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Where does COVID-19 risk for the homeless start and where might it end?

COVID-19’s uneven march across humanity demonstrates that homelessness increases vulnerability to infection.

Campaign Against Racism - Twin Cities
Members of the Campaign Against Racism - Twin Cities include authors Amy Finnegan (third from the front on the left side), Nasreen Quadri (sixth from the front on the left side), and Michael Westerhaus (fifth from the front on the right side).
Campaign Against Racism - Twin Cities

COVID-19’s uneven march across humanity demonstrates that homelessness increases vulnerability to infection. Most discussion around risk associated with COVID-19 centers on comorbidities or minimizing risk by physical distancing and hand washing. As such, risk is tallied by counting up one’s bodily or behavioral flaws, placing the blame largely on infected individuals.

As a collective of Twin Cities-based health educators and clinicians actively engaged in the Social Medicine Consortium’s Global Campaign Against Racism, we find such frameworks of risk not only misleading but complicit in maintaining systems of oppression that create the root causes of risk. Years of clinical and educational encounters with patients and communities struggling to maintain access to affordable, safe, and livable housing have taught us that we need to redirect our conceptualizations of risk away from the body and behavior and toward the underlying forces that create risky social conditions.

Shifting the inputs entered into our risk calculators requires honest attentiveness to the realities of homelessness in Minnesota. The Wilder Foundation’s Minnesota Homeless Study identified an estimated 19,600 people experiencing homelessness on any given night in 2018 with 57% reporting chronic medical conditions. It revealed that African-American and American Indian people are overrepresented in the homeless population.

Looking through a historical lens

We must look at the root causes of homelessness with a lens that magnifies history. In Minnesota, this lens guides our risk assessment to the early 1900s history of racially restrictive covenants on property deeds, limiting where African-Americans and other non-white minorities were able to buy homes. Today, Mapping Prejudice reveals such homes continue to hold more value than equal counterparts without a racial covenant history. Redlining in home lending practices followed in the 1930s and amplified the gap in wealth accumulation between whites and blacks through home ownership. In the 1950s, the federal government sponsored the “Voluntary Relocation Program” to move Indigenous populations off tribal lands, sell the land, and resettle people in cities with minimal social support. Such foundationally discriminative policies contribute to today’s disproportionately low levels of home ownership and home values for people of color in Minnesota, further tugging people toward the precipice of homelessness.

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Such interrogation reveals housing histories are rooted in racial capitalism. Cedric Robinson, who took the analytical concept of racial capitalism describing economics during apartheid in South Africa and reframed it to the general history of modern capitalism, explained that “capital can only be capital when it is accumulating, and it can only accumulate by producing and moving through relations of severe inequality among human groups … procedures of racialization and capitalism are ultimately never separable from each other.” What first legitimated the crimes of slavery against Africans and genocide against Indigenous peoples has continued for centuries through racialized policies and practices that normalize and sustain capital accumulation and private ownership for some at the expense of housing security for all.

Attuning our lens to perceive the linkages between homelessness and mass incarceration further exposes the machinations of racial capitalism. Well-known racial disparities are documented in who is incarcerated in our for-profit system. Once released, there are tremendous obstacles to obtaining housing with a history of incarceration or even conviction without incarceration.

Solutions to pursue

Today, as we consider the risk of COVID-19 for those who are unhoused, redirecting our conceptualizations of risk toward social and structural forces creates a paradigmatic shift in the solutions we pursue. Thus, we support:

  • Minnesota counties making public purchase of hotels for permanent and accessible housing. The process must be inclusive of unsheltered neighbors, eliminate punitive barriers to staying in hotels and incorporate trauma-informed harm reduction care in emergency housing plans as stated by Rosemary Fister, psychiatric nurse practitioner for Hennepin County’s Healthcare for the Homeless.
  • Preventing evictions by extending the peacetime emergency rent moratorium and by keeping public housing public.
  • Expanding “Ban the Box” legislation, preventing mandatory disclosure of criminal history on applications for housing, thereby removing a significant barrier to housing access.

As COVID-19 infections in Minnesota disproportionately impact communities marginalized by histories of racial capitalism, incorporating these sorts of prescriptions into a broader public health strategy will expand shelter and promote survival for all in our community both during this and future pandemics.

Nasreen Quadri, Michael Westerhaus and Amy Finnegan wrote this commentary on behalf of the Campaign Against Racism — Twin Cities Chapter, a group dedicated to dismantling structural racism and its effects on health by supporting local actions to improve the health and lives of those most affected by racism.

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