The Epidemiologist Running for Mayor to Bring Public Health to Sacramento Politics

Flojaune Cofer, the epidemiologist and leading candidate in Sacramento’s mayoral race, will always remember watching her father die from congestive heart failure in 1993. She was 11,  the same age he’d been when he started smoking cigarettes back in the late 1950s, when little was known about the health impacts of tobacco. By the time the Surgeon General issued the first report on the negative effects of smoking, it was too late for Cofer’s dad; he was already hooked. The traumatic experience of seeing her father lose his life from something so preventable stayed lodged inside Cofer, pushing her to get a PhD in epidemiology, pursue a career in public health policy, and eventually get involved in her adopted city’s budgeting process. “I recognize that the policies that we make every day are matters of life and death,” she told Bolts. 

Now, these experiences have led Cofer, currently a senior policy director at the organization Public Health Advocates, to seek the top job of California’s capital city. Cofer came in first in the nonpartisan mayoral primary in March, an upset victory for a young, Black, female first-time candidate running against several established politicians. In the general election in November, she is facing off against Kevin McCarty, a former Sacramento city council member who more recently served several terms in the state legislature. 

If she wins, Cofer has vowed to take a public health approach to setting policy in Sacramento. “Public health is about maximizing the two things that matter most to humans: the number of years in your life, and the quality of life in your years,” she told Bolts. “And I see that as the major charge of every public-facing institution.” 

For Cofer, this means seeing the city as an ecosystem, understanding homelessness, gun violence and other social problems as akin to infectious disease, and zeroing in on preventing their spread rather than simply treating its effects. “It’s one thing to fight a symptom, it’s another thing to eradicate a disease,” said Asantewaa Boykin, a nurse and activist against police violence who has worked with Cofer on community issues. 

While McCarty has espoused a fairly standard Democratic vision for homeless policy, speaking of the importance of services while also working on laws to restrict where unhoused people can camp, Cofer has called for stopping sweeps of homeless encampments and expanding and improving “safe ground” camping sites. She has also advocated for more funding for violence intervention networks, overhauling the city’s well-meaning but flawed alternative crisis response system, and using the budget to advance a set of clearly articulated values around health and welfare. 

As the primary results showed, hers is an enticing pitch to many in the city who are frustrated that the conventional solutions—a jumbled mixture of services, imperfect temporary shelter options, and homeless sweeps—aren’t working. But Cofer faces various barriers to realizing her vision: a $60-odd-million budget deficit, a district attorney and a state government bent on enforcing the criminalization of homelessness, and housed and homeless residents alike who are deeply mistrustful that anything will meaningfully change. 

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In response to an affordable housing shortage and a growing number of people sleeping outdoors, Sacramento has, like many of its counterparts, tried everything from services and temporary housing to criminalization. In 2021, now-outgoing mayor Darrell Steinberg unveiled a costly plan to increase shelter options, but the following year, the city and county each passed ordinances restricting camping on sidewalks or near businesses, infrastructure, and the city’s American River Parkway. 

Then, in the fall of 2022, voters approved Measure O, which outlawed camping on public property. Cofer opposed Measure O, while Cofer’s mayoral opponent McCarty worked on a bill to outlaw camping on the parkway that he suggested could work in tandem with these other restrictive measures. McCarty did not respond to a request for comment for this piece.

Homeless advocates like Anthony Prince, a lawyer for the Sacramento Homeless Union, whose 2,800 members represent nearly half of the city’s unhoused population, argue that the city has wasted much of the money it has spent under Steinberg’s plan. “It was about pop up tents, mass congregant shelters, a few tiny homes scattered here and there, some so-called safe parking sites and safe camping sites,” he said. “This is not housing.”

Charley Willison, an assistant professor at Cornell’s Department of Public & Ecosystem Health, called shelter “a really important first step—if it is used as a transitional housing mechanism. We can’t have shelter being used as the final step.” But she also noted that too many cities create behavioral requirements, like curfews or complete abstention from substances, for shelters that disqualify whole swaths of people. 

Niki Jones, the Executive Director of the Sacramento Regional Coalition to End Homelessness, believes that the city’s vast expenditures have accomplished little and left housed residents pessimistic, inclined to blame their unhoused neighbors, and thus more likely to support punitive measures against them. “There’s this idea that all this money has gone into homelessness—why isn’t it solved?” she said. “There’s a woman who lives outside who says it really well—she says, ‘They treat us like we blew $80 million.’” 

Meanwhile, homeless advocates in Sacramento say that the municipal government’s repeated  sweeps of unhoused people continue to be destabilizing and traumatizing. It’s a practice that Willison says has been proven ineffective over the long term. “The evidence base shows us that these punitive policies, whether that’s arrests, encampment closures, without links to housing, all make homelessness worse,” she told Bolts. 

Part of the underlying issue, Cofer argues, is that the city has never set explicit priorities for what it wants to accomplish each year, instead opting to create a “status quo budget” based on the previous year’s expenditures. “Unfortunately, when you do that, you keep getting what you’ve always got,” she said. 

To address the root issue of affordable housing and stop people from falling into homelessness in the first place, Cofer supports Sacramento Forward, a policy package put forth by several current city council members that aims to enact “Just Cause” renter protections, mandate a certain percentage of new housing be reserved for low- and very-low-income residents, and prevent corporate purchases of existing housing by giving priority to tenant buyers. If elected, Cofer says she’ll use her power as mayor to expand support for the package and place individual policy items on the agenda for direct approval or an eventual ballot initiative. 

