Unsheltered homelessness is a public health catastrophe. Homeless people are dying daily in King County and Seattle, it’s getting worse, and it’s preventable. Providing shelter or housing sufficient for all unsheltered people is an essential step to turn things around. 

After decades of regional dialogue and failed plans, however, the gap is still growing between suitable shelter options and the thousands of people living unsheltered in King County. The King County Regional Homelessness Authority estimates we need 18,000 additional units of temporary shelter or housing by 2027. 

Meanwhile, the City of Seattle is obsessed with “removals” of tent and vehicle encampments, better known as “sweeps”–-more than 900 happened in 2022—even when shelter units are unavailable

Seattle’s “Services not Sweeps” Coalition has launched a campaign to ban sweeps during winter and extreme weather, when survival outdoors is most challenging. Akin to the Seattle winter housing eviction ban, adopted pre-COVID in 2020, this policy would extend eviction protection to unhoused people.

As University of Washington public health faculty who have taught, conducted research, and developed policy on homelessness, we wholeheartedly support a winter sweeps ban. We further support a year-round ban on sweeps, at least until Seattle has enough dignified and suitable indoor space for all unsheltered people. Until then, a ban during winter and extreme weather is a healthful first step.

Sweeps achieve little more than shuffling visible reminders of homelessness from one neighborhood to another, and then shuffling them back again. However, sweeps also push people deeper into the shadows, farther from geographies they know, disrupting connections to care providers and street outreach workers. Sweeps risk loss of identification, paperwork, medications, and social connections. Imagine trying to transition out of homelessness, facing constant challenges like this, all topped by the continual threat of losing your meager tent, bedroll, or car, and everything you own. 

Even worse, sweeps kill. A recent study in the Journal of the American Medical Association (JAMA) looked at 23 cities, including Seattle, and found that continual “involuntary displacement” significantly increases hospitalizations and deaths. That’s the last thing Seattle needs. Deaths of homeless people in King County were already twice as high as the Washington state population. They soared higher in 2022, and so far in 2023 they are even higher than the same time last year.

We are not alone as public health professionals in calling for services and shelter, not sweeps. The American Public Health Association’s Caucus on Homelessness has come out against the forced disbanding of homeless encampments without readily available housing or suitable shelter. The editorial for the JAMA study summarized involuntary displacements as “making a bad situation worse.” The lead author on the JAMA study bluntly explained, “Sweeping people is not a solution to #homelessness, but is rather a form of (costly) state-sponsored violence.”

The King County Board of Health declared in 2018 that unsheltered homelessness is a public health crisis, with imminent threats to the health and survival of unsheltered people. The Board called for all King County jurisdictions to rapidly provide emergency shelter sufficient to serve all unsheltered homeless individuals.

Furthermore, federal case law has repeatedly required that sufficient shelter be available before removing tents or belongings of unsheltered people. Ninth Circuit Court rulings against Boise and Grants Pass established this, as did a December federal court order in San Francisco. Also, this week a King County Superior Court judge ruled that Seattle’s encampment removal policy is unconstitutional in instances where the City uses its overly broad definition of “obstruction” to justify removing and destroying property without notice or shelter offer–when there is no true obstruction or imminent hazard.

Seattle and King County are nowhere close to these goals, and it’s not on the horizon. The Regional Housing Authority’s recent Five-Year Plan, for example, has no specific timetable to meet current or projected needs for shelter. Seattle nonetheless continues a fearsome pace of encampment sweeps.

You might ask, what about all those homeless people who “refuse” shelter? Hmm. First, most Seattle sweeps are conducted without advance notification or shelter offers. Second, the City of Seattle’s own statistics confirm that most encampment residents accept offers when they involve “enhanced” and “non-congregate” shelter, like tiny house villages or motel spaces.

Although a mat on an “emergency” shelter floor meets the courts’ minimum expectations, this is not enough to help people transition out of homelessness. Basic “congregate” shelter offers minimal plumbing and weather protection—usually along with barriers to entry (such as excluding partners and animal companions), crowded sleeping, no privacy, limits on belongings, and morning ejection to the streets. These settings are neither healthful nor dignified. Not surprisingly, encampment residents in Seattle often decide against such shelter offers.

To help people stabilize and find real housing, shelter is best when enhanced with 24/7 access and privacy, open to full family units and partnered people, including animal companions, and with connections to case management, health, and social services. This is the type of shelter prioritized by both the Regional Homelessness Authority and the Board of Health.  

Homelessness is rooted in housing unaffordability, non-livable minimum wages, disabilities, medical debt impoverishment, institutional racism, and other economic system failures. Sustainable solutions will require transformative strategies, costly investments, and time. 

Fortunately, we live in a city with some of the richest people in the world’s history who have the capacity, if taxed, to support solutions. We also have lots of vacant units that could be made available for housing.

In the meantime, though, we should at least stop sweeping encampments during our coldest and hottest months, when displacement causes the most damage.

Bill Daniell is a physician, epidemiologist, and retired UW School of Public Health Associate Professor Emeritus. He served on the King County Board of Health for seven years.

Amy Hagopian is a Professor in UW School of Public Health, where she taught the school’s homelessness course. She’s chair-elect of the American Journal of Public Health editorial board.