Systematic review: Evictions haunt families, harm children's health

Harvard Medical School student Bruce Ramphal grew up in the bustle and blight of a five-story Bronx apartment building where, from an early age, he saw and heard about neighbors and friends losing their homes. Evictions were a part of life there—a block from the frenetic Grand Concourse thoroughfare and a stone's throw from a police station nicknamed the Alamo.

"There was just an acute fear of losing our home," said Ramphal.

Born nearby at Lincoln Hospital in the Mott Haven area, Ramphal was raised by a single mother. The family was poor, he said. His mother and sister emigrated from Guyana to New York City before he was born. After working as a housekeeper for many years, Ramphal's mother became a home health aide and carefully saved money to purchase a place in Yonkers, N.Y., and leave the Bronx a few years ago.

"We never got evicted ourselves, but we came to know the consequences intimately," Ramphal said. He believes witnessing the evictions and related stress he and his family experienced motivated him to expose the human trauma that stems from such crises and help protect others from the ravages of losing their home.

Today, Ramphal, a second-year medical student, has made an important step on that journey. He and collaborators at the Harvard T.H. Chan School of Public Health, Harvard Law School, and the Center on the Developing Child at Harvard University recently published an analysis of past research on evictions and their health impact in JAMA Network Open.

The team's overarching goal is to explore existing evidence, start a conversation about the long-lasting effects of childhood housing instability, and promote changes that protect the most vulnerable. To do so, they analyzed 11 previously published studies on evictions and child health outcomes.

"Stable housing is profoundly important to healthy child development," Ramphal said. "Every study in our review identified at least one poor health outcome associated with experiencing an eviction."

Such problems include low birth weight and premature birth, and worse cognitive development and overall health as rated by the parent, the review found.

Notably, the researchers said, other studies have already linked adverse adult health outcomes to experiencing eviction in childhood, adding further evidence to the long-term health effects of early traumatic events.

Additionally, Ramphal said, there is an emerging link between childhood adversity and adult risk for a wide range of conditions, including diabetes, cardiovascular disease, neurodegenerative disorders, cancer, substance use, depression, cognitive impairment, and immune derangement. Therefore, he said, preventing evictions may be a good public health investment.

Ramphal himself experienced some of this up close. One day, he discovered an eviction "notice to quit" on a table in his family's apartment. His mother had to borrow money from friends to vanquish that threat. More recently, neighbors came to Ramphal's Bronx apartment, their eyes downcast, a few simple belongings in tow. Unable to pay their rent, they had been evicted, facing homelessness and destitution.

Ramphal, his mother, and older sister took that family in until they could secure other living arrangements. Ramphal and his family have joined local tenants' rights organizations and helped residents in the area document unsafe living conditions, including rat and cockroach infestations, and a compromised floor through which one of their neighbors fell one night. He landed in the building's basement and had to be hospitalized.

"Importantly," said Ramphal, "involvement in an eviction proceeding, even if it is baseless, haunts a family for years, making them less likely to be approved on new leases and more likely to move to less safe, lower-quality housing. Therefore, when a property owner decides to initiate eviction proceedings, they condemn a family to cascading housing insecurity and long-term harm."

The team's review points to a widespread problem. More than 2 million eviction filings occur in the United States annually, producing almost 1 million completed evictions. And many more informal evictions occur each year, in which property owners evict tenants without using the legal system, the research team said.

In the context of a rental housing affordability crisis, ongoing racial disparities in evictions, and continuing harm to millions of families, health care practitioners and policymakers have an integral role to play in supporting safe, stable housing for all, the analysis team members wrote.

The researchers said future studies should consider how evictions are associated with a broader range of child health outcomes beyond the period around and shortly after birth and how these outcomes vary over time.

The authors said that clinicians could play an important role by identifying patients at risk of eviction and linking them to public and community-based solutions, including legal assistance and housing resources.

Ramphal, who earned a BS in neuroscience from Brown University and is in his clinical year at Cambridge Health Alliance, expects to earn his medical degree in 2025. He's not settled on a specialty, but said he intends to serve the disadvantaged, immigrants, and people of color. He also plans to conduct more research into evictions and the human damage wrought by them.

Co-authors on the study included Ryan Keen, Sakurako Okuzono, Dennis Ojogho, and Natalie Slopen.