But then, of course, there is the issue of the nearly 9,300 people currently homeless in Sacramento County. Prince has recently served as the lawyer for Camp Resolution, a “safe ground” site that allows people to camp without police interference at minimal expense to the city. Prince stresses that this is not a permanent solution for his clients—“they don’t want to stay there forever,” he told Bolts—but it is safer and more stable than sleeping alone on the street. 

The city initially signed and then renegotiated a lease with the organization Safe Ground Sacramento that promises it will not clear the camp until all of its residents get into permanent housing, but Prince says that officials have also intensified sweeps around the camp and sought various ways to compel residents to leave. Last week, Safe Ground announced that it cannot fulfill the terms of its lease, including providing water and electricity, which Prince worries will give the city another reason to void the agreement.

Cofer has praised the “safe ground” concept as a low-cost interim solution and said she’d extend Camp Resolution’s lease, open more sites around the city, and ensure that any sites have running water, electricity, shower services, and other amenities that allow the people there to live with dignity. She sees the sites as a form of stabilization that might allow people a moment to breathe and get connected to resources that can pave the way for more long-term stability. “60 percent of our unhoused folks have disabilities,” she said. “Are they all receiving disability? Are they all receiving food stamps? Are they all receiving the services that they’re eligible for?”

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Cofer also criticizes the city government’s reluctance to robustly fund a suite of programs that could prevent violence, homelessness, and unnecessary police encounters. In 2018, Cofer and others advocated for the passage of Measure U, which would have doubled an existing half-cent sales tax. The revenue from the first half-cent, around $50 million per year at that time, went largely to the police department, but the city said the additional half-cent would go toward things like inclusive economic development targeted at historically redlined neighborhoods, and an affordable housing fund. “That was the campaign promise and that was the way that this measure was marketed to voters,” Cofer said. 

But after the measure passed, most of the revenue from the tax ended up going back to the police department—not illegal, Cofer stressed, but “a breach of trust.” She advocated for the creation of a committee that would advise the council on how to better invest the funds from Measure U, and ended up chairing it from 2019 until the end of 2022. During her time there, the committee piloted a participatory budgeting process that invested money in community-led projects in two Sacramento neighborhoods, which Cofer hopes to continue and focus on youth-related projects if she’s elected. 

Cofer is clear-eyed about the way that Sacramento’s policing budget strains the city’s coffers and takes resources away from other departments. She notes that it’s gone up around $100 million in just four years to reach over $250 million today, and proposes a realignment of the Measure U dollars towards their intended purpose and a return to the 2018-2019 police budget of around $150 million. McCarty is clear that he will not cut police funding if elected. 

But Cofer is also leery about being portrayed as anti-police. She stresses that she empathizes with law enforcement officers and compares their plight to that of teachers: public sector employees burdened with the effects of social issues far outside their remit. 

One attempt to disrupt this paradigm came in the form of the Department of Community Response (DCR), which Mayor Steinberg debuted during the 2020 protests. The idea was to form a team of social workers and mental health specialists to respond to 911 calls related to mental health and homelessness instead of police. But Boykin, whose organization Mental Health First was already doing similar work, told Bolts the department engaged with her only superficially, and conversations soon ended. Jones, who has volunteered with Mental Health First, said that DCR has since betrayed its initial mandate as a police alternative and become imbricated in the broader apparatus of sweeps, displacement, and criminalization. 

“What really came into being was actually just a team that responded to unhoused folks, usually sent there before police,” she said. “They don’t respond instead of police. They respond as a precursor.” 

Cofer wants CDR properly staffed and resourced—she said it needs at least $7 million in additional yearly funds—so that it can fulfill its initial mission of taking over various 911 call types from the police department. This would, in turn, free officers up to respond to calls that involve violent crime, and leave the department less reliant on overtime. “If we’re talking about baking this into 911 response, that means that we have to have staff available 24 hours a day,” she said. “You kind of have to commit.” She also says she’d more closely collaborate with community partners like Boykin’s Mental Health First that have experience doing this work already.

In interviews, both Prince and Willison emphasized that any lasting solutions to the city’s homelessness crisis must come from listening to the people most impacted by it, rather than simply following housed residents’ complaints. 

Generally, Willison said, “the needs, rights and preferences, including the health and well being of people experiencing homelessness, get completely circumvented” in policy discussions around homelessness. A public health approach must prioritize “being responsive to the needs of people experiencing homelessness themselves.” 

Of course, Cofer would also have to contend with the many constituents who want some measure of criminalization, if only because they’re exasperated by the city’s lack of progress on reducing homelessness. Cofer says that it’s understandable that Sacramentans have looked to fixes like the 2022 ballot measure that ramped up enforcement, which she framed as well-meaning but misguided. But convincing residents to be patient as the city attempts to implement longer-term solutions will be a challenge. And it could be a lonely fight, too. 

Sacramento’s District Attorney, Thien Ho, has sued the city twice for failing to enforce its anti-homeless ordinances, and has also threatened a lawsuit over Camp Resolution. And the recent Grants Pass decision by the U.S. Supreme Court has made it harder for officials to argue that their hands are tied when it comes to criminalization. Shortly after Grants Pass, California Governor Gavin Newsom ordered state agencies to begin clearing encampments on state-owned land, and strongly suggested that local leaders follow suit. This could further alarm individual council members reluctant to assert the political will to oppose sweeps or build new safe ground sites in their district, leaving it harder for Cofer or any future mayor to get the votes they need to make significant changes on this front. 

Cofer said that she’ll try to work around these challenges by encouraging collaboration and setting an ambitious affirmative vision for Sacramento. “I want us to set the benchmarks. How many people are we going to house this year?” she told Bolts. “And I want the media and advocates and everyone to be able to call in, or go to the city’s website and see how are we doing towards that goal, and I want us to be unafraid of setting an ambitious goal and potentially failing.”