The NY Times published a story today about the rising number of homeless people who are dying on the streets. In a county as large and populous as Los Angeles, there was an average of five deaths per day last year. Some of this death toll is connected to the surge of fentanyl as a cheap street drug.

Two hundred eighty-seven homeless people took their last breath on the sidewalk, 24 died in alleys and 72 were found on the pavement, according to data from the county coroner. They were a small fraction of the thousands of homeless people across the country who die each year…

An epidemic of deaths on the streets of American cities has accelerated as the homeless population has aged and the cumulative toll of living and sleeping outdoors has shortened lives. The wider availability of fentanyl, a particularly fast-acting and dangerous drug, has been a major cause of the rising death toll, but many homeless people are dying young of treatable chronic illnesses like heart disease…

In Los Angeles County, the homeless population grew by 50 percent from 2015 to 2020. Homeless deaths have grown at a far faster rate, an increase of about 200 percent during the same period to nearly 2,000 deaths in the county last year.

The death toll is particularly high in California where an estimated 4,800 homeless people died on the street last year. Almost every conceivable cause of death is much more likely for people on the street. Most of the death toll is made up of men:

A study by the Los Angeles County Department of Public Health found that homeless people are 35 times as likely as the general population to die of a drug or alcohol overdose. They are also four times as likely to die of heart disease, 16 times as likely to die in a car crash, 14 times as likely to be murdered and eight times as likely to die of suicide…

In Los Angeles County, men make up 67 percent of the homeless population but 83 percent of homeless deaths. In San Francisco, men in their 50s have the highest rates of overdose deaths among all age deciles.

So what’s the solution to this problem? This story doesn’t try to offer any. Its goal is to be descriptive not prescriptive. Still, there are some interesting responses in the comments. From a reader in California, I think this makes a lot of sense.

We need to recognize that there are two distinct homeless problems: 1) ordinary people who are simply down on their luck and unable to make ends meet, and 2) the mentally ill, addicted and other antisocial people who can’t function. We need different approaches for these different groups.

And a similar response from someone in Florida:

Unless we decide that mentally ill people and drug addicts don’t have right to live on the streets this situation will never improve. If they are allowed this lifestyle the human cost should surprise no one.

This response from a reader in Minneapolis is obviously heartfelt but again the writer doesn’t have any clear solutions.

On the morning of August 5, 2015, my brother Bo, my only sibling, was found dead on a sidewalk outside a homeless shelter in Kansas City. Two weeks later, the medical examiner’s office finally tracked me down to let me know about his death. It was a call I had always known would come. For more than thirty years Bo roamed the country, living on the streets, in a tent when he could get one, sleeping in a sleeping bag when he could get one, riding a bike when he could get one, in and out of jails, in and out of hospitals. He panhandled and got a very small Social Security disability check each month. He was alcoholic, like our father. He was by nature a sweet, gentle, generous man who could be irascible and violent when he was drunk and/or desperate, and who spent most of his life achingly alone.

The world’s response to Bo was mostly to tell him where he could not be. He was driven from parks, businesses, towns, his few belongings destroyed or confiscated repeatedly by police officers responsible for making sure he didn’t stick around. He was one of those people we choose not to see as we pass them on the road or on the sidewalk. His problems were too numerous and all-pervasive for anyone to solve alone. I tried for so many years to help him, but without other resources and supports, ones that don’t disappear in a crisis, it’s impossible to know how to make a difference. I will never, ever stop mourning the pain of Bo’s life. I pray he is now at peace.

One more and I think this is the difficult truth that homeless advocates don’t want to admit.

As a photographer I’ve met many homeless men. A lot of the men I met have chosen a life of “freewheeling” and alcoholism. Studies have show 70% of homeless folks are alcoholics or drug users. Their homelessness is a choice. True that 20% of homeless are down on their luck and at least 10% are mentally ill. The question is how do we as a society begin to help those that want and need help and identify and then decide via policy what to do with the massive numbers of alcoholics and drug users.

Left on their own, serious drug addicts and alcoholics are going to continue to live as if drugs and alcohol are all that matters in the world and will wind up greatly shortening their own lives as a result. For a lot of these people, we need to make some of the decisions for them if we want to prevent them from dying on the streets.