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Health Affairs Editor-in-Chief Alan Weil interviews Abdinasir Ali from University of Iowa College of Public Health on his research assessing the effects of state eviction moratoriums on mental health.
Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
00;00;00;04 - 00;00;31;23
Alan Weil
Hello and welcome to “A Health Podyssey”. I'm your host, Alan Weil. The national media reported extensively on the moratorium on evictions put into place as the COVID 19 pandemic emerged, first by the CARES Act and subsequently through the authority of the Centers for Disease Control and Prevention. But less attention was paid to eviction moratoria put into place by almost every state and some localities.
00;00;32;10 - 00;01;07;03
Alan Weil
Now, a variation in the timing and design of those state level moratoria created a natural experiment allowing researchers to examine the effects of these moratoria. Eviction moratoriums don't only provide financial relief, they also relieve people from the stress of worrying about where they're going to live, so these policies can have a direct effect on people's mental health. How state eviction moratoria affected people’s mental health is the topic of today's episode of “A Health Podyssey”.
00;01;07;27 - 00;01;34;06
Alan Weil
I'm here with Abdinasir Ali, a doctoral student in the Department of Health Management and Policy at the University of Iowa College of Public Health. Mr. Ali and his colleague George Wehby published a paper in the November 2022 issue of Health Affairs assessing the effects of state eviction moratoriums on mental health and found some evidence of improvement. We'll discuss these findings on today's episode.
00;01;34;19 - 00;01;36;17
Alan Weil
Mr. Ali, welcome to the program.
00;01;37;11 - 00;01;38;26
Abdinasir Ali
Thanks, Alan. It's great to be with you.
00;01;39;08 - 00;02;00;16
Alan Weil
Thank you for taking some time talking about this important study that you conducted. As I said in the introduction, we heard about the moratorium on evictions, but I don't know if everyone paid a lot of attention to the details or how they work, who's affected by them? Can you give me some sense of what an eviction moratorium tries to do?
00;02;01;02 - 00;02;05;01
Alan Weil
What are the features of a moratorium on evictions?
00;02;05;23 - 00;02;33;24
Abdinasir Ali
So before I talk about the eviction moratoriums, first of all, eviction is a legal process by which landlords remove tenants from rental property. And the eviction process varies from state to state and between jurisdictions within the same state. Typically, the cost for eviction varies, but it's usually based on nonpayment of rent or lease violations or criminal activity in the property.
00;02;34;15 - 00;03;03;14
Abdinasir Ali
So now the eviction moratorium prohibited landlords from removing tenants from residential property for nonpayment of rent. And also what is important is that the justifications used for this moratoriums were also different. The duration of the moratoriums were also different. The source and the origin, the institutions that put in place those moratoriums within the state were also different depending on what state we're talking about here.
00;03;04;10 - 00;03;11;07
Abdinasir Ali
So generally those moratoriums were broad in place, depending on where you are in the country and what state we're talking about.
00;03;12;02 - 00;03;34;08
Alan Weil
So the idea is someone falls behind on their rent. We know under COVID that a lot of people lost their job, lost their income. We want to make sure that they don't also lose their housing. One of the dimensions along which some of these vary is when in the process the moratorium takes effect. Can you just say a little bit more about that?
00;03;34;08 - 00;03;48;28
Alan Weil
Like, is it right before you're about to get evicted or is it long in advance as you start to fall behind in your payment? Just trying to think about if you're someone who's exercising this this right to not be evicted, how do you really know that that you're covered?
00;03;49;22 - 00;04;12;14
Abdinasir Ali
Yeah, so that's a great point. So the eviction process is divided into five stages, typically. What happens is that if an individual fails to pay, fails to pay rent on the fifth of the month, the landlord typically places a notice on their door, meaning that they have to pay up rent. If within a certain amount of number of days, the tenant doesn't pay,
00;04;12;14 - 00;04;33;13
Abdinasir Ali
it's usually escalated. So the tenant files eviction through the court system. It's a local jurisdiction. So that's the stage two of the eviction process. And then we get to the third stage where a hearing is scheduled, an actual hearing happens of the court. So that's the fourth stage. The third stage, sorry. And then there's the fourth stage where a judgment is issued by a judge on an eviction order.
00;04;33;20 - 00;05;06;17
Abdinasir Ali
And then finally, the fifth stage of the process, when enforcement is done by either local police or a sheriff's office. So the eviction process is a legal process divided into those five stages. What these moratoriums did was, depending on what state you were in, some state stopped evictions from being notices-- landlords from putting notices on doors. Some states targeted through the court process, the sort of that that and the fourth stage where they halted courts from holding hearings.
00;05;06;23 - 00;05;41;22
Abdinasir Ali
And then finally, some states targeted the fifth or the last stage during enforcement of the eviction where they prevented local police from carrying out evictions and the justifications that were used for these moratoriums were different, depending on the states or in some states justified these moratoriums to prevent or to reduce the spread of the virus. Some states justified using the the economic reason for it, because a lot of people lost jobs and they were-- and the unemployment numbers spiked.
