Out of focus portrait of some of  Ms. Turrentine’s  daily medications. 2019. Photo by Karla Jimenez-Magdaleno.

Out of focus portrait of some of Ms. Turrentine’s daily medications. 2019. Photo by Karla Jimenez-Magdaleno.

 
 

A brief Literature Review

Eviction and Health

The literature connecting evictions to specific health outcomes is limited. And in order to comprehensively understand the connection, we need to understand some of the conditions that lead to evictions: low wages and being rent cost-burdened. This section outlines health outcomes associated with housing instability and evictions; it excludes any studies conducted outside of the United States.

Cost-Burdened Households and Threats to Eviction

Cost-burdened households spend more than 30% of their income on rent, and severely cost-burdened households spend more than 50%. Across the United states, the number of severely cost-burdened households increased from 9.3 million to a record 11.4 million households from 2008 to 2014. Because of high rent cost-burdens, tenants tend to fall behind on rent, and when households cannot pay rent on time, they are more likely to be evicted. Households that are extremely low-income (i.e., earning 30% or less of the area’s median income) and severely cost-burdened are especially prone to falling behind on rent payments, experiencing threats of eviction, and receiving eviction notices.

If evicted, tenants face a high risk of homelessness. In a survey of twenty-five cities across the United States, 32% of city Mayors cited eviction as one of the main causes of homelessness among families with children. The National Law Center on Homelessness and Poverty outlined a series of regional reports showcasing the influence that evictions had on homelessness. For example, in New York City, 33% of families cited evictions as the primary reason for their homelessness. A survey of 1,218 renters in Seattle also found that 37.5% of respondents were completely unsheltered due to an eviction, while 25% were in shelters or transitional housing, and 25% stayed with friends or family.

In attempt to understand the public health and economic impact of eviction, Collinson and Reed (2018) investigated the effects of court-ordered evictions on low-income adults in New York City. They parsed 200,000 New York City housing court cases from 2006 to 2016 and merged the cases with administrative data as proxies for socioeconomic and health outcomes (i.e., public benefits, applications and utilization of homeless shelters, employment and earning data, and hospitalization). The researchers then applied a quasi-experimental design to assess causality between evictions and these outcomes by randomly assigning closed eviction cases to the administrative data. The authors found that “evictions substantially increase residential mobility, homelessness, and mental health hospitalizations, lower earnings modestly, but have little effect on employment, earnings, or public assistance receipt.” The authors conclude that the lower than expected results are likely because those experiencing evictions are mostly living in poverty and labor market outcomes would not be significantly different post-evictions.

However, Collinson and Reed’s findings contradict a public health understanding of the consequences of evictions. For example, in an assessment of the effects of voucher programs on low-income renters’ reported health status, Pfeiffer (2017) used the Survey of Income and Program Participation and conducted an econometric analysis to find that renters who received vouchers spent less on health care costs over a year period. That is likely because tenants on vouchers tend to be cost-burdened and cut health care from their essential spending; and if they live in states with expanded Medicare, they also might rely on their Medicare coverage.

The table above summarizes reported health outcomes associated to various types of housing instability, including evictions.

 
Health Implications
 
 

Outcomes Related to General Housing Instability

In order to manage the cost of living, cost-burdened and severely cost-burdened households often reduce their spending on other basic necessities like food and medical care. Households that are severely cost-burdened spend 74% less on healthcare than households who spend the recommended amount on housing. Children in households that are behind on rent are more likely to have diabetes, developmental delays, or be malnourished than children in households without rental cost-burdens. Within households that moved multiple times within three years, children were likely to have poor oral care and moderate or severe chronic conditions.

Poor mental health outcomes are also associated with individuals experiencing housing instability. Across all types of housing instability, mental health conditions including depression, anxiety, and stress were prevalent in both children and adults.

Beyond the proximal health outcomes of experiencing housing instability, there are also distal health outcomes related to the consequences of experiencing homelessness—which is linked to evictions. When individuals or families experience homelessness, they are at greater risk of premature death, with women having a mortality rate 10 times higher than non-homeless women and men having a mortality rate 9 times higher than non-homeless men. Individuals experiencing homelessness die on average thirty years earlier than those who are not homeless, having an average life expectancy ranging from 48 to 64 years. Those experiencing homelessness also have increased risks of chronic stress, cardiovascular disease, respiratory infections (e.g., tuberculosis), asthma, trauma, and physical injuries.

Outcomes Directly Linked to Eviction or the Eviction Process

Vasquez-Vera and colleagues conducted a global systematic review on the threat of eviction and implications on health. Threats to eviction included rent and mortgage arrears, foreclosures, repossessions, and receiving an eviction notice. Six of the 47 studies identified direct links between eviction and poor mental health outcomes (in the form of depression, anxiety, stress, suicides) and poor self-reported physical health. Several of the qualitative studies revealed mediating factors in the eviction-health pathway, where experiencing an eviction could cause feelings of insecurity, lack of control over daily life, embarrassment, and self-stigmatization that create experiences of depression, anxiety, and suicidal ideation. A couple of the studies also concluded that the threat of eviction affected health through adoptions of unhealthy behaviors, such as unhealthy eating and smoking.

More specifically, the Fragile Families and Child Wellbeing survey of 2,676 renters around the nation) found that mothers who experienced a recent eviction at the time of the survey significantly reported higher counts of poor health than mothers who were not evicted. Mothers who were evicted also reported significantly poorer health for their children, and were more likely to experience depression and parental stress. Similar outcomes were observed in a survey of 1,218 tenants who were evicted in King County, Washington, where 36.7% of respondents reported stress because of eviction. They also found that 8.3% of respondents experienced increased or newly onset depression, anxiety, or insomnia because of their eviction; and five percent developed a heart condition.

Other mental health outcomes have also been observed in tenants who have been evicted. Collinson and Reed’s study identified correlations between evictions and mental health outcomes, like hospitalization and measured increases in hospitalization in an emergency room among tenants who were evicted within 1-2 years of their eviction (an increase of over 70% above the mean). Similarly, they noted that such population also had higher chances of being hospitalized for mental health conditions. In addition, timing mattered. Patterns of hospitalization were statistically significant for tenants post-filing, often within a few months of the court judgment.

A study assessing the effects of the U.S. recession identified links between eviction and foreclosure and suicide. Between 2005 and 2010, there was a significant increase in eviction-related suicides across the United States that mirrored the 389% increase in foreclosure and evictions. The majority of the suicide attempts were by white adults (87%) and men (79%), with the largest share of the suicides occurring within two weeks of receiving the eviction or foreclosure notice. It is important to note that this study did not control for the contributions that other financial stressors had in relation to suicides, or the effects that media reporting of suicide and foreclosure had on tenants and property owners.

Reah Siegel, Michele Plaugic, Madeleine Eldrige, and Adele Henderson contributed to the original writings for this page.