His swollen joints ached and the world rocked back and forth around him as he stood for hours at his day job as a security guard at a local university.
The college senior had been visiting a doctor at a nearby clinic every other week, searching for answers about why his body was failing him.
But as a Black man, Josh Edwards—whose name has been changed to protect his privacy—faced diagnostic hurdles that his white counterparts didn’t. He struggled to convince doctors to run tests on him and felt physicians’ judgmental eyes as they scrutinized whether he was just angling for pills.
Despite living in excruciating pain, Edwards pushed on with work and school. The son of a small business owner whose business had capsized years prior, he had no safety net to fall back on. He needed health insurance and a paycheck to help him complete his degree in human services, even if that meant finding a wall to prop his deteriorating body up against while on the job.
Finally, after visiting a new clinic in a predominantly white neighborhood, Edwards received a diagnosis: he had an autoimmune disorder.
“I was taking sick days off because my body and joints were swollen and I had vertigo and a ton of other inflammation issues that later the rheumatologist told me was present, but I didn’t know at the time,” he says. “I would just work and go home and sleep until I had to work again. I wasn’t able to do anything.”
But Edwards eventually ran out of sick days, and was given his pink slip. He stayed with a distant family member for some time after, but eventually was asked to leave after his relative said they needed more space.
Since then, Edwards—who is now 37—has bounced between couch surfing, staying in shelters, and sleeping in his car or on the streets. Getting a full night’s rest on the streets isn't easy, especially as a Black man.
“You wake up almost every hour for one reason or the next,” he says. “It’s not just that it’s cold, but you’re worried about other homeless people or somebody that would rob you. Or you’re worried about the fact that you’re in a sleeping bag and a cop approaches you and can’t see your hands and just shoots you.”
When he’s not looking over his shoulder for the police, he has his health to worry about. It took him four years before the state of California approved him for disability insurance. But even that hasn’t covered the cost of all of his medications, forcing him to trade his food stamps for cash to cover the rest.
In Santa Clara County, the number of homeless men and women living on the streets has exploded in recent years. The 2019 point-in-time count reported a record 9,706 homeless residents, 19 percent of whom are Black. That’s compared to 14 percent of 7,394 homeless residents in 2017 and 16 percent of 6,556 homeless residents in 2015.
That growth has come with deadly consequences—especially for Black men and women.
A San Jose Inside analysis of death records from the Santa Clara County Medical Examiner-Coroner’s Office found that the number of homeless individuals dying on the county’s streets has grown on average 13.79 percent year over year from 2009 to 2019. And Black homeless men and women are dying at disproportionate rates compared to their white and Asian counterparts.
Over the last decade, African Americans have made up anywhere from 2.5 to 2.8 percent of the county’s nearly 2 million residents, according to data from the U.S. Census Bureau. But homeless Black Americans have been dying at a rate two to five times higher than that percentage.
Over the last few months, the U.S. has faced a new reckoning over racial justice with the killings of Ahmad Aubery in Georgia, Breonna Taylor in Kentucky and George Floyd in Minnesota—all unarmed Black men and women. Their deaths ignited nationwide protests and calls to defund the police, shining a light on racial inequities that have plagued communities of color for centuries.
In the United States, African Americans continue to be overrepresented in the homeless population. The U.S. Department of Housing and Urban Development’s 2019 Annual Assessment Report to Congress found that 40 percent of people experiencing homelessness last year were Black, compared to the 13 percent of the national population that they make up. For families with children, that number is even higher, with Black families making up 52 percent of families experiencing homelessness.
Dr. Margot Kushel—who heads up the University of California at San Francisco’s Benioff Homeless and Housing Initiative, and has been studying homelessness for more than two decades—says the country’s homeless crisis is interwoven with structural racism.
“Until relatively recently in our country’s history, Black Americans have been excluded from home ownership,” Dr. Kushel said. “Because of that, not only did Black Americans not own homes, they lost the ability to build wealth [as] white Americans built their main source of wealth through homeownership.”
Starting in the 1930s, the Federal Housing Administration refused to insure loans to African Americans who wanted to purchase homes in predominantly white suburbs. The practice, known as “redlining,” was phased out three decades later with the passage of the Fair Housing Act of 1968.
But redlining, coupled with other attempts by federal, state and local governments to prevent African Americans from moving into white suburbs, has had trickle-down effects that have left neighborhoods across the country still segregated to this day.
Dr. Brian Greenberg, vice president of programs and services at the homelessness non-profit LifeMoves, says income disparities often parallel racial inequities in society.
