Treat evictions like a chronic disease

Protesters at the John Marshall Courthouse in Richmond in July opposed the end of a statewide eviction moratorium. (Ned Oliver/Virginia Mercury)

By Susie Turkson and Dr. Alan Dow

Before the COVID-19 pandemic, the city of Richmond was already afflicted by other public health crises, including an eviction epidemic. Our city ranks second in the nation in the rate of evictions. Within the Commonwealth of Virginia, four additional cities rank within the top 10. Because of the COVID-19 pandemic, policymakers are paying increased attention to evictions; however, we must recognize evictions as not just an acute crisis but as a chronic disease of public health that requires more than a temporary Band-Aid.

Evictions pose a substantial public health and safety risk, and they create an influx into the homeless population. Individuals who are homeless have a life expectancy of 10 years lower than the general population. They are at risk for exploitation, violence, suicide and substance use. Importantly, families with children constitute about 33 percent of the nation’s homeless population. Roughly 38 percent of households with children are in danger of facing eviction in the state of Virginia.

As clinicians, we confront the challenges of housing instability with our patients. We have taken care of numerous hospitalized patients who are homeless and cannot stabilize their chronic health conditions without stable housing. Individuals who are homeless have worse chronic health conditions, face more barriers to accessing care and use higher cost locations for care like emergency departments. Since most of these individuals rely on government-funded health insurance such as Medicaid or Medicare, these health care costs fall on taxpayers.

The COVID-19 pandemic has worsened the challenges posed by housing instability. Evictions impede access to shelter and clean water. Lack of these two basic resources make it impossible to follow even the simplest COVID-19 prevention measures such as practicing proper hand hygiene and staying home as much as possible to reduce exposure risks. Meanwhile, studies in homeless shelters demonstrate that individuals in these settings have COVID positivity rates well above the background rates in the community.

Government officials including the governor and the Supreme Court of Virginia have taken steps to curtail evictions during the pandemic. They have instituted a patchwork of eviction moratoriums to offset a surge in job instability and financial strain in order to maintain housing stability in our community during the COVID-19 pandemic. However, this is merely holding pressure on a gaping wound.

While these measures have provided temporary relief, they are impractical long-term and do not address the inadequacies of the housing system that perpetuate housing instability. Moreover, evictions disproportionately impact lower income areas and communities of color, a modern-day continuation of the racist redlining policies of last century. Now is the time to tackle these systemic issues that plague our region so that we can emerge with a housing system that builds stronger communities rather than one that solidifies the cycle of poverty.

While the city of Richmond is in a position to serve as a model for sustainable reform because of the depth of challenges faced in this locality, building a better housing system requires financial support that exceeds what a city can do alone. Realistically, funding is needed to cover statewide expansion of rent and mortgage relief programs to prevent increases in the growing eviction pipeline. Community partners working with the RVA Eviction lab have emphasized that the money currently available for rent and mortgage relief is inadequate to cover the needs of the over 200,000 households struggling to make payments. While we strongly support HB5111, HB5106 and SB5051, which would provide a true moratorium on evictions until the COVID-19 state of emergency expires, we recommend the following steps by the legislature to decrease evictions and increase housing stability:

  • Expand the eviction diversion program to make it more accessible to tenants in need,
  • Implement a tenant’s bill of rights that includes provisions for tenants to have access to data on the rental history and number of evictions filed by their landlord,
  • Codify repercussions for landlords who received money from the rent relief program in the CARES Act and yet proceeded with filing eviction claims during the moratorium (as addressed in HB5106),
  • Close the “debt collection” loophole used by landlords to collect rent from tenants they cannot evict,
  • Identify the underlying circumstances leading to high eviction rates in certain communities,
  • Invest in affordable housing grants with a focus on communities traditionally impacted by discriminatory housing, and
  • Establish a dedicated funding source for the Virginia Housing Trust Fund.

As clinicians, we are accustomed to thinking about both the short-term and long-term treatment of a health condition. While all of these recommendations are important, the long-term prognosis for housing stability depends on the recommendations further down the list. The first several recommendations are necessary first aid for housing during the COVID-19 pandemic; however, they will not treat the chronic disease of housing instability.

With the long-standing, insidious nature of our housing challenges, we need not just Band-Aids — we need a plan for a cure. Without a comprehensive plan to treat the chronic disease of housing instability, we will relapse into our pre-COVID state of housing instability as a smoldering public health crisis.

Susie Turkson is a medical student in the M.D.-Ph.D. program at Virginia Commonwealth University. Dr. Alan Dow is a professor of internal medicine at Virginia Commonwealth University School of Medicine and a general internist at VCU Health.