In the past two-plus decades, the number of evictions in the United States jumped some 70%, hitting close to 900,000 in 2016. Add in foreclosures, and nearly two million Americans are evicted each year. The COVID-19 pandemic, with its resulting economic downturn and job losses, has put 20 times that number at risk of losing their homes in 2021.
Yet, despite the enormity and urgency of the issue, University of Pennsylvania researchers Courtney Boen and Morgan Hoke noticed that little empirical research looked at the health consequences of getting evicted, particularly for young adults. The duo decided to take on the question.
Analysis of a nationally representative dataset revealed that eviction not only represents a unique stressor for young adults but also links to a greater risk for depression, findings the researchers shared in the journal Social Science & Medicine.
"What this research shows us unquestionably," says Hoke, an assistant professor in the Department of Anthropology, "is that eviction is, in fact, a health issue."
The right dataset
Hoke and Boen both arrived at Penn in 2017, shortly after Princeton University sociologist Matthew Desmond published "Evicted," a book about eight families struggling with poverty in the U.S. The book prompted a conversation between the two Penn researchers who, despite their differing scientific backgrounds and subject matter, share an overarching interest in how inequality shapes biological and physiological processes.
"We were thinking about ways we could combine our research interests," Hoke says.
Seeing a housing crisis unfolding around them, they initially contemplated studying eviction in Philadelphia. However, Boen, an assistant professor in the Department of Sociology, had previously worked with data from the National Longitudinal Study of Adolescent to Adult Health (often referred to as Add Health) that included countrywide eviction information. "Having access to a nationally representative dataset that asks questions about eviction—that's incredibly rare," Boen says.
Beyond that, the data encompassed an age group often overlooked in conversations on this topic: people in their early 20s through early 30s. "Much of what we hear about regarding eviction focuses on families with young children, for really good reason," says Boen. "But young adults are vulnerable to the consequences of eviction in a different way."
Twice during the 15-year period that Add Health covers—during the third and fourth waves of questioning—the survey asked participants whether they had been evicted from a house or apartment for not paying rent or a mortgage in the past 12 months. The surveys touched on health status and health behaviors, too. This allowed the researchers to follow participants over time to understand how their experiences with housing insecurity shape health risks.
Evictions and health
For Boen and Hoke, the question then became, how precisely does eviction affect health, both physically and psychologically?
To get at the former, they analyzed how participants ranked their health on a continuum from "excellent" to "poor." For the latter, they looked at how often participants noted they felt overwhelming fatigue, bothered by something that wouldn't usually bother them, and seven other emotions indicative of depression.
"When people study older adults, they often look at outcomes like risks of uncontrolled diabetes or hypertension, diseases already underway in these populations," Boen says. "Because our study focused on young adults, we looked at precursors of disease, and we thought depressive risk was a really important one, for mental and physical health."
Their analysis revealed a positive association between eviction and risk of depression over time. It also showed that young people of color and those from low-income households or poor neighborhoods were most vulnerable to getting evicted. "That tells us that eviction is an issue related to inequality and structural racism," Boen says. "This wouldn't just happen without broader forces at play."
Given previous research on how structural inequalities affect health, the findings didn't surprise the Penn team. "There's a whole history of work on the social gradient in health, which relates people's socioeconomic status to their health," says Hoke. "We know there's a very strong relationship between those two things. Here, we are seeing a pattern that we expected to see, that these inequalities tend to pile on and be multiplicative."
That remains true even after accounting for factors like living in a low-income neighborhood or coming from a poor family, she says. "Even when you remove all of those, eviction still really matters."
Home loss during a pandemic
Though this project began well before COVID-19, the pandemic adds another layer to an already complicated situation. There's the obvious implication: Many protections against the virus require a safe place to isolate from those outside an immediate family. For most people, that means their home, but eviction frequently leads to a phenomenon called doubling up.
"When you lose housing, one of the first things you do is move in with family or friends," Hoke says. "That increases crowding which, in the context of a pandemic, can be problematic, especially for populations who disproportionately have frontline jobs. More crowded homes with people going in and out is a recipe for more exposure."
In addition, part of what determines a person's susceptibility to COVID is infection risk and, once infected, the body's capacity to effectively fight that infection.
"We show that for young people exposed to devastating social stressors like eviction, their health erodes over time," Boen says. "In the case of depressive risk, the mental health risks experienced by young adults who face eviction in the pandemic have likely already been eroded by earlier experiences. The same people who got evicted during COVID or were at great risk for being evicted may already carry in their bodies the scars of previous evictions. This means they not only face increased risks of exposure to COVID-19 but diminished ability to effectively fight the disease."
The moratorium the CDC put in place, which currently runs through March 31, helps some. But there are eligibility restrictions, and, because it only protects against eviction for missing rent payment, people can lose their homes for other reasons, like a small unpaid utility fee of which they were not even aware. "For me, it all reveals the lack of protections for poor families and poor people in the United States," Boen says. "They're really exploited, and the system is not well-regulated."
In the future, she and Hoke hope to conduct a prospective research study of eviction with repeated stress and biological measures to better understand how inequality becomes embodied, in particular, how stressful, harsh experiences like eviction affect people's health and well-being in the long term. They would also like to study the effects of eviction in Philadelphia.
More information: Morgan K. Hoke et al. The health impacts of eviction: Evidence from the national longitudinal study of adolescent to adult health, Social Science & Medicine (2021). DOI: 10.1016/j.socscimed.2021.113742
Journal information: Social Science & Medicine
Provided by University of Pennsylvania