Alameda County Health Committee Meeting: Housing First, Maternal Health, and Wastewater Surveillance – April 27, 2026
Alameda County Health Committee Meeting: Housing First, Maternal Health, and Wastewater Surveillance – April 27, 2026
The Alameda County Health Committee, chaired by Supervisor Miley and including Supervisor Lena Tan, met on April 27, 2026, to receive three informational presentations: a Housing First overview, an update on maternal, paternal, child, and adolescent health, and a report on the county's wastewater surveillance pilot. The committee also heard public comments on these items and on behavioral health budget cuts.
Housing First Overview
- Jonathan Russell, Director of Alameda County Health Housing and Homelessness Services, presented an evidence-based overview of Housing First, emphasizing that it is not "housing only" but includes voluntary services. He noted that Housing First was adopted as federal policy under George W. Bush and has led to a 50% reduction in veteran homelessness nationally through the HUD-VASH program.
- Key local data: 73–88% of housing participants remain housed at follow-up; a Santa Clara County study found 93% housed after three years for highest-needs individuals. In Alameda County, over 4,700 people were housed in the last fiscal year, the return-to-homelessness rate dropped from 18% in 2020 to 13% in 2025, and the flex pool subsidy program has a 93% housing retention rate after two years.
- Russell explained the difference between the "staircase model" and Housing First, and outlined state requirements under SB 1380, AB 1220, and SB 184 (2021). He described county practices including coordinated entry, tenancy sustaining services (supporting 2,100+ people/year), the housing flexible subsidy pool (adding 150–250 subsidies annually), and updated shelter standards.
- Supervisor Miley questioned why homelessness remains a crisis despite decades of Housing First, citing $1.4 billion in Home Together funds. Russell argued the issue is scale and underinvestment, akin to renewable energy not solving climate change alone. Miley advocated for a "treatment first" approach, especially for those with mental health and substance use disorders. Russell clarified that Housing First is compatible with treatment and that housing improves treatment outcomes.
- Supervisor Tan asked about the division of roles between cities and the county, using Mandela Homes as an example. Russell noted that cities often fund shelters and siting, while the county provides navigation and permanent housing subsidies through coordinated entry. Tan also raised the possibility of cities handling capital projects and the county focusing on navigation services.
- Russell warned against over-investing in shelter at the expense of permanent housing, citing San Jose's budget challenges after diverting funds to shelters. He emphasized a balanced approach across prevention, shelter, and permanent housing.
- Public comments: Alison Monroe spoke about the need for higher service levels for severely mentally ill individuals, citing boarding cares as a missing link. Tessa McCarrow (Supportive Housing Community Land Alliance) advocated for licensed boarding cares as part of the housing continuum, noting a 20-bed facility in West Oakland ready to house 20 individuals.
Maternal, Paternal, Child, and Adolescent Health Presentation
- Anna Groover, Julia Rafman, and Dana Cruz Santana presented data and programs. Key statistics:
- Birth rate in Alameda County declined 26% since 2010 (from 19.3 to 16.0 per 1,000).
- More than 40% of births to Hispanic/Latina and African American/Black women are covered by Medi-Cal.
- Teen birth rate is 30 times higher for Hispanic/Latina teens than for Asian teens.
- African American/Black infant mortality is 3.1 times higher than Asian; fetal death rate is 3+ times higher for Black, Pacific Islander, and American Indian/Alaska Native populations.
- 7% of births are low birth weight; 8% are preterm. African American/Black women are 2.3 times more likely to have low birth weight infants.
- 78% of infants initiate breastfeeding in hospitals; rates lower for Pacific Islander and African American/Black populations.
- Congenital syphilis is rising, linked to homelessness and barriers to prenatal care.
- The "Starting Out Strong" program served over 3,000 families in 2024; 48% Latina, 41% African American/Black. 90% client satisfaction.
- The "Beloved Birth Black Centering" program has eliminated racial disparities in preterm birth outcomes.
- Abundant Birth Project provided guaranteed income ($981/month for one year) to 235 pregnant women—program concluding in about nine months.
- 22% of families in the program experience housing insecurity; 30 families identified as actively homeless. The county is collaborating with Housing and Homelessness Services on prevention.
- Supervisor Miley noted the importance of housing as a social determinant and asked about using Measure W essential services funds to fill gaps. Groover and Watkins-Tart emphasized community-based outreach and grassroots organizations to reach fearful immigrant families. Miley also questioned the sustainability of the guaranteed income pilot and the defunding of Fetal Infant Mortality Review (FIMR); the county funds it with public health dollars (approx. $150,000/year for one staff position).
- Supervisor Tan asked about disaggregating birth rate data and the impact of HR1 on Medi-Cal enrollment. The committee discussed the need to protect continuity of care and engage trusted messengers.
