Homelessness is a public health crisis, but whose health are we prioritizing?

Print More
Getting your Trinity Audio player ready...

As I read President Miguel Meléndez Jr.’s Report on Homelessness, I was struck by a deep sadness, because it feels as though the heart of the issue is being missed.

The report correctly identifies homelessness as a public health crisis. I agree wholeheartedly. But a public health crisis for whom? Much of the discussion focuses on the impacts experienced by housed residents, while giving far less attention to the people who are most directly and severely harmed by homelessness itself.

This imbalance is especially evident in the way overdose deaths are discussed. While the report acknowledges that unhoused people die from many causes beyond overdose, overdose death is primarily framed as something traumatic for others to witness. Of course it is. But what is largely absent is any meaningful acknowledgment of the cumulative harm homelessness inflicts on people experiencing it. Unhoused residents die not only from overdoses, but from untreated cancer, strokes, diabetes without access to insulin, infections, and exposure to extreme cold. How many unhoused people die in Rochester each year? How many have frozen to death outdoors? I personally know of at least one man this year. That data is missing from this report.

The report’s own data further reflects this gap. Only 11 percent of survey respondents were people experiencing homelessness. This is unsurprising given that participation required internet access through a QR code and online form, tools many unhoused people do not have. As a result, the voices of those most affected were largely excluded from the findings.

The report acknowledges that closing encampments and removing outdoor sharps containers has worsened conditions by displacing people, severing relationships with outreach workers, and increasing hazards in public spaces. Health and recovery providers testified that Rochester’s health and housing systems are not equipped to meet the serious medical and behavioral needs of unhoused residents and urged the adoption of harm reduction strategies.

Despite this testimony, the report recommends continued encampment sweeps or “closures” under the banner of a public health and safety approach. This is a contradiction.

A true public health response does not begin with displacement. Declaring that encampments cannot persist in residential areas before safe and accessible alternatives actually exist guarantees harm. Encampment sweeps without housing or truly low barrier shelter increase overdose risk, disrupt medical care, and push people into more dangerous and less visible conditions.

The inclusion of law enforcement in response to homelessness undermines any claim to a public health approach. It escalates situations that require care, not enforcement. Police are not healthcare providers, housing specialists, or trauma informed responders. Their presence deters people from engaging with outreach, increases fear and mistrust, and too often results in citations, arrests, or displacement rather than assistance.

Homelessness is not a criminal condition. People experiencing homelessness should not be managed through policing. A public health response must be led by housing professionals, healthcare workers, harm reduction providers, and trained outreach teams, without law enforcement involvement.

The report frames neighborhood wellbeing and the dignity of unhoused residents as interests that must be balanced. In reality, these interests are not in conflict. Homeowners want clean, safe, and stable neighborhoods. Unhoused people want safety, stability, and access to care. The solution to both is housing.Sweeps do not resolve neighborhood concerns. They relocate them. Housing resolves them.

The conditions described as public safety concerns such as syringe litter, public defecation, and visible distress are not failures of safety. They are failures of public health infrastructure. They reflect the absence of housing, bathrooms, trash service, healthcare, and harm reduction. Addressing these symptoms through enforcement rather than care has repeatedly failed.

When advocates say homelessness is a public health crisis, we are speaking first and foremost about the health and safety of people living without shelter. The safety of all residents matters. But policies that repeatedly displace people who are already vulnerable reveal whose lives are being prioritized.

I say this not out of disregard for housed residents, but out of concern for those facing the most immediate risk of illness and death. If the City is serious about compassion, dignity, and community wellbeing, it must stop encampment sweeps and focus on safe, voluntary alternatives and place housing first public health strategies at the center of its response.

Lives depend on it.

Mickey DiPerna
Rochester Grants Pass Resistance organizer

The Beacon welcomes comments and letters from readers who adhere to our comment policy including use of their full, real name. See “Leave a Reply” below to discuss on this post.

3 thoughts on “Homelessness is a public health crisis, but whose health are we prioritizing?

  1. This town has more than enough resources of various and all necessary kinds, and enough people who are concerned and willing to do the work necessary to address the homelessness situation here and the needs of those experiencing homelessness, but as usual it has fumbled the ball. Mickey DiPerna’s letter correctly points out that the report just done does not focus
    sufficiently on the problem itself; again, this is typical of Rochester. Over the past two decades, I have notified each Mayoral administration about the ACE Foundation in New York City, which developed a program that has been very successful in helping homeless people deal with addiction issues, become employed, and get back into the mainstream of life, has brought that program to other cities where it was similarly successful, and has been more than willing to come to Rochester to meet with City officials to discuss the possibility of their program being implemented, or at least tried, here. But the City has to contact them, and invite them, for that to happen. Enough said. There are plenty of nice, intelligent, capable people here, many of whom are trying and would be able, in the right atmosphere, to get things done right. But the basic nature of Rochester, and I say this as a professional astrologer who knows the city’s chart based on its date of incorporation, does not provide
    that environment and instead is smug, complacent, and provincial, to put it kindly, fosters misery and corruption, and doesn’t particularly care for competence. It’s exactly what one would expect, a good place for bad people that was built on a disease-infested swamp full of snakes. Of course it’s been racist, a mob town, and full of drugs and crime, and long has had one of the highest rates of homelessness in the nation, and of course now when a report is done on homelessness here the report doesn’t even focus on the homeless. This is a place
    that knows how to create homelessness no less than insanely high rents in SanFrancisco and Silicon Valley did, while both places are known for technical invention and prosperity. My
    heart goes out to those trying to help the homeless here. They deserve more intelligent, honest, and willing support and better cooperation than Smugtown, in its essence and in its city administration, has to offer. When it was a Republican town, it still had the negative traits that are intrinsic to its soul, but at least things were handled more competently and efficiently. Now we’ve got a Presidential administration that wants to address and solve
    problems, and naturally this “Sanctuary City” (how much sanctuary does it give the homeless?) is hell bent on giving it a hard time. Leaving the situation to the Open Door Mission, the House of Mercy which is a problem from its Board on down, not-for-profits,
    churches, etc. is typically inadequate on the City’s part, and that report actually reflects the true nature and attitude of this town.

  2. The city is contemplating purchasing the old Rochester psychiatric ward for office space. The space was specifically designed to house probably more people than are homeless today (or at least a significant portion of them). Converting the former restrictive environment into one where the homeless could live without being in a “jail” environment – remove the bars and add family based facilities – and the health care, addiction and mental health workers could assist them seems like a better use of that space. What if instead of worrying about office space we worried about people living a good life off the streets.

  3. I totally agree with this piece. A both-and approach is needed to address concerns/needs of currently housed and unhoused city residents. Data counts – and data shows housing first works best (tho imperfectly) of the solutions currently available to us.

Leave a Reply

Your email address will not be published. Required fields are marked *