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Homelessness is among the most urgent crises facing the United States. In addition to tents or sleeping bags on urban sidewalks, many people experiencing homelessness exist outside of public view, along rivers and other waterways, and elsewhere "out in nature." This paper explores reasons individuals live near waterways, specific health and human s...
Contexts in source publication
Context 1
... data suggest that barriers to hygiene and sanitation have very serious consequences for unsheltered people's health and for public health in general. Table 1 summarizes the demographics of our sample. These statistics are consistent with the most recent point-in-time count of the unsheltered population in San Diego County (RTFH, 2019b). ...Context 2
... statistics are consistent with the most recent point-in-time count of the unsheltered population in San Diego County (RTFH, 2019b). The mean length of homelessness in Table 1 shows that many people in our sample have experienced long-term and/or multiple periods of homelessness. In the City of San Diego in 2019, 22 percent of unsheltered individuals were chronically homeless; this term includes those experiencing homelessness for more than a year or experiencing multiple recent episodes of homelessness, and with a concomitant disabling condition (RTFH, 2019a). ...Citations
... 24 Homeless encampments have been considered to be another potential surface contributor of microbial contamination in urban streams 24 due to the lack of sanitation systems available to people experiencing homelessness, which often leads to open defecation in river margins. 25 However, there is insufficient evidence to suggest that encampments are responsible for contributing pollution to the river during dry weather conditions, yet there are potential risks associated with the use of this water by encampment residents. 26 The relative contributions of these diverse human-associated microbial pollution sources to coastal urban waterways still elude water managers, and the uncertainty can lead to misidentifying the source of contamination, resulting in misdirected policies and efforts. ...
Water quality benchmarks for fecal indicator bacteria (FIB) are often exceeded in many urban streams in southern California. Possible sources of elevated stream FIB concentrations within urban areas include sanitary sewer exfiltration, sanitary sewer overflows (SSOs), illegal discharges, and human or animal fecal material on the ground surface. Teasing apart the different sources remains a challenge, especially when untreated wastewater and runoff from open defecation sites both contain human fecal material. To distinguish the various sources of microbial contamination in an urban stream, temporal trends in biological and chemical markers of anthropogenic contamination were evaluated in the San Diego River and its tributaries during storm events in two consecutive hydrologic years. Temporal trends in FIB, HF183, pepper mild mottle virus (PMMoV), caffeine, sucralose, chloride, bromide, specific ultraviolet absorbance, and fluorescence index indicated that untreated wastewater flushed from the vadose zone was the main source of microbial pollution to the San Diego River, while open defecation near homeless encampments in the river margins was not a major source. We demonstrated that the combined use of caffeine/sucralose ratios and HF183 and PMMoV holds promise for identifying sewage inputs to surface waters. These findings highlight the need for maintenance and repair of aging sewer infrastructure.
... Unsurprisingly, a central survival strategy of unsheltered people under the pervasive penality regime is avoidance of police at all costs (Stuart, 2014;Welsh & Abdel-Samad, 2018; see also Brayne, 2014). Unsheltered people often seek out hidden or more remote locations for shelter, in part out of fear of policing, which leads to a host of risks to health and well-being, including increased risks of: infectious disease due to lack of access to basic sanitation (Leibler et al., 2017), injury or death due to vehicles (Schmitt, 2020;Hickox, 2014), death due to heat (Dialesandro et al., 2021;Schwarz et al., 2022) or cold exposure (Holland, 2019), as well as reduced likelihood of contact with social service outreach (Flanigan & Welsh, 2021). ...
... A third identified as female, 57.9% identified as male, and 8.8 percent declined to report; the median age of respondents was 40.8 percent. These demographics-particularly gender and age-are consistent both with prior studies we have conducted of similar populations in San Diego (Flanigan & Welsh, 2021;Welsh & Abdel-Samad, 2018) and official counts of people experiencing unsheltered homelessness in the region (RTFH, 2020). However, these demographics diverge substantially from official point-in-time counts in terms of racial/ethnic diversity, as discussed above, with recent official counts recording higher numbers of White people. ...