Wastewater Surveillance Monitoring Pilot Program
- Dr. Eileen Dunn presented on the wastewater monitoring pilot, funded by $750,000 from ARPA for a two-year contract starting January 2025. The contract is with Virally and covers six community sewer sheds (Castro Valley, San Leandro, Hayward, Livermore, and EB MUD sub-sewer sheds in East and West Oakland) and Santa Rita Jail. Sampling occurs twice weekly, testing for SARS-CoV-2, MPOX, influenza A/B, RSV, measles, influenza H5, and Candida auris.
- Examples of public health actions: wastewater data helped confirm no measles cases in Alameda County during a Contra Costa outbreak, and no MPOX detection helped rule out a larger outbreak. In San Mateo, wastewater detection led to identification of a measles case.
- Dunn noted that the state funds EB MUD's separate wastewater monitoring through 2027. The county is considering continuation after the pilot ends.
- Supervisor Miley asked about bringing testing in-house; Watkins-Tart stated it is more cost-effective to subcontract but they will explore costs. Miley also suggested having sanitary districts contribute funding to sustain the program, and inquired about testing for PFAS. Dunn will follow up with Dr. Moss on PFAS detection capabilities.
Public Comments on Non-Agendized Items
- Alison Monroe spoke about behavioral health budget cuts, identifying three programs being cut: Family Education and Resource Center (FERC), a patient advocate at John George (Bev Bergman), and the Supportive Community Housing Land Alliance. She urged the committee to ask Behavioral Health why these programs were cut and how much is still going to prevention programs. She noted the budget process was confusing and that the cuts amount to $53 million.
Key Outcomes
- No formal votes were taken; all items were informational.
- Supervisor Miley directed that an update be provided on the Radisson hotel (Oakland) for potential use as shelter/housing.
- The committee discussed the possibility of hosting a symposium on homelessness strategies involving other Bay Area cities.
- Supervisor Miley requested a follow-up report on the Abundant Birth Project guaranteed income pilot and on the PFAS detection capability in wastewater.
- The committee will continue to monitor behavioral health budget impacts and the sustainability of wastewater surveillance.
Meeting Transcript
All right, good morning. Let's call the order of the health committee for April 27th. Supervisor present. Supervisor Miley. Present. We have a quorum. Okay, thank you. Are there any instructions we need to provide this morning? For in-person participation, the meeting site is open to the public. If you'd like to speak on an item, fill out a speaker's card in the front of the room and hand it to the clerk for remote participation, follow the teleconferencing guidelines. Post it at www.ac.org. And use the raise your hand function to speak. All right. First items and informational item. Housing first overview. Good morning, uh, supervisors. Jonathan Russell, director for Alameda County Health Housing and Homelessness Services. Here with a brief overview presentation, I believe a month or so ago. Supervisor Miley, you'd requested an overview of Housing First, so that's what we have here. Go to next slide. Brief agenda, of course, first starting what is Housing First and what isn't it? What is the evidence for it? What are state related requirements for Housing First? And then how do we here locally implement it? Next slide. So first, what is Housing First? Oh, I should also mention this slide is a combination of some slides also taken from local uh researchers. So from UCSF, you will see you can see icons in the bottom right, whether it's an AC health slide or from UCSF or from the state. So I will note that. But this is some summaries from Dr. Margot Cushell, who runs the Benioff Homelessness and Housing Initiative at UCSF, which is a preeminent researcher on homelessness that does a lot of academic studies. Um, and also in the last several years completed the largest uh study of homelessness uh ever completed of about uh 30,000 individuals, I believe were uh survey um through a process across eight counties in California. So they're a highly respected researcher. So this is a slide taken directly from a presentation in a briefing um that we both participated in several years ago with our state legislature. So what is housing first? Housing first is first and foremost an evidence-based, that is to say a research backed approach to housing people experiencing homelessness. It is fundamentally an individualized approach, which means it is focused on providing a range of models to meet individuals' unique needs, and it is very much not housing only, which is to say there's much more involved in housing first than the housing part of it. It was initially developed and continues to work uh as a model to meet the needs of people that are experiencing chronic homelessness, by which we mean long and enduring homelessness with disabling conditions as a factor and serving those with severe mental illness and substance use disorders. It's also a long-standing practice in that it was first adopted as federal policy under the George W. Bush administration based on research and studies done at the time in Los Angeles that have grown since. So, why is it important as an evidence-based approach? First, it really prioritizes where possible getting people into housing as quickly as we can without mandating certain engagements with services in order to access that housing. Also, it's important to note that housing first models include services. So services are embedded throughout the housing first approach. The distinction is they're not mandated or required in a way that compels people. It also offers a really important setting. Housing, I like to say it's an environment first approach in order to offer stability that people need in order to meaningfully engage services and wellness. It's also supported by a robust evidence base that shows its ability to provide stable housing for people, even with significant behavioral health conditions. And uh it's been very robustly used by the Veteran uh Veterans Affairs Association alongside the Department of Housing and Urban Development that year over year has led to up until this point a 50% reduction in homelessness for veterans across the country. So significant impact by the VA taking a strong housing first approach, and I'll come back to that later.
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