Kathleen Hoke

Research indicates that policies designed to facilitate home ownership may do more to improve health and wellbeing, as well as economic stability, than renter protections. Home ownership rates in the U.S. remain low, especially among Black and Hispanic residents. One of the significant barriers is the need for most first-time homebuyers to obtain mortgages, which require that they have decent credit scores, steady incomes, and cash reserves to qualify. Federal and state mortgage lenders and/or assistance programs can remove some of these barriers to homeownership. This fact sheet discusses state and federal mortgage and homeownership assistance programs.

Safe, stable housing can contribute to improvements in mental and physical health, civic engagement, social skills, educational and professional achievement, and can decrease use of emergency services. When housing is affordable, it can prevent stunted growth in children and decrease hospitalizations. Unfortunately, safe and stable housing via ownership is not attainable for everyone. The number of people in the U.S. experiencing homelessness has been increasing steadily for the past several years. A system of “shared ownership” called a community land trust especially in areas facing rapid economic change and appreciating land values. This fact sheet offers a comparison of Community Land Trusts and traditional homeownership.

Housing instability is a public health crisis that causes and exacerbates health problems, erodes communities, and drives health inequities. Families grappling with housing uncertainty experience physical and mental health challenges, from elevated rates of childhood and chronic disease and mortality, to stress, depression, anxiety, and suicide. Those who lack stable housing are more likely to experience homelessness, unemployment, substance use, food insecurity, and violence. Housing instability makes it difficult for residents to invest in their homes, relationships, and neighborhoods; and where health-supportive connections have already been made, eviction can disrupt the fabric of entire communities. Nationwide, Black and Hispanic renters in general, and women in particular, are disproportionately threatened with eviction and disproportionately evicted from their homes. This fact sheet discusses housing as a community health and health equity problem and illustrates why legal and policy innovations are needed to address the issue of housing instability.

Eviction is costly and damaging for all parties involved. For tenants, “[e]viction is a cause, not just a condition, of poverty,” precipitating a “spiral of financial instability” that culminates in decades of poor health and economic hardship. For communities, evictions break down communal bonds and burden the court system with crowded dockets and administrative costs. For landlords, evictions come with surprising costs. Despite these deleterious effects, eviction filings have become a routine part of the collections process for landlords, who frequently leverage the threat of eviction to coerce tenants to move or pay. This is particularly problematic in states where barriers to filing are already relatively low.

The consequences of eviction do not end with a tenant’s removal from their home. Many tenants fail to recognize that a trip to housing court creates a long-term public record. Much like a criminal record, an eviction record can persist for years, following the tenant as they search for new homes and opportunities, and precipitating “a spiral of financial instability” that contributes to a lifetime of poor health and economic outcomes. As a result, evictions have been labelled the “top driver of homelessness,” and a “root cause” of poverty.

Between 2000 and 2016, more than 61 million eviction complaints were filed in the United States. However, not all eviction filings result in an executed eviction, when a tenant is removed from their home. Data suggest that there was roughly one eviction filing for every 17 renter households during this time, but far fewer—only one in 40 renter households—were actually removed. One reason for the disproportionate number of filings is the practice of serial eviction filing. These repeated filings remain on a tenant’s public record and can have long-lasting limitations on their ability to qualify for future housing. This fact sheet examines potential policy solutions to address this practice.

The U.S. severely lacks affordable housing. According to the National Low Income Housing Coalition, there are only 36 affordable rental homes available for every 100 extremely low-income renter households in the country. As the gap between supply of and demand for affordable housing grows, the problem becomes more difficult to solve. Countless government and non-profit sponsored programs aiming to increase the supply of affordable housing have been established around the country (mortgage assistance programs, community land trusts, etc.), but for them to operate effectively, zoning laws must first allow the development of affordable housing units. This fact sheet explores zoning reform law and policy options to increase affordable housing development.

Public housing is one of three forms of rental assistance programs used in the U.S. and has the potential to improve public health by addressing the need for quality affordable housing. However, significant changes are needed to match the successes seen in other countries. This resource examines public housing programs in other countries, the current state of public housing in the U.S., and the need for federal policy changes and increased investment in public housing.

Nearly half of renters in the U.S. are “cost burdened,” spending more than 30 percent of their incomes on housing, and about one in four renters spend more than 50 percent of their incomes on housing (“severe” cost burden). Cost burden leaves struggling renters with less to spend on other important needs such as healthcare. This fact sheet examines the use of rent control and rent stabilization policies to stop or slow increases in the price of rent, and whether they, or alternative approaches, are more effective at reducing the number of people considered to be cost burdened.

More than two million eviction cases are filed against tenants each year in the United States. That’s roughly one eviction filing every four minutes. Eviction can impact the physical, psychological, and economic health of individuals, families, and communities for years, and yet the vast majority of tenants navigate these weighty eviction proceedings without the help of legal counsel. This resource outlines various approaches to providing legal counsel to those facing eviction.

People who experience homelessness report overall poorer health. Homelessness itself also makes it more difficult for people to secure medical treatment, manage medications, access consistent or healthy food sources, and protect themselves from weather extremes and communicable diseases. People who experience housing instability similarly experience a range of negative health impacts. Knowing the negative relationship between housing instability and health, communities can choose to invest in infrastructure and resources to better respond to homelessness. This resource outlines possible measures to support housing stability in the community.

Women are disproportionately affected by food insecurity, and these disparities are even more pronounced during pregnancy, with some studies estimating that one in five pregnant people face food insecurity. There is growing interest in positioning food insecurity as a health issue requiring a health care response. Federal and state programs that center "food as medicine" show promise in addressing the negative health outcomes that can result from food insecurity, improving both maternal and child health outcomes.