... Some reasonably might wonder if the nature of regulations around COVID compliance might heighten respondent sentiment about police and/or service interactions, and thus the time of the study might have influenced responses. Based on our ample past research with this community, which has included questions regarding policing (Flanigan & Welsh, 2021;Welsh & Abdel-Samad, 2018;Welsh, 2018), we feel confident that this is not the case. However, as our findings will show, individuals' responses do indicate an influence of the Black Lives Matter movement. ...
This paper examines racialized encounters with the police from the perspectives of people experiencing homelessness in San Diego, California in 2020. By some estimates, homelessness doubled in San Diego during the first year of the COVID-19 pandemic. We conducted a survey of (n = 244) and interviews with (n = 57) homeless San Diegans during initial shelter-in-place orders, oversampling for Black respondents, whose voices are often under-represented despite high rates of homelessness nationally. Our respondents reported high rates of police contact, frequent lack of respect; overt racism, sexism, and homophobia; and a failure to offer basic services during these encounters. Centering our Black respondents’ experiences of criminalization and racism in what Clair calls “criminalized subjectivity,” we develop a conceptual framework that brings together critical theoretical perspectives on the role of race in the governance of poverty and crime. When people experiencing extreme poverty face apathy, disrespect, and discrimination from police—as our data show—the result is a reluctance to seek services and to engage with outreach when offered. This reinforces stereotypes of unhoused people as not “wanting” help or “choosing” to be homeless. We reflect on these findings and our framework for envisioning a system of public safety that supports and cares for—rather than punishes—the most vulnerable members of our society.
... Individuals are often separated from their families and places of origin, and become de-facto stateless (Dreby, 2015). Many reside in Tijuana's liminal urban spaces, and waterways (Flanigan and Welsh, 2020), especially El Bordo. In 2013, researchers from El Colegio de la Frontera Norte estimated that between 700 and 1000 people were living in precarious self-made shelters in El Bordo (Velasco and Albicker, 2013). ...
... The human right to potable, accessible, affordable, and sufficient A. Calderón-Villarreal et al. water is frequently violated among unhoused people, damaging their quality of life, health, dignity and exacerbating social exclusion (Neves-Silva et al., 2018;Uddin et al., 2016). Few studies, however, have investigated homeless populations in their fuller daily experience of their infrastructure, seeking refuge in de facto semi-abandoned public spaces of rivers and sewage/rainwater drainage canals to avoid police harassment, find temporary partial privacy and fleeing public embarrassment (Flanigan and Welsh, 2020;Friedman et al., 2021;Pinillos, 2020;Verbyla et al., 2021). This lacuna is surprising because access to basic WASH is the most crucial major urban environmental infrastructure necessary for human survival, a core concern at the dawn of the emergence of the discipline of public health, and also fueled the development of epidemiology and urban planning into well-funded, policy-relevant disciplines (Rosenberg, 1966). ...
... Possessions crucial to housing, quality of life and survival-including irreplaceable nationality identification cards necessary for accessing public hospital care (Pinillos, 2020)-were regularly stolen or destroyed by violently punitive police officers during raids in the name of the local government authorities. In this context, the semi-abandoned liminal public space of the polemically iconic US/Mexico liminal border wall is turned into a violent no-go-zone [see (Flanigan and Welsh, 2020;Palta et al., 2016) for comparative examples]. Our detailed social documentation of water use practices and laboratory analysis of water quality at distinct sources reveals how a public health, environmental analysis of the inadequacy of Tijuana's sewage infrastructure benefits from an understanding of structural political and economic forces of local government management, Mexican law enforcement logics, and US migration and drug policies. ...
Introduction
The US deports more Mexicans to Tijuana than any other borderland city. Returning involuntarily as members of a stigmatized underclass, many find themselves homeless and de-facto stateless. Subject to routinized police victimization, many take refuge in the Tijuana River Canal (El Bordo). Previous reports suggest Tijuana River water may be contaminated but prior studies have not accessed the health effects or contamination of the water closest to the river residents.
