglas College, for which I am serving as journalist-in-residence.
This newsletter is intended to be weekly so I don’t run out of things to write about too quickly, but I reserve the right to publish as needed. And it turns out “as needed” is within a few days of my first publication.
Unhoused drug users are often depicted as lacking impulse control. Their situation is a result of their own actions and their inability to contain themselves—a moral failing on their own part. At least, that’s the argument.
Poor drug users, the thinking goes, inflict this upon themselves because they can’t resist the urge to get a fix.
These particular arguments are especially prone to flare-ups in the wake of action against unhoused people, such as the ongoing decampment in the Downtown Eastside. Twitter replies abound with those who celebrate harm done to the unhoused community with this as their guiding principle.
But what if it’s, in fact, cities and their leaders that inflict wounds upon themselves and others in a short-sighted pursuit of immediate satisfaction at the expense of long- and medium-term damages?
Decampment was presented by Mayor Ken Sim as a safety issue. Safety of sexual assault victims in the encampment and fire safety to be specific.
Displacement and death
But a study published Monday—Day 6 of the displacement campaign—shows decampment to have fatal consequences.
The study, published in JAMA Network, focuses on 23 US cities and modelled population-level health outcomes for unhoused people over the course of 10 years.
And the results were stark.
The model projected that continual involuntary displacement could be associated with up to a quarter of all deaths among people who inject drugs and who are unhoused by 2028, according to the study.
It projected an increase in overdose mortality of 71% to 94% for the displacement scenario. In fact, it’s so bad that for the handful of cities (six out of 23) that were projected to see decreases in serious injection-related bacterial infections (SIRIs) in the displacement scenario, their explanation was that people would be dying too fast from overdoses.
Vancouver is its own city with its own rate of overdose deaths (certainly higher than most US cities) and its own network of harm reduction and supports. So where, exactly, that would place Vancouver in the modelling is certainly a question worth asking.
The authors are quick to point out that this is only a model—a guide rather than a prediction—and that there are limitations to the data.
Self-inflicted wounds
But it needs to be noted that, even if the impact is half of what the projections show, the impact isn’t passive or ambient, the result of a lack of resources available, but rather the result of an expenditure of resources. What the study depicts is a short-sighted lose-lose.
Far from alleviating homelessness, decampments only briefly pull a veil over its visibility. A temporary lack of tents acts as a guise for Doing Something on the part of politicians and police.
In the meantime, the death toll rises. From overdoses. From exposure to the elements. From infectious disease.
Compared to the health and life of marginalized community members, this is certainly secondary or even tertiary, but this harm comes at financial costs to the community as well, in the form of healthcare spending, policing and city staff expenditures, the study notes.
In fact, the authors noted displacement could incur $1.6 million in healthcare spending over 10 years on SIRI-related hospitalizations resulting from continual displacement in Miami alone.
Put another way, we spend immediate-term resources on quick fixes, like displacement, which in turn entrench health and social issues. In doing so, we create a long-term public health abyss—more people facing illness or overdose and the subsequent deaths. And the end result is even more long-term spending on healthcare and policing.
Decampment, then, can be seen as an impulse-driven, self-inflicted wound for a superficial short-term gain—the very definition of the moral failing that’s projected onto unhoused drug users.
Meanwhile, the same isn’t true of homelessness or drug use.
In an editorial for JAMA Network, reflecting on the modelling, Margot Kushel wrote that homelessness is, indeed, an issue of housing. This seems obvious at the face of it, yet proponents of the street sweeps continue to argue that those living on the streets don’t want housing.
But as Kushel notes, homelessness rates “do not vary according to the rates of drug use or mental health problems in a community; instead, they vary based on the availability of affordable housing.”