Abstract

Excerpted From: Emily A. Benfer, Housing Is Health: Prioritizing Health Justice and Equity in the U.S. Eviction System, 22 Yale Journal of Health Policy, Law & Ethics 49 (Winter, 2024) (477 Footnotes) (Full Document)

The COVID-19 pandemic underscored the interdependence between individual and community level health outcomes, as well as the social and structural determinants of health--such as eviction--that thwart best attempts to control the spread of disease. The pandemic precipitated pandemic-related job and wage loss and subsequent evictions due to nonpayment of rent. Eviction placed tenants at heightened risk of contracting COVID-19 and, in turn, the risk of infection in the entire community increased. In recognition of the cascading health effects of individual housing loss on the community, policymakers nationwide issued eviction moratoria to prevent widespread eviction and its health consequences at the outset of the pandemic. The Centers for Disease Control and Prevention (CDC) and policymakers in twenty-seven states and the District of Columbia justified eviction moratoria on the relationship between eviction and the spread of COVID-19. For example, the New Jersey governor provided a public health justification for the statewide eviction moratorium: “housing security and stability are important to public health, particularly as homelessness can increase vulnerability to COVID-19; and ... removals of residents pursuant to evictions ... can increase the risk to those residents of contracting COVID-19, which in turn increases the risks to the rest of society and endangers public health.” Indeed, multiple studies demonstrated that eviction-related housing insecurity and the lifting of moratoria were associated with increased COVID-19 infection and mortality, with one study estimating that the lifting of eviction moratoria in the first six months of the pandemic resulted in 433,700 excess COVID-19 cases and 10,700 excess deaths by September 20, 2020. Despite the demonstrated relationship between COVID-19 transmission and eviction, the vast majority of policymakers narrowed eviction protections or allowed moratoria to lapse by the end of 2020, at the height of the pandemic and before vaccines were available. At a time when health justice and equity should have been prioritized, the failure to attain it was evident throughout the COVID-19 pandemic.

Extreme racial and socioeconomic healthinequity and the health threat of eviction on the individual and community levels is not contained to pandemics. Eviction consistently functions as a social and structural determinant of healthinequity. It is undisputed that housing loss related to eviction is associated with numerous negative physical and mental health outcomes, including increased risk of premature death, and particularly harmful effects on children, elderly people, and people with disabilities. For women, it is associated with physical and sexual assault and future housing precarity. Eviction is particularly devastating to children, resulting in emotional trauma, developmental delay, lead poisoning, food insecurity, and decreased life expectancy. For infants who are born during or soon after their mothers experience an eviction, it leads to adverse birth outcomes, such as low birthweight or pre-term birth. Eviction also narrows a family's housing options, forcing renters with a history of an eviction filing to move into substandard housing in disadvantaged, higher crime neighborhoods divorced from resources, transportation, and access to opportunity. In this way, eviction dismantles pillars of resiliency, locking families out of safe and decent housing, disrupting employment and education, and preventing access to well-resourced schools and communities.

The negative impact of eviction reverberates through whole communities, destabilizing neighborhoods, dismantling social networks, straining non-evicted households that provide temporary shelter and other material support, and increasing the rate of violent crime, among other harms at the neighborhood level. Ultimately, eviction deepens long-standing patterns of economic and housing instability and poor health among historically marginalized groups. Majority-Black communities, which have the highest rates of eviction, are particularly vulnerable to the increased cycles of crime, poverty, and community disinvestment precipitated by eviction. However, policy makers have yet to adopt eviction prevention as a public health strategy beyond the pandemic. By Fall of 2023, any remaining eviction prevention measures, such as federal Emergency Rental Assistance and changes to the eviction court processes, ended at the state and local levels, with few exceptions.

This Article posits that the “housing is health” principle should not be limited to the pandemic, but rather the pandemic should serve as a catalyst to adopt eviction prevention as a major public health aim that is critical to health equity among historically marginalized populations, as well as our collective health. The public health field frequently tackles social issues, like eviction and housing displacement, that function as social determinants of poor health. For example, public health strategies and evaluation methods are frequently employed to address interpersonal and gun violence, food insecurity, homelessness, early childhood education inequity and barriers to educational attainment, and built environment deficiencies, among other social issues.

