A collage-style image in the shape of a square. Four images in the background show a graveyard, boxes of narcan, a tent with candles outside, and a drawing of an encampment. The number "809" stands at the center of that image in the middle, representing the number of homeless deaths counted in the report.

Note: This story was originally published in January after an early version of the report was shared with Street Spirit. This version has been edited to reflect changes in the report, which was published in April.

Alameda County Health Care for the Homeless (ACHCH) has officially released their long-awaited report about homeless death in the East Bay. After spending years developing a new methodology for counting the deaths of unsheltered people, they have published the results of their work: between 2018 and 2020, at least 809 unhoused people died in the county. The report is the first of its kind. 

Using a massive list of every person who died in the county from 2018 through 2020, David Modersbach— grants manager for ACHCH—and his team, along with Matt Beyers and Yilak Fantaye of the county’s Community Assessment, Planning and Evaluation (CAPE), painstakingly combed through each name, comparing each person with Homeless Management Information System (HMIS) records, coroner’s reports, and death records, to determine each individual’s housing status at the time of their passing and their cause of death. 

This year is the first time in history that Alameda County has conducted a review of homeless deaths. Other counties have also struggled to keep data about deaths on the streets, though San Francisco began to conduct a similar manual mortality-analysis process starting with data in 2016. But before now, Alameda County officials had no idea exactly how many people were dying on the streets in the East Bay, or how. This effort by ACHCH has been years in the making, and will go a long way toward illuminating the nuances of the crisis of homelessness in the county—and help identify solutions. 

Until now, media has relied on data from the coroner’s office to track the deaths of unhoused people in Alameda County. This data is maintained by law enforcement employees under the jurisdiction of the Alameda County Sheriff. Their records shine a light on some homeless deaths, including accidents, suicides, and some overdoses. But they only capture a small part of the picture. The office does not reliably record or investigate an individual’s housing status. Their data is insufficient and incomplete. 

“How does a responsible community respect the lives and deaths of its members?” Modersbach asked at a memorial for unhoused people who died in the county, that ACHCH held in December, 2021. “We do this by acknowledging, documenting, and learning from the deaths of all of its members, especially those most disadvantaged and vulnerable. 

“We must register and learn from every homeless death. We have to give value and meaning to every life and death, to work to prevent every preventable death, and to provide solace and peace needed by those who die.” 

Ultimately, Modersbach and his collaborators identified 809 deaths of unhoused people in Alameda County in 2018, 2019, and 2020. The numbers increased each year: In 2019, 51 more houseless people died than in 2018. In 2020, there were 122 more deaths than there were in 2019. 

The new data also revealed numbers of people who died after moving off the street and into housing. Modersbach’s team discovered that 250 recently homeless people who had been permanently housed within the past five years, also died during their period of study. Additionally, from 2018-2020, there were 598 deaths of people who had recently documented experiences of homelessness but for whom the county could not confirm a housing status at their time of death. 

Back in September, Modersbach told Street Spirit that his vision is for this data not just to be released periodically by the county, but to create a Community/County Homeless Mortality Task Force, with participation from members of the public. This task force would determine what information is most important for the public to know, and steer future versions of this reporting. 

While the official mortality report has not been released, the preliminary numbers released at Tuesday’s memorial revealed the leading cause of death for unhoused people was overdose, causing about one-quarter of all fatalities. 

From 2018 to 2020, 59 unhoused people were the victims of homicides, and at least 35 died by suicide. 


The numbers at a glance, according to the ACHCH 

  • 809 unhoused people died in 2018, 2019 and 2020 in Alameda County: 
    2018 – 195 homeless deaths 
    2019 – 246 homeless deaths 
    2020 – 368 homeless deaths 
  • There were 250 deaths of people who had recently moved into housing 
  • An additional 599 people died during that time period who were recently unhoused or whose housing status the county could not confirm 
  • Two-thirds of 2018-2020 deaths occurred on streets/sidewalks, parks, vehicles, encampments, railroads, on public transit, or in motels 
  • One-third of deaths occurred in facilities including hospitals, nursing facilities, or jail 
  • 77 percent were men 
  • Black unhoused people made up 43 percent of deaths, despite making up 19 percent of the county’s population 
  • Overdose was the leading cause of death, linked to over a quarter of mortalities. Alcohol and drug use were factors in 44 percent of deaths 
  • These numbers included at least 59 homicides and 35 deaths by suicide


“We know that people who are unhoused have a life expectancy that is 30 years less than those who are housed,” noted Dr. Aislinn Bird, psychiatrist with ACHCH. “This directly shows how housing is healthcare.” 

This difficult, manual process for recording homeless data could be streamlined if the state of California, and specifically the California Department of Public Health, required all reporting agencies and facilities to include details about an individual’s housing status when they die, county workers told Street Spirit

According to the representative from the California Department of Public Health (CDPH), the California Health and Safety Code contains the contents of a death certificate, which includes the residential address of the deceased. “The lack of a residential address, such as when a decedent is experiencing homelessness, can be entered as free text in the residential address fields on the death certificate,” they wrote in an email. CDPH is currently working on adding a checkbox to indicate homelessness in their electronic death registration system. “There is not currently an estimate as to when that enhancement will be deployed,” the representative wrote. 

The new data uncovered by ACHCH is shocking, and further highlighted the importance of community mourning during the homeless persons’ memorial event in December. 

Dr. Danielle Williams, a family medicine physician, sees patients in East Oakland as medical director for the street outreach team for Roots Community Health Center, known as STOMP (Street Team Outreach Medical Program). 

During the memorial, Dr. Williams recalled a Roots patient who passed away this year. Dr. Williams had just learned that the patient, who was unhoused, was accepted into the Safer Ground program for people who are exceptionally vulnerable to COVID-19, and would be offered housing. When Roots looked for the patient to let them know, they found out the person had died days before. 

“I feel like we don’t acknowledge a lot of these lives,” Williams told the memorial audience. “Our days are very busy, and we just hear about it, and then we just kind of continue to press on. But these lives definitely deserve mention. 

“Let us keep fighting to house the homeless,” Williams said. 

Melissa Moore is a street outreach worker with Tiburcio Vasquez Health Center and a survivor of homelessness. She formerly lived at a curbside community at 580/Grove in Castro Valley. Moore said she had lost nearly 20 unsheltered friends and acquaintances over the last year. As she spoke at the memorial, she began to weep. “One name is too many,” she pleaded. A stranger entered the video frame and held her in a long hug. 

“Never forget why we do what we do,” Moore urged. “We lose some battles. We also achieve big wins. 

“Moving forward we need to push harder and go the extra mile for change to happen, in order to remember those who have left us this year. They deserve better, and in their memory, we can do better.” 

The video meeting platform on which the December memorial took place, Zoom, is not always accessible for unhoused people. It requires internet access and uses lots of battery power on a phone. But a video of the 2021 memorial has been archived and is available on the Alameda County Health Care for the Homeless YouTube page for those who wish to watch. 

ACHCH will soon be holding a celebration in June, during the summer solstice, celebrating the resilience of unhoused people. 

Ariel Boone is a freelance journalist and reporter for KPFA Radio in Oakland, California. Ariel previously worked at Democracy Now! in New York.