How LA's Homeless Industrial Complex Brought Tuberculosis to Town

MAILANDER’S LA - Let's talk public health for a minute.  Let's talk about this because, by means of their usual indifference to our general welfare, our current political class is now posing a threat to our ability to control diseases we used to control easily. Mayoral candidates are not immune to the charges.  But neither are  County Supervisors, from affable Zev Yaroslavsky to stodgy Mike Antonovich. And certainly outgoing Mayor Antonio Villaraigosa is in the catbird seat when it comes to neglecting to protect the City of Los Angeles from one of the most pernicious of all diseases: tuberculosis.

Our print media has remained largely ostrich-like on the recent Downtown tuberculosis outbreak.

A tuberculosis strain--one unique to Los Angeles--has emerged on downtown's Skid Row.  This alone is deplorable news.  It's not afflicting an enormous amount of people, only a handful.  But it takes an astonishing degree of political negligence, and an equally astonishing degree of class stratification, for a city to produce its own TB strain.  Think Calcutta and its untouchables, think Paris before Pasteur.

The highest concentration of LA's tuberculosis victims, far and away, are among Downtown's homeless population.  Over five of every six cases since 2007 have occurred among those homeless in Skid Row, for whom we have failed to provide housing, despite two decades of affordable housing programs and recent costly developments that are purported to house the greatest at risk.

While the County's top health official, Jonathan Fielding, said that the "the TB outbreak is not a threat to the public at large," the situation Downtown on Skid Row is alarming enough that Fielding has asked for Federal assistance in addressing the matter.

The outbreak and new strain may prove to be a setback to programs like the Los Angeles Area Chamber of Commerce's partnership initiative with the United Way, launched in 2010, called "Home for Good," which aspires to "end chronic and veteran homelessness in LA by 2016" by controversial means.

The most controversial point of the partnership's plan is its Point Two: "create the housing and services to help people thrive."  Creating new housing for the homeless from the ground up is very costly, far more costly than putting the most at risk, many of whom have access to benefits, into Section 8 housing.  Only a fraction of the homeless end up getting housed.

Critics have called the policy of putting any kind of special class of homeless, whether veterans, most at-risk, or most mentally ill, another cruel lottery for the poorest among us.  And they have a point, as for over a decade, many programs in Los Angeles such as the partnership between the United Way and the Chamber of Commerce have emerged, and many in the County's "Homeless Industrial Complex," developers and contractors alike, have made eye-popping profits and salaries through the decade, yet homelessness has declined in the City and the County only marginally.

The directors of the agencies that create homeless housing developments from the ground up typically make between $175,000 and $200,000 a year--far more than the nuns, volunteers, and social workers who have historically serviced the homeless population in the past.  The directors often bill themselves as "CEOs" and form exotic donor networks that are also of considerable use to politicians.  Promising to solve homelessness in a given community, they end up housing a small fraction of LA's homeless population, while charitable resources end up going to high priced administrators, developers and contractors.

The strength of their "lobby" was demonstrated in the recent run-up to the Mayoral primary, when a league of six-figure administrators hosted an "affordable housing debate"--and did not invite the two candidates who were the top critics of the City's and County's homeless policies.

Entrusting a chamber of commerce to partner with a program that may impact public health is not especially a prudent path, as business interests, always fearful of bad publicity, are not anxious to acknowledge threats to public health.

The City of Los Angeles's long-standing policy of "containment"--restricting homeless agencies to the Central City East area of Los Angeles, more commonly known as Skid Row--has proven a fertile ground for the cultivation of the new TB strain.  As the city has eliminated some "last resort" temporary residential occupancy housing in its Skid Row, the numbers of homeless on the streets downtown has diminished only slightly, creating the kinds of conditions in which diseases like tuberculosis may spread.  Tuberculosis is often contracted through sustained exposure to a disease victim; those with weak immune systems are particularly vulnerable.  Both these conditions exist among the homeless population Downtown.

Many of the new developments cost well over $300,000 a unit to construct, approximating the cost of an average home in Los Angeles County.  Critics say that spending top dollars on a few, rather than putting the homeless in existing housing or cheaper housing, is the kind of misappropriating of resources that created the conditions for the tuberculosis outbreak.

At the recent affordable housing debate (to which candidates who were critics weren't invited), Controller Wendy Greuel emphasized a need for accountability of expenditures.  This was a profound reversal from her own recent actions.  On Christmas Day, Greuel volunteered at the kitchen of one of the city's high-expenditure/low-impact homeless development agencies.  Dale Thrush, Greuel's old planning director from her Council days, serves on the agency's board.

(Joseph Mailander is a writer, an LA observer and a contributor to CityWatch. He is also the author of Days Change at Night: LA's Decade of Decline, 2003-2013. Mailander blogs at




Vol 11 Issue 20

Pub: Mar 8, 2013