“Homeless folks tend to grow up in lower income ZIP codes,” he said. “People in lower income ZIP codes tend to have less access to healthcare, less access to a quality education, less access to nutritional food and limited access to upward mobility. When you grow up in a lower income ZIP code and you have less access to healthcare, education [and] nutritional food, those disparities tend to have lifelong impacts and implications.”
Over the years, these systemic barriers have created a smaller social safety net for Black Americans compared to their white counterparts.
As a result, Dr. Kushel says that white homeless individuals are more likely to have challenges with mental health or substance abuse. “We didn’t see that so much in the Black community where we saw it was just low-wage workers who had an injury or they got sick or their supporter got sick or their partner died,” she says of her research. “One relatively small thing pushed them out into homelessness.”
In Silicon Valley, the high cost of living has triggered an exodus of Californians fleeing from the Golden State in search of a more affordable place to live. But for Edwards, his rare and chronic illness has prevented him from relocating to a place where he can afford four walls and a roof over his head.
The standard of care in some of the cities he’s considered moving to just aren’t up to par and lack the resources to treat his condition. As a Black man, moving also means reliving the trauma of starting over from square one.
“Once you have someone who actually sees you as a person, as a Black person, it’s a big fucking deal and it takes a long fucking time,” Edwards says. “When you do meet that [doctor], it’s very difficult to consider going somewhere else after that.”
Despite having access to doctors who can treat his condition, the day-to-day wear and tear of living on the streets has taken a toll on his health. He previously snagged a coveted bed at a shelter in Sunnyvale, but his compromised immune system couldn’t handle being in such close proximity to others.
“I had to start sleeping in the car again, because I couldn’t deal with being sick constantly,” he said.
According to the 2019 point-in-time count, 24 percent of Santa Clara County’s homeless population suffers from a chronic illness. Coupled with exposure to the elements and the lack of access to healthcare, the life expectancy of people experiencing homelessness is around 20 years less than non-homeless individuals.
Over the last decade in Santa Clara County, the average age of death was 53.8 years for homeless men and 50.3 years for homeless women. In the U.S., the average life expectancy is 81.1 years for women and 76.1 years for men.
San Jose Inside’s analysis of cause of death for homeless individuals over the last decade found that drugs or alcohol were listed as the main or contributing cause of death for 38.1 percent of deaths. Heart-related conditions such as cardiomyopathy, heart disease and congestive heart failure were listed by the coroner as the main or contributing cause of death in 20.4 percent of cases.
For African Americans, heart conditions were listed as the main or contributing cause of death in 26.9 percent of cases. In 2017, in the U.S. general population, African Americans were 20 percent more likely than their white counterparts to die of heart disease.
Alma Burrell, the South Bay regional director for the Roots Community Health Center in San Jose, attributes the disproportionate number of African Americans dying from heart disease to higher stress levels and structural racism. The Oakland based non-profit was founded in 2008 and works to rectify health disparities and aids Black families in navigating the healthcare system.
“When [Black] women’s amniotic fluid has been measured, ours tends to have more stress,” Burrell said. “We are basically bathed in a toxic environment in utero and it causes us to be more sensitive to stress once we’re born. I think a lot of it has to do with what we’re living through.”
For Black homeless men and women who have frequent encounters with the police, lack access to medical care and are constantly exposed to the elements, the compounded stressors can turn deadly.
But having access to medical care doesn’t necessarily improve health outcomes. From the Tuskegee Experiment that studied the effects of untreated syphilis on African American men to the unauthorized use of Henrietta Lacks’ cells to create a polio vaccine and map the human genome, Black Americans have a documented history of being abused by the healthcare system.
“We get different kinds of treatment; oftentimes the treatment is rude or it’s insensitive,” Burrell said. “Sometimes folks just don’t want to be bothered with it all. We are a very resilient people and oftentimes we just suck it up until it gets to a point where we can’t bear it any longer.”
Raymond Ramsey was a San Francisco-based lawyer for two decades before he slipped into homelessness. An acrimonious divorce, the loss of his job and a mental health crisis formulated the perfect storm. He went from sleeping on friend’s couches to staying in hotels to living in his car. Eventually he ended up on the streets.
Ramsey, 54, says he’s alarmed and disheartened by the disproportionate number of Black homeless men and women dying in Santa Clara County.
Speaking from experience, he says the racist attitudes toward people of color are magnified even more when one is homeless.
