A housing, financial, and impending health crises are all caused by eviction.
Families all throughout the nation are experiencing financial hardship. Rents are going up, and everything is getting more expensive due to inflation. The CDC’s pandemic-related eviction moratorium was overturned in August 2021, and statewide eviction restrictions are no longer in effect. As a result, eviction rates over a large portion of the nation are at levels not seen since before the coronavirus pandemic.
Housing stability is essential for healthy health. According to research, being evicted is linked to a host of negative health consequences, a loss of access to medical treatment, and a cycle of ill health. However, physicians and the healthcare system can take action to lessen the impact by offering assistance to patients who are facing eviction and housing insecurity.
According to Kathryn Leifheit, PhD, a social epidemiologist and assistant professor of paediatrics at the UCLA David Geffen School of Medicine, housing is the foundation upon which everything else in terms of our health is built. However, we are also aware of the extremely high rates of housing insecurity in the United States and high-income nations generally.
A problem with health equity is eviction.
Black single women with children are the group most likely to face eviction or housing insecurity, according to Leifheit. There are already significant racial and ethnic health disparities among this population. According to her, increasing eviction rates only pose a threat to the gap’s widening.
“Upstream and Basic”
One of the five social determinants of health—economical and societal factors that have an impact on people’s and populations’ health—is housing. Leifheit claims that, out of all of these, “housing has this peculiar standing in our thinking as the most upstream and most essential.”
Scientists have just begun to estimate the direct effects of eviction on people’s health.
Because it is so difficult to do these research, says Karen Sheehan, MD, MPH, a paediatrician and professor at Northwestern University Feinberg School of Medicine in Chicago, “I don’t think the exact process is mapped out yet because it is so intricate.” However, there are numerous correlations in virtually every arena between eviction, foreclosure, and poor health.
Stress is one of the key causes of these negative consequences on health. According to Sheehan, having unstable housing increases stress, which has effects on a variety of bodily functions.
Numerous health repercussions of evictions have been identified by research. According to one study, patients who are kicked out of their homes are more likely to end up in the hospital in the two years that follow, says Gabriel Schwartz, PhD, a social epidemiologist and postdoctoral student with the Social Policies for Health Equity Research Program at the University of California, San Francisco. According to a Swedish study, persons who were evicted had a higher likelihood of dying in the near future from any cause than those who kept their homes.
Similar unsettling trends have been discovered by Schwartz in his own investigation. Pregnant women who faced housing instability throughout their pregnancies had children who had higher rates of low birth weight and/or preterm births, as well as longer hospital stays and stays in the neonatal critical care unit or a stepdown unit.
In elementary school, a crucial time when they are getting ready for later education, children who have been evicted as children seem to have weaker cognitive performance, according to Schwartz. Children who had been evicted during middle childhood, according to his research, scored much worse than their peers who had not been evicted—by as much as an entire school year.
According to their parents, children in households who had undergone a formal or informal eviction within the previous five years had a 43% higher likelihood of being in fair or poor health and a 55% higher likelihood of experiencing developmental risks. Even after the researchers took into account variables including financial challenges and housing-related difficulties, those impacts persisted.
Eviction can and frequently does force people into unsanitary or overcrowded living situations. According to a another study, having unstable housing could make you more likely to get an STD. Additionally, living in close quarters following an eviction, whether at a shelter or with family or friends, might increase the risk of contracting infectious diseases like COVID-19, monkeypox, and the flu, according to Schwartz.
Eviction has even been connected to lead poisoning, presumably because a family’s housing options may be limited if they have a history of eviction, causing them to settle for less desirable housing or neighbourhoods, according to Leifheit.
Getting Lost in the Safety Net
It may be more difficult to schedule appointments or reach doctors after moving abruptly to a new location. According to Leifheit, “You see people dropping out of these extremely important safety net programmes right when they need them the most.”
Eviction may jeopardise Medicaid coverage. According to Leifheit, families must recertify their eligibility on a document that is mailed to them in order to renew their Medicaid enrollment. In New York City, eviction was linked to 63% higher probabilities of losing Medicaid coverage compared to people who were not evicted, according to research by Schwartz and colleagues. Additionally, they discovered that evicted individuals filled fewer prescriptions.
Evictions’ impact on a person’s health may cycle. According to Schwartz, eviction can both cause and be a result of poor health.
For instance, someone who is evicted might no longer have Medicaid coverage, be unable to see a doctor for a minor health issue, and end up experiencing a serious health crisis that requires hospitalisation. This might make obtaining secure home much harder and lead to even more financial instability. The cycle continues, according to Schwartz.
How to Assist
Although housing is a complicated and wide-ranging issue, medical professionals can help patients who are facing eviction.
According to Craig Evan Pollack, MD, an internal medicine specialist and professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore, the first step is to be aware that patients may be at risk of eviction. Patients should be screened at clinics for eviction and unstable housing. There are manuals that explain how to sensitively screen for social determinants of health, he claims.
According to Yogesh Shah, MD, MPH, chief medical officer and vice president of medical affairs at Broadlawns Medical Center in Des Moines, Iowa, doctors should also be aware of the social services and housing resources available in their neighbourhood so they can direct patients to organisations that offer housing assistance, legal representation, and other services.
Shah also advises going over and streamlining as much as feasible a patient’s medicine list for patients who are experiencing a housing crisis. Priority should be given to drugs that don’t need to be taken as frequently, like once daily, and drugs that don’t need to be stored in a unique way, like being kept cold.
Providers might expect that the patient won’t be able to visit the clinic anytime soon. Shah suggested using telemedicine rather than in-person follow-up visits, performing a more thorough workup while the patient was there, and providing patients with a physical copy of their medical records. Patients who are facing eviction might not be able to access their information online or might move to a different clinic or neighbourhood and want a simple way to share their medical history.
Institutions that provide healthcare can also contribute. According to Pollack, the team approach is essential for supporting patients dealing with or experiencing housing instability since it gives patients access to social workers and other providers besides doctors.
According to Shah, hospitals and other medical facilities should regard social services as preventive medicine. He claims that at Broadlawns Medical Center, a county hospital that caters to a minority patient population, that has recently been a priority.
“What options do hospitals have? What can we do about nutrition, housing, transportation, education, and housing availability? Our attention is on upstream investment; how can the hospital system engage the neighbourhood to improve [patients’] quality of life?” Says Shah.