This Article proposes the Health Justice Framework, which emphasizes social justice and health equity, as a holistic approach to understanding the roots and effects of the eviction crisis, as well as viable interventions that promote housing stability and health equity. The health justice frame complements and widens other relevant frames (e.g., access to justice, right to housing, economic, or race) to surface the full extent of the problem and robust interventions. The broader and historical scope offered by health justice principles prevents partial issue spotting or solutions that can occur when other frames are applied in isolation. For example, non-health frames might surface the need for a tenant right to counsel that provides attorneys for eviction defense or rental subsidies and rent caps to increase housing affordability. A health justice lens would also surface the need to address substandard housing conditions, barriers to access, power structures, and lack of enforcement mechanisms, among others. The health justice lens expands the problem identification to include an assessment of socioeconomic and political contexts, the historical underpinnings, as well as the role of discrimination and power hierarchy. In health justice, any solution defers to the needs and goals of the affected community.

This Article first combines literature from public health and housing fields with the World Health Organization (WHO) Conceptual Social Determinants of Health (SDOH) model to demonstrate the public health context of the eviction system. This examination highlights how eviction laws, policies, practices, and courts operate as structural determinants of healthinequity among historically marginalized groups. It then applies the Health Justice Framework to the eviction system to develop a multi-pronged policy strategy to address eviction and healthinequity, thereby offering a point of intervention and roadmap for remedying the crisis. Part I describes the Health Justice Framework and its relationship to the SDOH. Parts II, III and IV demonstrate how eviction is a structural and intermediary determinant of healthinequity within the WHO Conceptual SDOH Framework. Part II describes how eviction is a driver of poor health that disproportionately affects historically marginalized people. Part III describes the relationship between eviction and the intermediary determinants of health. Part IV demonstrates how eviction courts, laws, policies, and practices operate as structural determinants of healthinequity. Finally, Part V applies the Health Justice Framework and demonstrates how courts and policy makers can achieve health equity and eviction prevention.

[. . .]

Philosopher Amartya Sen posits that “health is among the most important conditions of human life and a critically significant constituent of human capabilities which we have reason to value ... Equity in the achievement and distribution of health gets, thus, incorporated and embedded in a larger understanding of justice.” Yet, for millions of Black people and historically marginalized groups, the U.S. eviction system operates as a major driver and structural determinant of healthinequity. The system, thereby, undermines justice and thwarts efforts to achieve the housing stability so fundamental to one's capability and thriving at the individual and community level.

With the COVID-19 pandemic as the only exception, the nation has never made a concerted effort to confront the eviction system as a structural determinant of healthinequity or to address its disproportionate and harmful impact on historically marginalized people, especially Black families. During the COVID-19 pandemic, when it was widely understood that health is inseparable from housing, policy makers prioritized health equity and eviction prevention. The result was unprecedented: eviction courts halted proceedings, filing rates dropped to all time historical lows, and new financial resources that were equitably distributed increased housing stability among the estimated tens of millions of renters who were at heightened risk of eviction. The United States achieved what was once dismissed as impossible when it appropriately treated the eviction crisis as a public health crisis and prioritized health equity and housing stability.

Today, as the vast majority of pandemic-era interventions have lapsed and eviction increasingly threatens the health and stability of historically marginalized communities, the country is called to act. The pandemic should serve as a catalyst to prioritize health justice in the U.S. eviction system as a major public health commitment. Without swift intervention at the federal, state and local levels, the predictable result will be a bolstered eviction system and return to the pre-pandemic norm where millions of renter households face eviction each year and we wittingly strip young children and infants of their homes at the highest rates. Especially after successfully preventing the COVID-19 eviction crisis, there can be no conscionable justification for allowing the eviction system to operate unchanged. Inaction and complacency as the country returns to the status quo--or worse--guarantees the perpetuation of healthinequity among historically marginalized groups, especially Black women, families, and children.

Policymakers and courts can immediately employ the Health Justice Framework to address the structural and intermediary determinants of healthinequity inherent in the U.S. eviction system. The Framework demonstrates how to effectively supplant harmful laws, policies, and practices with equitable, protective, and supportive ones. It requires an investigation into the historic and modern day causes of healthinequity and their dismantling. It emphasizes that structural change is only possible if people facing obstacles to equity and justice have the power to drive that change. Ultimately, the achievement of health justice and equity demands that every individual in America has uninhibited access to stable, safe, decent, and affordable housing free of the threat of eviction and its devastating consequences. It is this America--a place where housing and health equity are ensured--that we must all demand.

Associate Professor of Clinical Law, Director of the Health Equity Policy & Advocacy Clinic, George Washington University Law School; Research Collaborator, The Eviction Lab at Princeton University; former Senior Advisor to the White House and American Plan Implementation Team; LLM, Georgetown Law Center; JD, Indiana University McKinney School of Law.//