Methods
A binational, transdisciplinary team undertook a socio-environmental, mixed methods assessment to simultaneously characterize Tijuana River water quality with chemical testing, assess the frequency of El Bordo residents’ water-related diseases, and trace water contacts with epidemiological survey methods (n = 85 adults, 18+) in 2019, and ethnographic methods in 2019–2021. Our analysis brings the structural violence framework into conversation with an environmental justice perspective to assess how social forces drive poor health outcomes enacted through the environment.
Results
The Tijuana River water most proximate to its human inhabitants fails numerous water-quality standards, posing acute health risks. Escherichia coli values were ∼40,000 times the Mexican regulatory standard for directly contacted water. Skin infections (47%), dehydration (40%) and diarrhea (28%) were commonly reported among El Bordo residents. Residents are aware the water is contaminated and strive to minimize harm to their health by differentially using local water sources. Their numerous survival constraints, however, are exacerbated by routine police violence which propels residents and other people who inject drugs into more involuntary contact with contaminated water.
Discussion
Human rights to drinking water, sanitation and hygiene are routinely violated among El Bordo inhabitants. This is exacerbated by violent policing practices that force unhoused deportees to seek refuge in waterways, and drive water contacts. US-Mexico ‘free-trade’ agreements drive rapid growth in Tijuana, restrict Mexican environmental regulation enforcement, and drive underinvestment in sewage systems and infrastructure.
... Capone and colleagues found thirty-nine open defecation sites near shelter and soup kitchens that tested positive for pathogens, which poses an increased risk of infection by faecal-oral route in unhoused communities [16,23]. Furthermore, the criminalization of unhoused communities pushes people into hazardous spaces and further disconnects them from much-needed services [24,25]. Pushing unhoused people to hazardous environments is seen in the work of Flanigan and Welsh (2020) that found unhoused people living along the San Diego River are more socially isolated and disconnected from services compared to those living in downtown areas [25]. ...
... Furthermore, the criminalization of unhoused communities pushes people into hazardous spaces and further disconnects them from much-needed services [24,25]. Pushing unhoused people to hazardous environments is seen in the work of Flanigan and Welsh (2020) that found unhoused people living along the San Diego River are more socially isolated and disconnected from services compared to those living in downtown areas [25]. Flanigan and Welsh report that unhoused people live along the riverbed to avoid police harassment and encampment sweeps [25]. ...
... Pushing unhoused people to hazardous environments is seen in the work of Flanigan and Welsh (2020) that found unhoused people living along the San Diego River are more socially isolated and disconnected from services compared to those living in downtown areas [25]. Flanigan and Welsh report that unhoused people live along the riverbed to avoid police harassment and encampment sweeps [25]. In addition to creating barriers to access safe WaSH services, living in secluded areas raised the risk of exposure to contaminated water and disease outbreaks [25,26]. ...
Background: Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation.
Methods: We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and multivariate analyses to describe (1) How unhoused communities cope and gain access to WaSH services in different places? Moreover, (2) What individual-level factors contribute to unhoused people’s ability to access WaSH services?
Results: Our findings reveal that access to WaSH services in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access was also among the most limited services reducing people’s ability to maintain body hygiene practices and limiting employment opportunities. Our regression models suggest that access to WaSH is not homogenous. Community differences exist, with the odds of having difficulty accessing sanitation services being two times greater for those living outside of Skid Row (95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (95% CI: 1.36-8.07).
Conclusion: Overall, this study suggests a need for more permanent and 24-hour accessible WaSH services for unhoused communities living in Skid Row, including restrooms, drinking water, water and soap for hand hygiene, showers, and laundry services.
