In the mid-1990s, Dr. Margot Kushel came west to do her residency in internal medicine at San Francisco General Hospital. Many of the patients she saw were experiencing homelessness, and she realized that no matter how much the health care system improved, or how skilled she became as a physician, she could only help her patients so much if they were unable to find safe, permanent housing.
“I figured out pretty quickly that if I really cared about health, I needed to address the crisis of homelessness,” she said.
Nowadays, Kushel leads the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and is a nationally recognized expert on homelessness who speaks at conferences and is often quoted in the New York Times and other media outlets. Last year, she was on the Forward 50 list of influential American Jews.
In May of last year, she was tapped to helm a new homelessness and housing project at UCSF supported by a $30 million gift from philanthropists Marc and Lynn Benioff.
In a recent interview, Kushel spoke about the urgency of her work at the current moment, calling the coronavirus crisis a “pandemic on top of an epidemic” and saying the economic disruptions it has caused will likely result in “huge numbers” of additional people living on the streets.
“In some ways, this is our worst nightmare,” she said. “It makes the point so tragically real what we as health care providers have been trying to say for so long, which is that health care doesn’t hold a candle against the assault of homelessness.”
A member of Kehilla Community Synagogue in Piedmont, Kushel has been instrumental in shaping California’s response to the pandemic, which she described as “better than most, which isn’t to say it has been enough.” Two months ago, she consulted with state officials in Sacramento and helped develop Project Roomkey, an initiative aiming to place thousands of homeless people in vacant hotel and motel rooms.
In San Francisco, which has a homeless population of about 8,000, according to SFgov.org, around 10 percent have been placed in SIP (shelter-in-place) hotels, according to Kushel, either because they have contracted the virus, are “under investigation” or are at risk of poor outcomes should they become infected. In Oakland, according to the San Francisco Chronicle, several hundred people have been placed in hotels, and more have been relocated to travel trailers in East Oakland funded in part by Jewish philanthropists Tad and Dianne Taube.
Asked about the Covid-19 outbreak last month at San Francisco’s MSC South shelter, which left nearly 100 sick and was reported to be the country’s largest outbreak at a single shelter, Kushel replied, “They emptied that shelter right away, and those folks went to SIP hotels. Most of them have either recovered or finished their period of quarantine.”
Kushel acknowledged that it has been difficult to secure more rooms due to hotel owners’ concerns about staffing and reimbursements. (Earlier this week, the Los Angeles Times reported that only about half of the 15,000 hotel and motel rooms leased by the state as part of Project Roomkey were occupied.) She said another critical need is to ramp up testing among the homeless.
Health care doesn’t hold a candle against the assault of homelessness.
In addition to her efforts on the state level, Kushel has advised local leaders, including Oakland Mayor Libby Schaaf, both before and during the pandemic. Queried for this article, Schaaf said Kushel is “one of my most valuable thought partners around our homelessness crisis,” adding, “She brings a unique merger of academic brilliance with compassionate humanity. Her work identifying the role of structural racism in homelessness should be required reading for every policymaker in this country.”
Kushel said she is hopeful that those currently staying in SIP hotels will be moved into housing when shelter-in-place orders are lifted. “Many localities are working on plans to try to house as many people as possible who were in SIP hotels through a variety of mechanisms,” she said. “It would be horrible to return people from hotel rooms to shelters or unsheltered settings.”
As a researcher, Kushel has focused on the relationship between race and homelessness, as well as on senior homelessness. Among her findings are that structural racism both precipitates and perpetuates homelessness, and that the homeless population in the Bay Area is aging. In one study, she found that nearly half of all older, single homeless people first experienced homelessness after age 50.
Local homelessness agency leaders said Kushel brings compassion and pragmatism to her work.
“Margot has been a true champion during this health crisis, fighting on behalf of our most vulnerable residents,” said Tomiquia Moss, the CEO of All Home. “She leads with acknowledging the racial disparities that persist through this health crisis and challenges policymakers to address those disparities.”
On March 26, Kushel participated in an online talk with Rabbi Ryan Bauer of Congregation Emanu-El in San Francisco. She noted that, contrary to popular belief, economic and political factors contribute to homelessness much more than substance abuse or mental health issues. “Don’t let anyone tell you it’s about opioids or methamphetamines,” she said. “This is a person-made crisis due to changing federal policies toward affordable housing, mixed in with a toxic stew of racism and income inequality.” She added, “There’s no medicine as powerful as housing.”
Bauer said that “the world is very blessed that we have” Kushel, and he praised her for her groundbreaking research. “She is able, almost like a hot air balloon, to go up to 10,000 feet and say, in a really thoughtful, academic way, ‘Huh, how did we get here? What caused this in the first place and how do we get out of it?’” he said. (Since 2016, Emanu-El leaders and members have participated in several fundraising and volunteer efforts to combat homelessness in San Francisco.)
Kushel, who lives in San Francisco with her husband and two children, mostly has been working from home during the last two months. Her children, who are high school seniors, won’t be walking in a graduation ceremony due to the crisis, but “they’re troopers about it,” she said.
In her life and work, Kushel said she is guided by Jewish values, including the phrase “Justice, justice you shall pursue” (Deuteronomy 16:20). “For me,” she said, “health equity and housing equity are key issues to creating a just world.”