“When you’re Black and you’re homeless it’s even worse, because [people think] you have something, you’re completely lazy, [or] you must have done something to deserve the situation that has happened to you,” he says. “People are less likely to help me on the street than they would my white counterparts at times.”
During the 10 years he lived on the streets, Ramsey says he was harassed by the police at least twice a week. At the time, he was on probation, which allowed the cops to search him without a warrant. He says they’d tear through his bag of personal belongs and scatter its contents across the sidewalk.
But for the last year-and-a-half, Ramsey and his wife have been housed at Second Street Studios: a 134-unit apartment complex for chronically homeless individuals. Referred to as permanent supportive housing, the first of its kind development in Santa Clara County opened in May 2019 and provides formerly homeless men and women with social services on top of a stable place to live.
For county leaders, this type of housing has become a key part of their plan to prevent homelessness. And studies show it works.
New research out of the University of California at San Francisco examined Santa Clara County’s Project Welcome Home program, which provides chronically homeless individuals with housing and supportive services.
From 2015 to 2019, 86 percent of participants received housing and remained stably housed during the course of the four year study.
During that same time period, the county—in conjunction with its non-profit partners—has housed 14,132 people, with 96 percent of them remaining in stable housing for at least 12 months, according to a report from Destination:Home.
But for every person who is housed in Santa Clara County, three more become homeless.
Speed of Need
Jennifer Loving, the CEO of Destination:Home, calls homelessness one of the most “pressing civil rights issues” in the Bay Area. In San Jose, 40 percent of households are considered low-income, meaning they make less than 80 percent of the area median income. That translates to less than $112,150 a year for a family of four.
But in recent years, San Jose has struggled to meet its state-mandated affordable housing goals. In 2019, San Jose issued 853 permits for all types of affordable housing compared to the 2,370 required by the state.
For extremely low income housing, the numbers are even more bleak, with San Jose issuing only 58 permits compared to the state’s goal of 525.
“Extremely low-income housing [is] the type of housing that I’m always advocating for,” Loving says. “You can see city-by-city, state-by-state how under-built that type of housing is in this country, which is why people can’t afford to live.”
Extremely low-income households make up 30 percent of the area median income, or $47,350 for a family of four in Santa Clara County.
In the San Jose, Santa Clara and Sunnyvale metro area there are only 34 extremely low income apartments available per every 100 renters, according to research from the National Low Income Housing Coalition.
But in Silicon Valley, building housing isn’t cheap. San Jose Mayor Sam Liccardo says that one of the strategies to prevent homelessness is finding ways to cut through the bureaucratic red tape and build housing faster and at a more cost effective rate.
In light of the Covid-19 pandemic, Gov. Gavin Newsom in April temporarily suspended certain requirements under the California Environmental Quality Act, which under normal circumstances triggers project reviews that make it longer to build housing.
But with the emergency orders in place, it took the city of San Jose just four months to construct interim housing at Monterey and Bernal roads that will serve as transitional housing for 300 homeless residents.
“This has been an important opportunity for us to learn about how we can do this,” Liccardo said. “Now we simply need to scale these results, and obviously that’s going to take some legislative push, because when the emergency goes away, so do the emergency orders. We need to learn the lessons of this pandemic, which is if we’re able to move at the speed of the need we can actually get something done.”
San Jose Councilwoman Maya Esparza says that the city needs to “stem the bleeding” and do a better job at preventing homelessness through policy and protections. The Covid-19 pandemic, which has disproportionately impacted Black and Latino residents in Santa Clara County, has created a ticking time bomb for renters who are now at an increased risk of eviction and displacement.
“In making that correlation between who becomes homeless, we look at those that are going to be displaced,” Esparza said. “According to city statistics, 57 percent of the Black population is below 80 percent AMI, 56 percent of the Latino population is below 80 percent AMI, compared to 36 percent of the white population.”
With thousands living on the streets in Santa Clara County and thousands more at risk of becoming homeless, Ramsey has learned to find gratitude in the small things in life: a door he can lock at night, four walls and a roof over his head and the ability to take a shower daily. Over the last year-and-a-half, he says he’s had the chance to join mainstream society again and do things like visit the dentist or read the news.
The studio apartment that he and his wife live in only had a bed in it when they moved in last May. But over time, the space has become a furnished home with a kitchen set, a sofa and a television. Although small in size, Ramsey says that to him, it feels like a mansion. To this day he still finds himself overwhelmed at how his life has transformed.
“I wear my key kind of like a golden ticket around my neck right now,” he says. “[I’m] still rubbing it and saying, ‘Thank you Lord, I can’t believe I’ve fallen back into place.”