Eviction, Health Inequity, and the Spread of COVID-19

March 27, 2021

By: Carson Bryant

A recent article from the Journal of Urban Health highlights the connection between eviction and health inequity, paying particular attention to the ways in which evictions amplify the risk of COVID-19 infection and spread. As the COVID-19 pandemic has laid bare many of the inequities that persist in our society, the authors focus on two areas in particular: housing inequity and health inequity. Amidst an economic crisis, millions of Americans have lost their jobs and have struggled to pay their bills. This is the type of economic distress that leads to eviction and displacement, a situation that is magnified by an existing affordable housing crisis and the presence of a life-threatening pandemic. 

During the COVID-19 pandemic, eviction has been a particularly severe threat to individual and public health. Eviction, or even the threat of eviction, has been shown to have detrimental effects on a person’s health, owing to higher stress levels, anxiety, and depression, all of which weaken the immune system (more on this later). Moreover, eviction compels people to seek shelter in transient, overcrowded living situations, whether the person is couch surfing, entering a homeless shelter (which often don’t provide adequate living space), or moving in with family. In such environments, one’s ability to exercise caution towards the virus (i.e., social distancing, self-quarantine) is diminished, increasing exposure. Evictions are also associated with reduced access to healthcare, as they often displace people into areas lacking a presence of medical providers and healthcare services.

The authors argue that the link between evictions and exposure to COVID-19 is compounded by prevalence of evictions and comorbidities among vulnerable populations, noting that “people most vulnerable to eviction are also more likely to suffer from poor health conditions that place them at high risk of severe or fatal cases of COVID-19.” CDC research has identified several comorbidities that increase the risk of severe illness from COVID-19, including pulmonary disease diabetes, and high blood pressure. A sizable body of evidence indicates that these comorbidities as well as evictions are most prevalent among low-income communities and communities of color. While the health consequences of evictions during the COVID-19 pandemic have the potential to be severe, evictions reinforce broader patterns of health inequity that undermine public health independent of the COVID-19 pandemic. Using a wide swathe of research, the authors identify an array of negative health outcomes associated with evictions, including high levels of stress and anxiety, physical health issues, physical and sexual assault, food insecurity, and exposure to substandard housing.  

With a significant race- and class-based disparities in COVID-19 infection rates, eviction prevention is an essential way to both contain the virus and to promote health equity. The authors emphasize the importance of policy interventions that prevent evictions, citing research on the relationship between the absence of eviction moratoria and increased rates of COVID-19 transmission. One study applied a model that found that an eviction rate of 0.25% per month is associated with a 0.6% increase in total infections, which was shown to have serious consequences on the level of a major metro area. In another study, researchers determined that lifting eviction moratoria was associated with 1.6 times higher COVID mortality after 7 weeks and 5.4 times higher mortality after 16 weeks, after controlling for other pandemic containment measures. In short, available evidence strongly indicates that lifting eviction moratoria leads to additional COVID-19 cases and consequentially, COVID-19 deaths. 

While eviction moratoria are the most direct and effective way to stem evictions in the immediate term, further eviction prevention measures are essential to containing the virus and achieving equitable health outcomes, including rental assistance, eviction diversion programs, expanded tenant protections, and tenants’ right to counsel (e.g. NEWR). As evictions are harmful to public health beyond the context of the COVID-19 pandemic, these policy tools will play a central role in shaping the relationship between housing security and health equity. 

This study reinforces the connection between housing security and public health, lending the issue particular urgency during a devastating pandemic. Evictions play a central role in this story. Evictions perpetuate patterns of economic and housing insecurity, resulting in poor health outcomes and, in the case of the pandemic, increased exposure to COVID-19. With COVID-19 severely affecting the communities most vulnerable to eviction, it is evident that public health, health equity, housing security, and social justice are closely linked. Housing security is arguably a precondition to public health, if we accept, as the authors express, that “public health and health justice require that all people have equal opportunity to achieve good health and protect themselves from COVID-19.” This a convincing premise. Housing and the opportunity to achieve good health — both of which are systematically denied by eviction — are human rights and therefore must be promoted in conjunction with each other. This issue does not end with COVID-19. Housing security is a central pillar of individual health and public health, making eviction prevention a crucial strategy not only for mitigating the impact of COVID-19, but for building health equity.