An unusual time

The city has sufficient shelter beds for everyone who wants it, according to the Health and Human Services officials. But shelters are not homes. Many prefer the streets citing safety and freedom as reasons. Living on the street is not without perils: they are still subject to violence and theft, are vulnerable to cleanups and may loose their meager belongings. Some encampments, those at the underpasses in the NoMa neighborhood (right next to the spacious, bright lighted REI store), for example, look crowded and dirty. Recently I spotted new trash bins and toilets installed on the encampment sites.

Everyone who ends up in the street has a sad story. It can be misfortune: loss of a job and consequently home due to health issues and debts. When one looses “track records” and doesn’t have an address to put on job applications, it is hard to get back. If somebody stays long on the street, it could become a habit. Veterans have a good share of the homeless. Some have mental illness. For a few, it may be a “better” life. After all, it’s not that outrageous to ask: is it worth all your time and energy to earn so low a minimum wage that it doesn’t even pay rent, if you have some sort of talent? These different paths leading to the streets imply different approaches needed to address the problem. But overall there is no easy solution – homelessness is rooted in poverty largely due to macro economic processes, and has much to do with social welfares, values, and culture.

Homelessness is not unique to DC and is primarily an urban issue. New York City, Los Angeles, San Francisco, and Seattle are among the cities with most homeless people. An increase in homeless young people (students) is also noted. In 2020, there were about 580,466 homeless people in the country. The number started to increase in the last two years following steady decreases since 2007; the highest increase between 2018 and 2019 was found in New Mexico.

An anecdote: in Albuquerque, New Mexico’s largest city, I had seen people carry a bag around; they would lie down to sleep under a shade and wake up to pick up the bag and walk on. Some had a dog, but none of them had a cell phone. It felt like a different country.

Numbers and data are from statista.com

Any medical procedure’s connection to negative outcomes cannot be flatly rejected by arguing that they are rare and that the chance is no higher than what naturally occurs in the population. Even controlled experiments that are considered the golden standard for research don’t establish causal effects unless we know WHY. Only an understanding of the mechanism through which an intervention produces effects constitutes a scientific explanation.

Actually, any negative outcomes, no matter how rare, that are under suspicion of a medical intervention, should be investigated this way. Even if we cannot predict who are likely to suffer from it, understanding the mechanism helps come up with effective treatments in case it happens – the standard treatment can do more harm as shown by this investigation.

Simple numbers can be very powerful to reveal the state of affairs. For public policy, statistics provide useful guidance. But statistics are cold. Ask those who have experienced low-probability dramatic side effects from a routine medical procedure; they will tell you how devastating it is to a healthy person. (It’s different from that you gave poor people vitamins, which didn’t translate into improved income.) This is why it’s extremely important to investigate the mechanisms so to understand individual and group differences and have a remedy at hand.

Investigating the mechanisms should be the focus of science in general.