MONDAY, May 19, 2003 (HealthDayNews) -- A series of notices popping up around San Francisco would lead you to believe that giving to panhandlers will have a deleterious effect on American health.
One of the ads features a tourist couple cheerfully reporting, "Today we rode a cable car, visited Alcatraz and supported a drug habit."
In another ad, a man says, "Today I did t'ai chi, donated some change and helped spread STDs."
Although the ads make it sound like panhandlers are the sick ones, the campaign was actually launched because San Francisco itself is ailing.
Tourism, including meetings and conventions, began to decline steeply even before the terrorist attacks of Sept. 11, 2001. Add to that the dot-com crash and the overall shape of the national economy and the city had a potential disaster in the making.
The ads debuted on May 1.
"We are down with visitors," admits John Hutar, president of the Hotel Council of San Francisco, which sponsored the campaign. "It was a combination of things that happened, the dot-coms, the overall economy, 9/11. We have been the last of the major American cities to rebound."
Because of the downturn, hotels have become, by default, the top economic generator for San Francisco. "As we go out and call on large clients, large associations that bring 10, 15, 20,000 people to the city, we've been getting asked and quizzed, 'Why don't you do something about it?'" Hutar says, referring to the number of panhandlers asking for change on San Francisco's streets.
"Someone needed to take a leadership position," he adds. "A lot of people were scared to step out because you are perceived as mean-spirited and we've taken some lumps, so be it. We're passionate that the solution is out there."
Although the council is careful to say not all homeless people are panhandlers and not all panhandlers are homeless, most of the research cited on their Web site concerns homeless people.
And the ads, appearing on taxis and buses, have generated quite a stir among homeless advocates, health-care practitioners and among homeless people themselves.
At the center of the campaign is an assertion that most money given to panhandlers is used on drugs and alcohol. "If you give money to an agency, you will probably better serve the whole process," Hutar says. "If you give money to individuals directly, it is probably going to drugs and alcohol."
Dr. Stephen W. Hwang, a researcher and physician at the University of Toronto, begs to differ -- at least from the alcohol-and-drugs part of the statement. When Hwang went out and surveyed panhandlers in Toronto, he found they earned an average of $638 Canadian per month and the bulk was spent on food and housing, followed by tobacco, then alcohol and/or illicit drugs. Granted, the results, which were published in the Sept. 3, 2002, issue of the Journal of the Canadian Medical Association, were based on the testimonies of the panhandlers themselves, but it didn't seem like anyone was getting rich off the activity.
"I think that it's a reasonable question to raise and a reasonable concern," Hwang says. "What my study showed is that the self-reported amount spent on drugs and alcohol, while not insignificant, was significantly less than what had been reported in the popular literature."
"Everybody has spending needs. If you smoke cigarettes, you need money to buy cigarettes," adds James, a homeless man in San Francisco who says he has never panhandled. "Some are out there doing it strictly for necessity and it's unfair to say that a person is panhandling for drug use, you understand. A lot of them are doing it because Social Security maybe don't give them enough money."
Drug abuse does seem to be an issue among many homeless people, but it's complicated by mental illness and other factors. "In standard surveys conducted by the U.S. Census bureau, about 40 to 50 percent of homeless persons indicate a problem with substance abuse during the month before the survey," says Dr. Stefan G. Kertesz, an assistant professor of preventive and general internal medicine at the University of Alabama at Birmingham. "Half of these people also had a mental illness."
There's also the issue of who's using drugs and alcohol now. "The campaign's Web site has chosen to cite data concerning the percentage of homeless persons who have experienced substance abuse problems at some point in their lifetime. This is misleading, because for many homeless persons the substance abuse problem is no longer current," says Kertesz, who has a five-year award from the National Institute on Drug Abuse (NIDA) to study addictions in homeless people.
Sexually transmitted diseases appear to have an even weaker link to the homeless community. "The National Health Care for the Homeless Program reported sexually transmitted diseases among 1.6 percent of adults who sought care with that program," Kertesz says. "This is clinically important but has nothing to do with panhandling."
True or not, many homeless advocates are concerned the messages will damage an already vulnerable group of people.
"The message that they're giving really stigmatizes a group of people who are in an unfortunate circumstance" says Dr. Eric Meininger, medical director of the Health and Wellness Clinic at YouthLink, which provides services to at-risk and homeless youth, and director of outreach for the community university health-care center at the University of Minnesota in Minneapolis. "My worry with this kind of campaign is that it's going to create such a negative view of the homeless and those out there trying to collect change that it's going to dampen people's compassion to support programs such as shelter."
The hotel council's Web site does include a list of organizations that serve the homeless and would welcome donations, and Hutar stresses other approaches to the problem.
"San Francisco is a very compassionate city. We're trying to point out that some of that compassion in the long run is doing a disservice," Hutar says. "We're trying to get people engaged in the dialogue. Often people want to do something and don't know how. It seems wrong that our city would spend, per person, three times more than any other city yielding this kind of result."
"Whether or not to give a dollar is always a tough question for me," Kertesz adds. "One of the most valuable things I can do is spend a minute talking with a homeless person, and try to understand things a little more deeply than what the billboards say. I always feel like I gain at least as much as the homeless person who talks to me."
And talking to people who are homeless yields a far different perspective than that of the hotel council.
"I think [the campaign] is wrong because everybody out there is not a drug user or a sexaholic," James says. "The 'haves' tend to think they're the closest thing to God and they're so much better than the rest of us. It's almost like trying to wipe out the poor people."