(Simone Rotman)

Each year, National Homeless Persons’ Memorial Day takes place on December 21, the day of the winter solstice. Throughout the month, hundreds of events spring up around the country to celebrate the lives of unhoused people who have passed away. In Alameda County, we had two such virtual events, one hosted by St. Mary’s Center, and the other by Alameda County Healthcare for the Homeless (ACHCH). At each memorial, a range of service providers, community members, and advocates got together to share their grief about friends, family members, and patients who passed away in 2022—and to demand justice for those who live on our streets.“

Today is the shortest day of the year. It’s the longest night for our clients and patients outside,” Dr. Jason Reinking—a physician and medical director of LifeLong Trust Health Center—said at the ACHCH event on December 21. “It’s a cold time of year. We get more requests for gloves and socks than we do for medicine. We get more requests for housing than we do for medical care. It’s a rainy time of year. We get more requests for tents than we do for medical appointments. And it’s a tough time of year. It’s a time of year that brings a lot of sorrow and sadness for our patients and clients with so many friendships and family relationships that have been broken.”

Both events included touching reflections about individuals who have passed away, and silent appreciation for those who died in the shadows. At the St. Mary’s Center memorial, which took place on December 8, organizers read the names of 28 unhoused people who died in 2022. Those names were Corey Hamilton, Corey B, Tyrie Foster, Edward, Tone, Troy, Dave from Lake Merritt, Bob from Wood Street, Eddie Valdez, Brandon Thomas, John W, Darrell W, Olufola S, Stanley T, Theophilus P, Glenn T, Eddie T, Melver R, Kenneth Y, Jerry G, Regina T, Donald W, Urias Smith, Johnny Butler, Linda McCrory, James Goucher, Sarah Rosilla, Courtney Heshimu, and Deandre Irvin.

These names were submitted by individuals—friends and family members who lost a loved one sometime in the past year. But up until recently, there was no official way to track homeless death in Alameda County—which relied on incomplete data from the coroner’s bureau to track the deaths of unhoused people. However, since 2020, National Homeless Persons’ Memorial Day has come to coincide with new data from the county’s homeless mortality report, launched as a way to illuminate the nuances of the crisis of homelessness and help identify solutions. 

To generate the report, ACHCH collaborates with county epidemiologists with CAPE (Community Assessment Planning and Evaluation). Together, they identify homeless deaths through data matching across homeless services utilization lists, community reporters, and California Comprehensive Death File (CCDF) records in the California Vital Records Business Information System.

The data about homeless death that is tracked by the coroner’s bureau is maintained by law enforcement employees under the jurisdiction of the Alameda County Sheriff. Their records shine a light on certain 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. That’s why the county’s mortality report is so important—it provides a badly needed insight into when, and why, unhoused people are dying here. Because of methods used to generate their report, Alameda County’s homeless death numbers appear higher than those of other localities that rely solely on coroner’s reports of homeless deaths.“A responsible and just community must work to be closely aware of the deaths of all its members, strive to learn from those deaths, implement policies and practices to reduce preventable deaths, and work to reduce the harm that preventable deaths create for families, friends, caregivers, and the community,” said David Modersbach, grants manager for ACHCH, who helped launch the mortality report.

At the December 21 event, Modersbach shared the key findings from their 2021 report—the newest available data. It showed that a total of 661 unhoused people died in 2021. Of those people, 348 were known to be homeless at the time of death; 167 had been homeless within five years of dying but were housed when they died; and 146 were homeless within five years of dying but maintained an unknown housing status at the time of death. These numbers are high, and comparable to the reporting from 2018 to 2020.

ACHCH plans to release the full 2021 mortality report in the new year. But at the memorial events, Modersbach shared data in the following categories:

Unattended deaths 

Sixty-five percent (227 out of 348) of all homeless deaths took place outside of a medical setting (i.e., hospital or nursing facility), occurring on streets/sidewalks, outdoors, in vehicles, encampments, shelters, other’s residences and other locations. Half of homeless acute/chronic disease-related deaths (77 out of 153) occurred in non-medical settings. Both of these numbers significantly increased between 2018-2020 and 2021.

Disparities in ethnicity and gender

African American/Black persons represent 41 percent of total homeless deaths, compared to 19 percent of general population deaths. Men represent 75.6 percent of homeless deaths, compared to 52.7 percent of general population deaths. 

Death rates by cause of death

The age-adjusted mortality rate for people experiencing homelessness in Alameda County in 2021 was 5.8 times higher than that of the general population of Alameda County, and in all causes of death, mortality rates are many times higher for people experiencing homelessness than the general population. 

Causes of death

Overdose: Thirty percent of homeless deaths in 2021 (104) were directly due to drug overdose, with the number of overdoses among people experiencing homelessness continuing a sharp rise. Sixty-seven percent of overdose deaths took place in outdoor settings. People experiencing homelessness have a 50 times higher overdose death rate than the general population.

Acute/chronic medical conditions: Forty-four percent homeless deaths in 2021 (153) were due to acute/chronic medical conditions, led by heart and cardiovascular disease, and followed by cancer, COVID, liver disease, cerebrovascular disease, respiratory disease, and others. Half of acute/chronic disease-related deaths occurred outside of medical/clinical settings.

Accidental injuries: Accidental injuries accounted for 31 (9 percent) homeless deaths, the large majority being pedestrians and cyclists hit by automobiles, followed by falls and struck by trains. Homeless pedestrians/bicyclists are 28 times more likely to be killed by cars than the general population.

Homicide: Homicide accounted for 22 (6 percent) deaths of people experiencing homelessness, mostly due to shootings and stabbings taking place in street and outdoors. Homeless homicide death rate is 23 times higher than the general population. 

Suicide: Nine people experiencing homelessness took their own lives in 2021, a rate ten times higher than the general population.

COVID: COVID-19 was the cause of death for nine persons experiencing homelessness in 2021. There were no shelter resident COVID deaths in 2021. Still, the COVID death rate for people experiencing homelessness was 2.6 times that of the general population. COVID deaths took place primarily in hospitals among people staying place to place, living in motels, and in an encampment. 

In the midst of these shocking and tragic numbers, the virtual vigil events maintained a sense of community and love, which provided a bright light on the dark day.

“The suffering we experience is exponential. In that darkness the only thing that can bring us together is hope,” said Dr. Jason Reinking, known to his patients as Dr. Jay. “Hope is the one thing that can bring us together. To foster this hope, which we have a great responsibility to do, we must come together.”

By Anonymous

Not true
That I am invisible. 

That I disappear into thin air when you take
My blankets, my food
And everything I own. 

Not true
That I don’t want to come inside
If inside wanted me, I would go. 

Offer me more than what I have
Offer me dignified housing
Offer me a home without an end date
A home that does not take every dollar I have
And I would go 

Not true
That I want to live in squalor.
That I want to live without water or a bathroom
Without hot food; without safety
In fear and uncertainty 

Not true
That I steal, 
That I steal profits from businesses
and property values from owners 

Not true
That I want charity
More than the right to live free
From harassment, from judgement
From shame 

What’s true
Is that some cannot see me
As their neighbor, their friend,
Valuable, capable, worthy
Of existing by them. 

More true
Is that some … maybe you
Cannot see me at all.

Alastair Boone is the Director of Street Spirit.