This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility: Residential evictions are associated with adverse health outcomes, particularly among low-income populations. Less is known, however, about whether interventions designed to prevent evictions can improve health outcomes—including whether they may reduce visits to the emergency department (ED).
UCLA Health researchers explored this question by examining the relationship between New York City's tenant right-to-counsel program, which provides free legal representation to tenants facing eviction, and emergency department use. The study, published in the Journal of General Internal Medicine, found no overall association between right-to-counsel programs and ED visit rates. However, among certain population subgroups that were at the highest risk for eviction, these programs were linked to lower rates of all-cause emergency department visits—suggesting possible population health benefits.
At the same time, certain types of ED visits (specifically those related to mental health and substance use disorders) increased in frequency after the tenant right-to-counsel program was launched. "Our finding that right-to-counsel was associated with reduced ED visit rates in populations at elevated risk for eviction underscores the importance of housing stability for overall health," said Katherine L. Chen, M.D., assistant professor of internal medicine and population health scientist at the David Geffen School of Medicine at UCLA.
Chen was the study's first and corresponding author. Researchers analyzed more than 8 million ED visits from January 2016 through February 2020, limiting the analysis to Medicaid-insured and uninsured New York City residents. They used the program's staggered rollout as a natural experiment to find out how it may have impacted emergency department usage among residents of ZIP codes where the program was implemented.
They also explored differences across age groups and phases of program implementation. New York City's program, the country's first tenant right-to-counsel policy when it was introduced in 2017, contracts with nonprofit law offices to provide free legal representation to low-income tenants facing eviction proceedings. The program was launched in 10 ZIP codes with especially high eviction risk, homelessness rates and limited housing resources, then expanded to additional ZIP codes in phases.
Across all covered ZIP codes, the researchers estimated a slight drop in ED visits per 10,000 residents following program implementation. However, the scenario differed in the neighborhoods targeted for the earliest phase of the program due to their especially high eviction risk. During its initial phase, the right-to-counsel program was associated with more than 26 fewer ED visits per 10,000 residents—a significant reduction.
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