The HEAT Kills. Here’s What We Can Do to Stop It

Op-Ed by Sabrina Hennecke, MD, MPH and David Peery, JD

The HEAT is killing Miami’s homeless. 

No, we’re not referring to the Miami Heat professional basketball team, which is only metaphorically “killing” its higher seeded playoff opponents.  Nor are we writing about extreme urban heat that is, in fact, physically harming Miami’s unsheltered homeless at an alarming rate.

No, we’re pointing the finger at the Miami Police Department’s “Homeless Empowerment Assistance Team” otherwise known as the police HEAT unit.  This  squadron, armed with deadly force, spearheads an army of city street cleaners that conduct daily homeless encampment  sweeps throughout Miami, thereby routinely evicting the homeless from their sleeping spaces, destroying their valued possessions and scattering them throughout the area without regard for their dignity or humanity as human beings. 

As now demonstrated by groundbreaking research recently published in Journal of the American Medical Association (“the JAMA study”), these homeless encampment sweeps result in increased hospitalizations, escalated drug overdoses and early deaths of people experiencing homelessness.  

We are a physician and public health professional (Dr. Hennecke), and longtime advocate for the homeless (Peery) with a combined 20 years in advocacy, direct service, and lived experience of homelessness. This JAMA study provides further  validation of what we’ve personally observed for years: that homeless encampment sweeps, locally headed by the Miami Police HEAT unit, are quite literally hospitalizing and killing the vulnerable people who are condemned by poverty to live on Miami’s streets. 

Homeless encampment sweeps are often violent affairs. As on-the-ground advocates, we’ve encountered deeply troubling reports in which people were physically dragged from their tents because they didn’t move fast enough.  One woman reports that city workers tossed the ashes of her deceased mother into the trash. Another alleges that their beloved kitten went into the trash along with their tent. Though common, we’re always alarmed to see walkers, wheelchairs and canes carried off in these dump trucks. In a world where so much is already stacked against the disabled and unhoused, the loss of these essential possessions is indefensible.

As if these civil rights violations weren’t perilous enough, encampment sweeps devastate the health of unsheltered people. We (Dr. Hennecke) have personally observed several cases that brought patients to the emergency department in need of immediate medical treatment to reverse the life-threatening harm done. A sixty-seven year old woman who’s blood pressure medicine was thrown away in a street sweep placed her at risk of losing her kidneys or worse. 

An eighty-one year old man who fell and hit his head after his walker was trashed. A forty-six year old man who’s cellulitis was getting better after starting antibiotics, but reportedly lost his medication in a recent sweep and came to a local hospital unable to bear weight on the engorged and infected leg – now at risk of sepsis and loss of his limb.

Miami’s encampment sweeps are conducted under the authority and implied force of the armed police officers assigned to the Miami police HEAT unit. Unsurprisingly, the City is now battling a lawsuit in which four unhoused persons allege that the City violated their Constitutional rights through a pattern and practice of unlawfully confiscating and destroying their valued property.  

With rigorous analysis of data, the  JAMA study fundamentally confirms our observations that encampment sweeps often irreparably damage  unhoused persons’ health. The authors of this study (Peery is a co-author) produced a model to estimate the effects of  involuntary displacements on the unhoused populations of twenty-three U.S. cities, including Miami, across a ten-year period. 

We compared scenarios with no displacement, to scenarios in which street sweeps continued as they have been in numerous U.S. cities including Miami, over the next ten years. This model focused specifically on unsheltered people who inject drugs, which accounts for an estimated 30% of the unhoused population.  

Involuntary displacement compounds the stress of living unsheltered on the streets.  As a result, people increasingly self-medicate with drugs to provide some temporary solace from the ongoing  trauma of unsheltered living, with a concomitant increase in overdoses, hospitalizations and deaths. 

However, the harm caused by involuntary displacements is not restricted to cases related to drug use. Encampment sweeps break the connections that unhoused people have with physicians, outreach workers and other service providers. Unhoused individuals already have higher rates of illness and disability, and a life expectancy 12 years below the national average. 

Overall, we estimate that continued street sweeps will cause a 151% increase in overdose deaths, an 11% reduction in life expectancy, a 50% increase in hospitalizations, a 6% increase in serious injection related infection deaths, and a 38% decrease in medication for opiate use disorder initiations. In Miami, we estimate that nearly 70 people will suffer early deaths due to encampment sweeps across the ten year period studied. 

Ultimately, this seminal study provides valid scientific and medical evidence to inform public policy about the harms of homeless encampment sweeps.

Here are two actions that we can undertake now to stop the ongoing harm of encampment sweeps:

First, we must all urge the Miami City Commission to disband the Miami police HEAT unit. It is fiscally irresponsible to continue funding this police unit, at a cost of $70,000 per month, when the HEAT are in fact directly harming community health.  Unsheltered homelessness has actually increased since the formation of the HEAT unit. Police appropriately enforce the criminal justice laws, but should never be in the forefront of housing, healthcare and homelessness matters. Disband the HEAT now.

Second, educate yourself on the root causes of homelessness. Homelessness results from extreme poverty and the failures of our health care and housing institutions.  And homelessness is deeply rooted in racism; 60% of Miami’s homeless population is Black while the overall Miami-Dade County population is only 18% Black.  Understand that people are homeless not because of choice – rather, they are homeless because they lack choices.

Housing and housing-related policies are inextricably linked to health. Let’s all work to improve our community’s health and stop the HEAT from killing our homeless neighbors.