Looming eviction crisis may put Californians at increased risk for unmet medical needs

Research published in the peer-reviewed Journal of General Internal Medicine found that Californians who had moved due to unaffordable housing are significantly more likely to report unmet medical needs compared to people with non-cost-related moves.

Our results suggest efforts may be needed not only to ensure healthcare delivery to people who have had to move because of unaffordable housing, but also to prevent cost-related moves in the first place. Such interventions may be particularly urgent in light of widespread economic hardship during the COVID-19 pandemic, which has raised concerns about a looming eviction crisis that could make an effective response to the pandemic itself even more challenging."

Frederick Zimmerman, Professor of Health Policy and Management, UCLA Fielding School of Public Health and Study's Senior Author

The study found those forced to move because of financial issues are 17% more likely to report unmet medical needs, compared to people with non-cost-related moves. The likely result are long-term health problems for everyone affected by these moves, researchers said.

"The findings have never been more relevant, given the financial strains posed by the pandemic," said co-author Dr. Katherine L. Chen, a physician at UCLA and Cedars-Sinai and scholar at the Fielding School. "I am worried about long-term clinical consequences of the backlog of unmet medical needs that can be expected from the pending wave of evictions and moves … I've seen patients who had stressful moves put their medical care on hold and suffer because of otherwise preventable disease."

The findings were based on 146,417 adults who responded from 2011 to 2017 to the California Health Interview Survey, or CHIS, the largest such state survey in the U.S. CHIS is managed by the Fielding School's UCLA Center for Health Policy Research, led by Ninez Ponce, also a Fielding School professor of health policy and management and director of the center.

"This is exactly the kind of long-term, in-depth work and insights the CHPR's CHIS data was established to generate," Ponce said. "Our CHPR mission is to improve the public's health by advancing health policy through research, public service, community partnership, and education."

The study compared those who had moved their residences in the last five years to those who had not. It found those who had moved due to cost, as opposed to other reasons, were more likely to report delaying or not receiving prescribed medicines and needed medical care during the previous 12 months. Within the study sample, they found the odds of unmet medical needs were increased by 38% for people with cost-related moves and 17% for people with non-cost-related moves, compared with people who did not move.

"We were surprised to find that even people who moved within the same neighborhood for cost reasons experienced disruption of medical care," Zimmerman said. "And having a higher income did not insulate movers from the negative effects."

The research team also included Dr. Joann G. Elmore, UCLA Fielding School of Public Health professor of health policy and management and of medicine at the David Geffen School of Medicine at UCLA; Lauren E. Wisk, assistant professor at the Geffen School of Medicine; W. Neil Steers, Veteran's Affairs Greater Los Angeles Healthcare System and an adjunct professor at the Geffen School of Medicine; and Dr. Teryl K. Nuckols, professor of medicine, Division of General Internal Medicine, Cedars-Sinai Medical Center.

"Policymakers seeking to improve population health should consider strategies to limit cost-related moves and to mitigate their adverse effects on healthcare access," said Nuckols, Cedars-Sinai site director for the UCLA National Clinician Scholars Program, a two-year fellowship for doctors and nurses. "In our study of California adults, nearly 1 in 20 reported moving due to unaffordable housing costs in the past five years. That is equivalent to 1.4 million people per year in California alone."

The research was funded by Cedars-Sinai Medical Center via the National Clinician Scholars Program at the University of California, Los Angeles, and supported by the authors' institutions and the Fielding School's UCLA Center for Health Policy Research.

"This analysis highlights the link between stable, affordable housing and healthcare, demonstrating that cost-related moves may be a modifiable driver of health disparities," Elmore said. "Promoting public health during an affordable housing crisis requires collaboration among clinicians, public health leaders, housing agencies, and community advocates."