00;05;41;22 - 00;06;05;04
Abdinasir Ali
And so to keep people in their homes due to economic factors, some states used sort of that justification and then these moratoriums the way they were designed, depending on what state you were in, some states were, you know, used the legislature to put together these moratoriums. Some used the executive branch of state governments through the governor's office.
00;06;05;12 - 00;06;10;17
Abdinasir Ali
And so there were variations, depending on where you are, what state you were in across the country.
00;06;11;11 - 00;06;30;06
Alan Weil
So this is really interesting to me. I mean, we sort of heard this term. But what you're saying to me is that the way it plays out is actually quite variable. The rationale for it is variable. The legal authority to put it into place is variable. Let's turn to what you are trying to study in your paper.
00;06;30;06 - 00;06;46;29
Alan Weil
You're looking at the mental health implications. So maybe before we get into the findings per se, you could just say a little bit about why you would expect there to be a connection between people's housing circumstances and their mental health.
00;06;47;12 - 00;07;14;04
Abdinasir Ali
So we know a lot about the relationship between unstable housing and mental health. So the risk of eviction, which is as a result of unstable housing, places tremendous mental strain on the lives of affected individuals, right? So and unstable housing has traumatic effect on the lives of affected individuals and families and usually leads to worse mental health outcomes, including long term stress and depression.
00;07;14;28 - 00;07;41;08
Abdinasir Ali
And unstable housing is also a big driver of homelessness and substance abuse among vulnerable populations. And so there are many studies that have shown the impact of sort of unstable housing or evictions on our mental health. Well, recently, there are studies that have also shown that and unstable housing patterns were also associated with higher rates of hospitalization, increased cost to the health care system.
00;07;41;27 - 00;07;53;10
Abdinasir Ali
And so when we were doing our literature review for our study, we found that, you know, unstable housing, poverty and mental health are all interrelated and drivers of disparity in health outcomes.
00;07;54;06 - 00;08;11;18
Alan Weil
Okay. So you've laid the foundation here very clearly. We have a period where we put eviction moratoriums in place at different times in different states. We have an evidence base suggesting the critical relationship between stable housing and mental health. Tell us what you found out.
00;08;11;29 - 00;08;43;28
Abdinasir Ali
Before our study, there were two other studies that looked at this topic effect of evictions on-- eviction moratoriums on mental health in 2020. One study found declines in likelihood of African-American families reporting feeling anxious or down, according to data from COVID-19 household survey. And then there was another interesting study, you know, before our study that looked at moratoriums that blocked notices of eviction by property owners.
00;08;43;28 - 00;09;30;28
Abdinasir Ali
So sort of they looked at and evaluated what stages of eviction had more impact on mental health. And what they found was that the evictions that targeted the early phases, meaning the notices of evictions that that are put by landlords on tenants’ properties, had more effect on it. So those two studies were sort of the precursor to our study and our study adds to this by we used a national data from 2021 that looked at the association between those two and we found that state eviction moratoriums were associated with improvement in mental health and the estimates showed that there were 0.4 fewer days not in good mental health in the past 30 days among renters
00;09;31;05 - 00;09;53;27
Abdinasir Ali
with active state eviction moratoriums. We also found eviction moratoriums were associated with declines in the likelihood of reporting frequent mental distress among renters by 1.3 percentage points. So our study was much more comprehensive, and we used a national data to look at the impact of eviction moratoriums on mental health.
00;09;54;08 - 00;10;38;25
Alan Weil
Okay, so you find that there is a positive effect on mental health. I'd like to go into a little bit more of the detail of what you discovered and what the implications are. We'll have that conversation after we take a short break. And we're back. I'm speaking with Abdinasir Ali, who has written a paper on the effects of state eviction moratoriums on people who rent, and particularly with a focus on the mental health of those renters.
00;10;39;10 - 00;11;07;06
Alan Weil
Before the break, we got the top line results which show a positive effect on mental health, which fits with what you might expect from the literature regarding stability of housing. But I'd like to go a little deeper than just that top line. In addition to sort of seeing the positive effect, I'm interested in what you know about these renters and whether there were any differences depending on their demographic characteristics.
00;11;07;16 - 00;11;27;16
Alan Weil
I'd also like to talk a little bit about the timing. You mentioned using national data. And I'd like to think about whether or not we have a sense of what the longer term implications are. But why don't we start with demographic characteristics? What do we know about these renters’ characteristics and whether or not the implications were different based on those characteristics?
00;11;28;01 - 00;12;03;29
Abdinasir Ali
So we do observe that effects across all subgroups that we analyzed in our study. The estimate was largest among non-Hispanic Black people, about 3.2 percentage point decline in the likelihood of reporting frequent mental distress. Among non-Hispanic Whites who rent, the declines were a 1.1 percentage point in the likelihood of reporting frequent mental distress. And then for women, we saw 1%, 1.4 percentage point decline in the likelihood of reporting frequent mental distress.
00;12;04;08 - 00;12;16;18
Abdinasir Ali
And then we also analyzed groups by income as a percentage of federal poverty level. And we found that all income groups saw declines in the likelihood of reporting frequent mental distress.