... Again, the anthropology of disgust offers key insights into perspectives on hygiene (Bubandt,1998). For example, individuals experiencing homelessness have extremely poor access to sanitation and hygiene (Moffa et al., 2019;Flanigan and Welsh, 2020) and are implicitly stigmatized by health care workers, social service providers, and other members of society Budescu et al., 2021), which may motivate perceptions that lead to disgust and contribute to not in my backyard attitudes and further denial of their access to public WASH facilities (Clifford and Piston, 2017). ...
Anthropologists contribute key insights toward a comprehensive understanding of water, sanitation, and hygiene (WASH) as a multidimensional, multiscalar, and culturally embedded phenomenon. Yet, these insights have yet to be sufficiently operationalized and implemented in WASH development and wider WASH access-related paradigms. Ensuring WASH security requires a comprehensive approach to identifying both human health risk and environmental impact of WASH-related programs and strategies. It requires an understanding of how sanitation is integrated into households and communities and how individuals within particular cultural contexts practice sanitation and hygiene. This work facilitates that goal by outlining the major contributions of anthropology and allied social sciences to WASH, as well as outlining key considerations for future work and collaboration. We identify six major themes that, if applied in future engineering approaches, will more equitably integrate stakeholders and multiple vantage points in the successful implementation of WASH projects for marginalized and diverse groups. These include a critical understanding of previous approaches, culturally aware interventions, capacity building that considers (un)intended impact, co-created technology, collaboration between fields such as anthropology and engineering, and challenge-ready initiatives that respond to historic and emergent social and environmental inequity.
... Open defecation is commonly practiced by unsheltered homeless individuals in urban environments (Frye et al., 2019), especially those who reside near rivers (Flanigan and Welsh, 2020). One study reported that 23% of fresh stools from open defecation sites in Atlanta, GA tested positive for human pathogens, including enterotoxigenic Escherichia coli, Giardia, norovirus, and Salmonella (Capone et al., 2018). ...
... However, homelessness also exists in natural spaces outside of the public view, especially near urban waterways, which provide cooler, shaded areas with water for washing, cooking, drinking, and fishing (DeVuono-Powell, 2013;Palta et al., 2016;Demyers et al., 2017). Based on data reported by Flanigan and Welsh (2020), which drew from interviews with 84 individuals experiencing homelessness in San Diego, CA, individuals at riverbank encampments were 1.9 (95% confidence interval [CI]: 1.1-3.0) times as likely to practice open defecation, and 2.8 (95% CI: 0.7-11.6) ...
... Despite the fact that the latter results from Flanigan and Welsh (2020) were not statistically significant at the 0.05 level, the fact that 41 out of 56 (73%) interviewed riverdwelling individuals reported the practice of open defecation at their encampments and 11 out of 56 (20%) interviewed river-dwelling individuals reported the use of river water for nonpotable purposes highlights the potential public health risks faced by this population based on their lack access to water and sanitation services. ...
Individuals experiencing unsheltered homelessness face significant barriers to accessing water, sanitation, and hygiene services, but the risks associated with this lack of access and barriers to service provision have been largely understudied. We analyzed water samples upstream and downstream of three homeless encampments in the San Diego River watershed and interviewed service providers from public and nonprofit sectors to assess local perceptions about challenges and potential solutions for water and sanitation service provision in this context. Water upstream from encampments contained detectable levels of caffeine and sucralose. Escherichia coli concentrations downstream of the encampments were significantly greater than concentrations upstream, but there was no significant change in the concentrations of other pollutants, including caffeine and sucralose. The HF183 marker of Bacteroides was only detected in one sample upstream of an encampment and was not detected downstream. Overall, there was insufficient evidence to suggest that the encampments studied here were responsible for contributing pollution to the river. Nevertheless, the presence of caffeine, sucralose, and HF183 indicated that there are anthropogenic sources of contamination in the river during dry weather and potential risks associated with the use of this water by encampment residents. Interviews with service providers revealed perceptions that the provision of water and sanitation services for this population would be prohibitively expensive. Interviewees also reported perceptions that most riverbank residents avoided contact with service providers, which may present challenges for the provision of water and sanitation service unless trust is first built between service providers and residents of riverine encampments.
