The Healthy Project Podcast

Corey Dion Lewis sits down with Dr. Margot Kushel, a practicing general internist with over 30 years of experience at San Francisco General Hospital and Director of the UCSF Benioff Homelessness and Housing Initiative, to explore why homelessness is fundamentally a housing problem—not a healthcare problem—and what this means for medical professionals and communities. Dr. Kushel shares compelling insights from her three decades of clinical practice and research, revealing how the lack of affordable housing creates impossible situations for healthcare providers trying to treat patients experiencing homelessness. From managing diabetes in a tent to storing insulin without refrigeration, she illustrates why "there is no medicine as powerful as housing." What You'll Learn: Why regions with high homelessness rates are defined by housing affordability, not mental health prevalenceHow structural racism and redlining created the current crisis, with Black Americans 4-5 times overrepresented in homeless populationsThe stark reality: only 36 affordable housing units exist for every 100 extremely low-income households in AmericaWhy Housing First policies work better than Treatment First approaches, backed by evidence from veteran homelessness reductionThe hidden homeless population: workers living in cars, college students couch-surfing, and older adults losing housing for the first timeHow the politicization of Housing First policies threatens progress and patient outcomesPractical ways healthcare providers can advocate for housing as a health interventionKey Clinical Insights: Dr. Kushel explains why treating chronic conditions like diabetes, hypertension, and mental health disorders becomes nearly impossible when patients lack stable housing. She shares real stories from her practice, including a 63-year-old patient who hadn't eaten in four days while fighting eviction, and discusses how readmission penalties unfairly penalize hospitals serving homeless populations. The Evidence for Housing First: Learn about the dramatic 85% housing retention rate of Housing First approaches compared to 5-10% success rates of traditional Treatment First models, and why the George W. Bush administration adopted this evidence-based policy. Dr. Kushel also shares findings from California's comprehensive statewide homelessness study, debunking myths about people traveling from other states. For Medical Professionals: This episode is essential listening for physicians, nurses, nurse practitioners, physician assistants, medical students, residents, community health workers, social workers, case managers, and anyone in healthcare who treats patients experiencing housing instability. Dr. Kushel provides a framework for understanding how to advocate beyond the clinic walls. About Dr. Margot Kushel: Dr. Kushel is a physician and researcher who has dedicated her career to understanding and ending homelessness. She directs the UCSF Benioff Homelessness and Housing Initiative and the Action Research Center for Health at the University of California, San Francisco. Her research informs policy at local, state, and federal levels. Resources Mentioned: UCSF Benioff Homelessness Initiative: homelessness.ucsf.eduCalifornia Statewide Study of People Experiencing Homelessness"There Is No Place" by Brian GoldstoneEpisode Takeaway: "There is no medicine as powerful as housing. Homelessness is a housing problem." Whether you're a healthcare provider frustrated by social determinants of health, a medical student learning about population health, or a community advocate, this conversation will change how you think about the intersection of housing and health. SHOW NOTES Episode: Housing as Medicine: Why Homelessness is a Housing Crisis Guest: Dr. Margot Kushel, MD Host: Corey Dion Lewis Category: Medicine Duration: ~49 minutes ABOUT THIS EPISODE Dr. Margot Kushel, Director of the UCSF Benioff Homelessness and Housing Initiative, explains why homelessness is fundamentally a housing crisis and how this understanding transforms medical practice and healthcare advocacy. GUEST BIO Dr. Margot Kushel, MD Practicing General Internist, San Francisco General Hospital (30+ years)Director, UCSF Benioff Homelessness and Housing InitiativeDirector, Action Research Center for Health, UCSFLeading researcher on homelessness and health outcomesPolicy advisor at local, state, and federal levelsKEY TOPICS & TIMESTAMPS [00:00] Introduction: The Housing-Health Connection [02:00] Homelessness is a Housing Problem Why mental health and substance use don't explain geographic variationsThe role of affordable housing shortagesComparing high vs. low homelessness regions[05:00] The Clinical Reality: Hands Tied Behind Our Backs Treating diabetes in patients living in tentsWhy standard medical care fails without stable housingThe frustration of healthcare providers[08:17] The Numbers: America's Affordable Housing Crisis 36 units per 100 extremely low-income households nationallySan Francisco: 24 units per 100 householdsOne million units short[09:15] "There is No Medicine as Powerful as Housing" Using physician voices in policy advocacyThe limitations of healthcare aloneAddressing root causes[13:55] Hospital Readmissions and Housing Instability How readmission penalties penalize safety-net hospitalsPatients discharged to sidewalksThe need for systemic change[17:08] Structural Racism and the Homelessness Crisis Black Americans: 4-5 times overrepresentedThe legacy of redlining and housing discriminationHow wealth gaps perpetuate housing instabilitySan Francisco example: 5% population, 37% of homeless[19:28] Historical Context: How Housing Policy Weaponized Race Post-WWII home ownership boomRedlining and mortgage discriminationIntergenerational wealth transfer blockedOngoing discrimination in rental housing[23:49] The Hidden Homeless Population Workers living in cars (Uber drivers, janitors, fast food workers)College students experiencing housing insecurityThe invisible crisis in CSU, UC, and community collegesPeople with addresses who aren't truly housed[27:17] Older Adults: The Growing Crisis Half of single homeless adults are 50+40% experiencing homelessness for first time after age 50Bodies breaking down from physical laborThe eviction-to-homelessness pipeline[28:14] Clinical Case: The Amoxicillin Story Patient in garage without refrigerationAntibiotic treatment failure due to housingWhy "having an address" doesn't mean housed[29:11] Debunking the Migration Myth California study: 90% lost housing in-state75% in the same county...