School of Public Health

Giving a Photovoice to Those Who Are Homeless

Faculty researcher Dr. Jerel Calzo and his team wanted a fresh way to see and understand San Diego’s response to the recent Hepatitis A crisis, from the eyes of those caught in the middle of it – people experiencing homelessness. Specifically they wanted to concentrate on transitional-aged youth (young adults aged 18-25). He and co-investigator Dr. Jennifer Felner received a university grant to better understand these individuals’ experiences with homelessness. To give the community a voice, they used a community-based research methodology called Photovoice. They collaborated with two community members who had experienced homelessness—Daniel Kirkland and Hunter Call—and were assisted by a SDSU student research team consisting of: Saanjh Boyani, Amanda Farr, Talia Kieu, Ethan Lopez, Andrew Stieber, Cameron Wadstrom, Carrisa Wijaya, and Sally Windisch. Together, the research team, which called themselves Action4healthSD, took tours of the city, taking photos as they went and engaged in a critical analysis of how the public health response to Hep A impacted the health of people experiencing homelessness.

While they started out trying to understand the response to the Hep A crisis, they quickly realized that this was a symptom of a larger problem. They ended up taking a much broader view, looking at the question “What are the barriers to health among transitional-aged youth experiencing homelessness and how do we overcome those barriers?”

Two bins -- an unlocked garbage bin and a locked recycling bin.
Description: Two bins — an unlocked garbage bin and a locked recycling bin. Analysis: We took this photo because it suggested to us that anyone can have access to garbage but that people who might make money of the recycling need to stay out. This was a symbol of stigmatizing those who may need access to things they can sell to survive.
“This is symbolic of who should be protected and how a community can be clean, by not promoting helping those who are poor and/or homeless.”

Each day they went out in search of answers to some basic questions, such as “Where do people go to meet hygiene needs?” or “Where do people go to feel safe?” They took photos of the community and then used a systematic analysis method called SHOWed. This method asks the questions: “What do we See here?”; “What is really Happening here?”; “How does this relate to Our lives?”; “Why does this problem, concern or strength exist?”; “What can we Do about it?”

In addition to the photography and analysis, they also interviewed persons experiencing homelessness, as well as service providers, county officials, and other experts. This resulted in several central and consistent themes. They shared their conclusions in community forums, asking for feedback and responses. These forums were well attended by members of the community, including those who were experiencing homelessness, policy makers, service providers, academicians, and members of the media.

The themes they identified were:

    • Stigma plays an important role in shaping the day-to-day life of people experiencing homelessness. For example, people experiencing homelessness were frequently viewed as transmitters of disease rather than people with complex lives and needs. In addition, social discourse and policies concerning people experiencing homelessness (e.g., media coverage, signage) reinforced an “us vs. them” dynamic in neighborhoods where people experiencing homelessness reside.
Sign posted outside of the 7/11 on University Avenue in Hillcrest Analysis: The sign requests that people say “no to panhandlers” as a way to keep the store and local community “safe and clean.” The language in the sign stigmatizes those experiencing homelessness, while also putting onus of responsibility to act on individuals rather addressing these things at a structural level.
Description: Sign posted outside of the 7/11 on University Avenue in Hillcrest Analysis: The sign requests that people say “no to panhandlers” as a way to keep the store and local community “safe and clean.” The language in the sign stigmatizes those experiencing homelessness, while also putting onus of responsibility to act on individuals rather addressing these things at a structural level.
“They are stigmatizing the homeless to be dangerous and dirty.” “This sounds like signs that say ‘don’t feed the birds.’”
    • The data collected via Photovoice and follow-up discussions suggests that the Hep A outbreak was the symptom of largerissues, such as insufficient services and resources, especially the lack of housing and public restroom facilities. In addition, community members indicated that the public health response did little to improve the everyday lives of those experiencing homelessness, which could help prevent outbreaks of Hep A and other infectious diseases in the future.
    • Resources contain and constrain. Services are concentrated in a small geographic section of the city and the schedule for those services is often difficult to navigate. This creates a situation where individuals who are homeless spend their days trying to obtain basic resources, leaving little time to resolve issues that contribute to homelessness in the first place (such as pursing housing or employment security). There is a great need for more resources with fewer restrictions, particularly for transitional-aged youth, who are at risk for entering a cycle of chronic homelessness.
    • Criminalization and over-policing were common. The team observed heavy police presence in areas where people experiencing homelessness concentrate due to resource availability. Public signage also suggested that those loitering in many public places would be cited, leaving people few opportunities to sit and relax without fear of being ticketed or arrested.

The research team also presented recommendations for service providers and for individual and institutional policy changes, such as partnering with transitional-aged youth and other populations experiencing homelessness when studying or designing policies to address homelessness. The team also recommended increasing access to clean and well-maintained public restrooms and handwashing stations.

Now that the research has concluded, the team is looking at its next steps. They have identified some areas they would like to conduct further research, such as the “housing first” models as a way to reduce homelessness. They are also eager to present their findings to the wider community to help everyone understand some of the barriers those who are homeless face and how the city, the county, service providers, and the wider community can help. They welcome invitations to present their research and discuss their findings and can be contacted at action4healthsd@gmail.com or by visiting https://publichealth.sdsu.edu/arches/.