Rhetoric without Resources: Evaluating Health Risk Communication in the Bay Area’s Unhoused Community

Abstract

The Bay Area is home to the third largest unhoused population in the United States with its growth in recent years accounting for more than a quarter of the growth in the total homeless population in the U.S. This striking increase has made the community in the Bay Area especially vulnerable to inequities and crises in public health due to the distinct challenges they face as a population: rapid disease spread, inequitable access, negative past history of care, provider turnover, and other systemic barriers. In particular, the lack of effective health communication has substantially risked public health in the unhoused community. For instance, the COVID-19 pandemic, fentanyl crisis, and hepatitis A outbreaks exemplify how ineffective health communication combined with crowded living conditions, limited hygiene, and pre-existing health conditions exacerbate dangers for unhoused individuals. In terms of regional context, whilst in other parts of the country, such as New York, COVID-19 was the leading cause of death, in the San Francisco Bay Area, 82% of deaths were associated with synthetic drug overdoses such as fentanyl. This statistic further emphasizes the growing need for effective preventative risk communication across crises. Although this need continues to grow, prior research has consistently demonstrated these specific difficulties in communicating with unhoused communities, posing a barrier to effective and essential health communication. A combination of these challenges makes the Bay Area a critical area of interest for understanding and planning how to communicate public health crises to people living in unhoused communities. My research argues that these public toolkits released by Bay Area agencies rely more heavily on aspirational rhetoric than on resourced, actionable language, demonstrating a critical gap in scientific communication across crises.