The death rate among homeless people in Alameda County was more than four times the rate among the general population, the report found. Credit: Pete Rosos

More than 800 unhoused people died in Alameda County from 2018 to 2020, according to a staggering report on homeless mortality released this week.

The long-awaited report from the county’s Health Care for the Homeless Program is the first of its kind, pulling data from a range of sources and breaking it down by location, cause of death, and demographic information. Previous efforts to track homeless deaths relied solely on numbers from the coroner’s office, providing a less comprehensive picture of the lives that ended on the street and in shelters.

“Our community needs information,” said David Modersbach, director of the county program and author of the report, at a memorial for unhoused people in December. “That community responsibility really rests with the county, our local government. We must work to prevent every preventable death.”

Over the three years the report tracks, the death rate rose significantly for unhoused people. In 2018, 195 homeless people died, compared to 368 in 2020, a nearly 90% increase. 

The 809 deaths during that period represent about 10% of the 8,022 homeless people estimated to live in Alameda County at last count in 2019—4.4 times higher than the general population’s death rate, according to the report.

Half of all deaths were caused by acute or chronic medical conditions—primarily heart disease, followed by cancer, strokes, and other conditions and illnesses. Around 42% of these deaths occurred away from a medical setting like a hospital. 

More than a quarter of the 809 deaths were caused by drug overdoses, mainly from use of synthetic opiates like fentanyl, as well as heroin and meth, making this the leading single cause of death among this population. The fatal overdose rate tracked in the report is 43 times higher than the rate among the general population, according to the authors, who note that most overdoses are reversible before death occurs, by witnesses calling 911 or administering naloxone.

Between 2018-2020, 59 homeless deaths were deemed homicides and 35 unhoused people died from suicide. 

Source: Alameda County 2018-2020 Homeless Mortality Report. Chart: Supriya Yelimeli/Datawrapper

The report’s authors also attempted to determine where people were living when they died. The county identified 61 people who were living in homeless shelters or programs at the time they died, including 33 from medical conditions, 19 from overdoses, three from suicide, and two accidental injuries. For the most part, the authors could not determine whether the other deceased people had been living in encampments, because of the unclear information collected in official records.

The report also lays bare the demographic disparities of homelessness in Alameda County. The county’s homeless population is disproportionately Black and male, and the mortality data reflects that. Forty-one percent of the unhoused people who died between 2018-2020 were Black, compared to 19% of the general population deaths. And 77% were male, compared to half of the overall deaths. 

These disturbing trends will only be reversed if policymakers and community members understand the extent and nature of homeless deaths, the report says.

“A responsible and just community must work to be closely aware of the deaths of all its members, strive to learn from those deaths, implement policies and practices to reduce preventable deaths, and work to reduce the harm that preventable deaths create for families, friends, caregivers, and the community,” the authors wrote.

Paul Kealoha-Blake, a member of Berkeley’s Homeless Commission, said the report reflects the conditions he sees on the streets, and the calls he receives at all times of night from people reporting that their friends and loved ones are unresponsive in their tents.

“It’s incredibly depressing, specifically because I feel that these are preventable,” said Kealoha-Blake, a volunteer with the grassroots group Consider the Homeless. He said access to more drop-in crisis centers, safe injection sites, and kits to test drugs could go a long way in stopping deaths. Most overdoses he’s witnessed happened because people didn’t know what drugs they were taking, and some turned out to be cut with other substances like fentanyl, he said.

“We have some control over these statistics, but we don’t take the time, money or energy to address these,” Kealoha-Blake said.

Even the 809 deaths in the mortality report are likely a significant undercount. The county identified another 598 deaths of people who were known to be homeless within the past five years, but whose current housing status was unclear. 

The new study identifies nearly double the number of “transient” deaths tracked by the Alameda County Coroner’s Office, 421. Part of the reason is because the sheriff/coroner only investigates and documents deaths that are either unattended, meaning not in a medical setting, or suspicious. 

Health Care for the Homeless used a broader set of sources, cross-referencing state death records with community and media reports, shelter reports, and an academic study. Anyone can submit a report of an unhoused person who died to the county.

A bit over half of the 809 people who died, 458, were living in Oakland or Emeryville, roughly reflecting the portion of the county’s homeless population residing there. Sixty-two people died in the Berkeley-Albany area. 

The report tracked deaths through the end of 2020, less than a year into the COVID-19 pandemic. The county found six people who had died from the virus by then, including one living in a shelter, but the investigation concluded before the more contagious delta and omicron variants caused COVID-19 rates to skyrocket among both homeless and housed populations.

Since the county’s study was conducted, numerous additional unhoused people have died in the county. Just last week, a man died in an RV fire in West Oakland that also displaced five others.

Following the release of the report, the county plans to assemble a “community homeless mortality task force,” to analyze the data and make policy recommendations.

Natalie Orenstein covers housing and homelessness for The Oaklandside. She was previously on staff at Berkeleyside, where her extensive reporting on the legacy of school desegregation received recognition from the Society of Professional Journalists NorCal and the Education Writers Association. Natalie’s reporting has also appeared in The J Weekly, The San Francisco Chronicle and elsewhere, and she’s written about public policy for a number of research institutes and think tanks. Natalie lives in Oakland, grew up in Berkeley, and has only left her beloved East Bay once, to attend Pomona College.