This is a guest blog post by John Pollock, JD, and Kathryn Leifheit, PhD MSPH.
The fields of public health and preventive medicine seek to prevent disease or injury before it occurs (i.e., primary prevention) or reduce the short- and long-term impacts of disease (i.e., secondary and tertiary prevention, respectively). This preventative orientation allows populations and patients to avert worst-case health outcomes such as long-term disability and death. Preventative medicine also tends to be cost saving, with investments in social determinants of health and primary care lessening the need for expensive emergency and specialty care as well as treatments to manage chronic disease.
Legal Support for Renters is preventative legal medicine to treat the problem of evictions, where only 3% of tenants on average have access to representation, compared to 81% of landlords. By intervening early and providing tenants facing eviction with a right to counsel, we can prevent evictions from exploding into a panoply of negative health outcomes and other consequences experienced not only by evicted families, but by society at large. Given that tenants of color, especially Black women, are evicted at a disproportionate rate, Legal Support for Renters is also a treatment for entrenched inequities in housing markets.
A growing body of research suggests that evictions are not just a consequence of poverty but also a cause of future hardship, contributing to poor health outcomes for renters and their communities. Evictions harm renters’ health by increasing mental distress, reducing access to safe housing and neighborhoods, increasing exposure to infectious disease, and constraining access to food, healthcare, and other health-promoting resources. Through these pathways, evictions have been linked to adverse health outcomes across one’s lifespan.
Pregnant people who are evicted are more likely to deliver preterm and have infants with low birthweight. Evictions in childhood are associated with food insecurity at age 5 and lower cognitive scores at age 9. In adolescents and young adults, evictions are associated with depressive symptoms. Large, population-level studies have linked evictions to increased risk of suicide and death. In the context of the COVID-19 pandemic, studies suggest that evictions result in increased disease transmission, leading to excess COVID-19 cases and deaths. Evictions can also disrupt access to healthcare, leading to costly emergency department visits and increased healthcare spending.
Evictions also result in harms to families and costs to city governments that go well beyond healthcare. Numerous reports have documented the links between eviction and homelessness, foster care for children left without a stable home, school disruptions (and school transportation for unhoused children), and unemployment. And this list does not include the costs that have not yet been quantified due to data gaps, such as public benefits for evicted tenants facing unemployment and law enforcement/incarceration costs related to the criminalization of homelessness.
At the same time, studies have repeatedly demonstrated that representation for tenants facing eviction is incredibly effective as both a primary and secondary eviction prevention intervention. From a primary prevention standpoint, in Hennepin County, Minnesota, a study found that represented tenants were twice as likely to stay in their homes. Likewise in Oklahoma, legal representation increased the odds of tenants staying in their homes by 75%. A Massachusetts study found fully represented tenants were twice as likely to remain in their homes as those who received more limited legal assistance. These are just several examples; there have been many other studies like these.
Representation has also proven its effectiveness in secondary prevention of future eviction, mitigating the negative effects of displacement. In the Hennepin County study, represented tenants (compared to those without representation) who needed or wanted to move following an eviction were granted twice as much time to do so. Represented tenants were also four times less likely to use a homeless shelter than those without counsel, and were 13 times more likely to finish the legal proceeding with a clean eviction record — dramatically increasing their chances of accessing quality, affordable housing in the future. In California, 71% of represented tenants who moved following an eviction hearing obtained a new rental unit, compared to only 43% of non-represented tenants. Chicago tenants with representation were three times more likely to avoid an order of eviction. And Stout LLC, a financial analysis company that has produced extensive right to counsel reports for numerous cities, has consistently found that a right to counsel leads to more than 90% of tenants avoiding disruptive displacement. Stout’s data also suggests that the costs of a right to counsel are substantially less than the governmental costs incurred through avoidable evictions and the resultant disruptive displacement.
Since 2017, 16 jurisdictions (13 cities and three states) have enacted Legal Support for Renters policies. 2021 in particular was a banner year, with 11 states introducing Legal Support for Renters legislation in 2021, a dozen cities taking steps in that direction, and 9 jurisdictions (3 states and 6 cities) enacting a policy. The primary and secondary prevention results from these programs have more than justified the investment. In New York City, 84% of represented tenants have remained in their homes; in Cleveland, 93% of represented tenants have avoided eviction or an involuntary move; and in San Francisco nearly 60% of represented tenants have retained their units. It is highly likely these cities are saving money as a result of these policies: prior to enactment, a study estimated New York City would save $320 million by enacting such a policy, while a pre-enactment study of a pilot program in San Francisco estimated that the City saved over $1 million from avoided shelter costs.
Legal Support for Renters policies can help families and cities to mitigate the harms — both health-related and otherwise — associated with evictions, while providing substantial cost benefits to city governments. For the same reasons that preventive medicine is integral to ensuring population health, preventative legal medicine in the form of Legal Support for Renters is integral to building equitable, thriving communities.
John Pollock, JD, is Coordinator of the National Coalition for a Civil Right to Counsel, which works nationally to establish a right to counsel in civil cases implicating basic human needs such as housing.
Kathryn Leifheit, PhD MSPH, is an epidemiologist and postdoctoral fellow at the UCLA Fielding School of Public Health. Her research has documented impacts of evictions on the health of children and communities.