... Utilizing clinical and consensus organizing skills, social workers build trust through continuous communication with police officers and other agencies [18], usually with a backbone organization such as the SDSU Consensus Organizing Center housed in the School of Social Work. However, prior research suggests that police officers' presence on these teams can hinder homeless outreach efforts, particularly for people experiencing chronic homelessness and/or those who may be "service avoidant" for an array of reasons, most notably past negative encounters with the police that have resulted in tickets, arrests, and the loss of personal belongings [23,40]. Social workers can be the leaders in a paradigm shift away from police as first responders to homelessness and toward a more social service-oriented and trauma-informed approach to outreach. ...
... Many people experiencing homelessness live alongside water bodies [78][79][80] and in canyons and other softscape environments, where they lack access to water and sanitation systems and where their use of surface water and the practice of open defecation can increase health risks to themselves and others [40,81,82]. The implementation of sanitation solutions in softscape environments is a major challenge due to the more remote locations of many encampments and the reality that access to sanitation is needed 24 hours a day, not just during daylight hours. ...
Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region.
... Open defecation is commonly practiced by unsheltered homeless individuals in urban environments (Frye et al., 2019), especially those who reside near rivers (Flanigan and Welsh, 2020). One study reported that 23% of fresh stools from open defecation sites in Atlanta, GA tested positive for human pathogens, including enterotoxigenic Escherichia coli, Giardia, norovirus, and Salmonella (Capone et al., 2018). ...
... However, homelessness also exists in natural spaces outside of the public view, especially near urban waterways, which provide cooler, shaded areas with water for washing, cooking, drinking, and fishing (DeVuono-Powell, 2013;Palta et al., 2016;Demyers et al., 2017). Based on data reported by Flanigan and Welsh (2020), which drew from interviews with 84 individuals experiencing homelessness in San Diego, CA, individuals at riverbank encampments were 1.9 (95% confidence interval [CI]: 1.1-3.0) times as likely to practice open defecation, and 2.8 (95% CI: 0.7-11.6) ...
... Despite the fact that the latter results from Flanigan and Welsh (2020) were not statistically significant at the 0.05 level, the fact that 41 out of 56 (73%) interviewed riverdwelling individuals reported the practice of open defecation at their encampments and 11 out of 56 (20%) interviewed river-dwelling individuals reported the use of river water for nonpotable purposes highlights the potential public health risks faced by this population based on their lack access to water and sanitation services. ...
... Although the study focused on a local issue, the findings align with prior observational and intervention research on factors contributing to the chronic cycle of homelessness, especially how inefficiencies and lack of coordination of homelessness services and over-policing can limit healthcare access and treatment, curb the attainment of long-term housing, and further stigmatize and constrain economic and social mobility among PEH [52][53][54][55]. In addition, the findings support previous theory and research on stigma [15][16][17][18] and the stigmatization of economically marginalized TAY and PEH [13,47,56,57]. ...
San Diego, California is consistently ranked among regions with the highest rates of homelessness in the United States. From 2016 to 2018, San Diego experienced an unprecedented outbreak of hepatitis A virus (HAV), largely attributed in media and public health discourse to the region’s growing population of people experiencing homelessness. Little attention, however, was devoted to examining the experiences and needs of this population, particularly transitional aged youth (TAY, aged 18–24) experiencing homelessness who may have been uniquely affected by the outbreak. This community-based participatory research study leveraged diverse qualitative methods, principally photovoice, to explore how the social and built environment shapes health among TAY experiencing homelessness in San Diego, how these environments may have contributed to the HAV outbreak, and TAY’s perceptions of HAV-related public health interventions. Emergent findings include stigmatization of TAY and other people experiencing homelessness, interventions that failed to address root causes of the outbreak, and interactions with housing-related and other social support resources that limit rather than support economic and social mobility. Findings have implications for understanding how media and public discourse, public health interventions, and availability and delivery of resources can contribute to and perpetuate stigma and health inequities faced by TAY experiencing homelessness.