00;12;16;29 - 00;12;38;14
Alan Weil
Okay. So these are broadly experienced benefits, although they do vary a bit by characteristic. Let's talk just a bit about the time horizon, the dates of the moratoriums you were looking at, as well as the time period for the effect. Because I know one of the interesting questions will be whether these benefits are long-lived or short-lived.
00;12;39;07 - 00;13;03;08
Abdinasir Ali
We were able to observe these effects when the moratoriums were in place in 2020. So obviously this was a short term effect. When more data becomes available, we're hoping it's one of the things we're trying to evaluate and find out whether we'll be able to see those effects through 2021. So our data was limited to to 2020 because that's the data we had available.
00;13;03;14 - 00;13;10;00
Abdinasir Ali
One of the things we're looking at is trying to see whether the effect would be sustained over 2021.
00;13;10;12 - 00;13;31;11
Alan Weil
Well, it'll be very interesting to look at the longer time horizon. And just before we leave the topic of the findings, you mentioned a few percentage point declines in various sources of mental or types of mental distress. I just wonder, based on your reading of the literature, the other studies you looked at, does this seem to you like a large effect?
00;13;31;11 - 00;13;37;16
Alan Weil
Is this something we should be really excited about, or is it sort of, well, it's positive, but maybe not making that big a difference.
00;13;38;10 - 00;13;59;28
Abdinasir Ali
So that's a great question. It's it's a positive. I mean, we but we expected this because similar studies have also found declines, even though the sample they used was very limited. Ours was a national data. It was a representative data set that we were working with. And so I think what I would look out for is to see whether this would be sustained in 2021.
00;13;59;28 - 00;14;09;05
Abdinasir Ali
I'd be very interested in, you know, in looking at 2021. And I think that would really determine whether I mean, this is a sustained positive outcome.
00;14;09;12 - 00;14;34;21
Alan Weil
Yeah, that would be very meaningful. Well, I'd like us to look forward a bit. It's great to see positive mental health effects of any policy intervention, but presumably a moratorium can't be permanent. At some point, people are going to have to be expected to pay rent. So how do we take what you've learned here and think about what its implications are for public policy?
00;14;35;09 - 00;15;13;20
Abdinasir Ali
Again, that's a great question, Alan. I think these findings do suggest that policies that increase housing instability, lower the cost of rent and provide affordable housing to communities during crisis would alleviate some sort of economic burden on those families who are at risk of eviction. And I think these findings also do speak to the possibility of putting together policies that will ultimately improve the health and well-being of communities by increasing the availability of rental units or providing other interventions that reduce eviction risk.
00;15;14;24 - 00;15;36;03
Abdinasir Ali
And so more broadly speaking, I would say the findings suggest the importance of continuing to study the implications of different policies at the state level, especially policies that target housing by subsidizing housing for the poor and really working towards improving the housing stability of vulnerable populations.
00;15;36;11 - 00;16;02;27
Alan Weil
Well, I'm glad you brought that up, because as I was sitting here thinking about our conversation, the general goal of increasing stability of housing is a topic that that I would think would be of great interest to many. And you have positive effects from increasing stability. If we think of the moratorium not just as a moratorium, but as a single tool to increase housing stability.
00;16;03;07 - 00;16;15;19
Alan Weil
I wonder if you're thinking about your own research, there are other dimensions of policies that could address that broader goal of stability that go beyond the eviction moratorium.
00;16;16;00 - 00;16;50;02
Abdinasir Ali
When I think about and I've been doing housing research for the last two years now in one of my research areas is housing and residential instability, especially among vulnerable populations. And I think one of the things that we and I think we allude to in our study, you know, is that broadly how populations, you know, that are affected by, you know, residential property really require help from government subsidized housing.
00;16;50;02 - 00;17;16;03
Abdinasir Ali
I think it's one area that could potentially help people who are on the margins of our society. And our study found the impact on health on, you know, unstable housing and so I think providing policies that increase the number of housing units available to communities, particularly areas that are deprived, I think would really improve health outcomes and lower disparities among these communities.
00;17;16;14 - 00;17;40;08
Abdinasir Ali
One other area that I think that focus of policy should be, you know, subsidized housing should also play into is... Generally in an economic climate where now we talk about housing affordability as a big problem, you know, rising rents, inflation, and sort of all these economic factors that are at play usually affect poor people, people who are of low income.
00;17;40;09 - 00;17;50;27
Abdinasir Ali
And we've seen how that, you know, problems with unstable housing really affects health and increases health disparities among these communities.
00;17;51;02 - 00;18;17;06
Alan Weil
Well, I really appreciate you broadening out the topic. That's what it's going to take, I think, to see a sustained and significant movement in some of the indicators you mentioned. Mr. Ali, thank you so much for the study, for the thought and interpretation of the work you've done and the focus on such a critical issue. Thank you for being my guest today on “A Health Podyssey”.
00;18;18;01 - 00;18;22;11
Abdinasir Ali
Thank you, Alan. I enjoyed being with you. Thank you so much.