Intimate partner violence has been called “a pandemic within the pandemic.”
A study of fourteen American cities found that the number of domestic violence calls to law enforcement rose 9.7% in March and April 2020, compared to the previous year. A hospital-based study spanning the same time period found significant increases in the number of people treated for injuries related to intimate partner violence. And a 2021 review of 18 studies relying on data from police, domestic violence hotlines, and health care providers found that reports of intimate partner violence increased 8% after lockdown orders were imposed.
Although almost half of people subjected to abuse never call the state for assistance, our responses to intimate partner violence are largely embedded within the state and rely heavily on law enforcement. A disproportionate amount of funding under the Violence Against Women Act — by one estimate, 85% — is directed to the criminal legal system. A growing number of activists skeptical of state intervention are arguing that responses beyond the carceral state are essential.
The pandemic showed that community-based supports, like pod mapping, mutual aid, and community accountability, originally developed by activists critical of law enforcement responses to violence, can foster safety and accountability without requiring state intervention. The pandemic could spur advocates seeking to distance themselves from state-based responses to expand their services.
Amid the COVID-19 Delta variant surge, the federal eviction moratorium — a key public health protection — will soon expire, and faces tough prospects for extension due to a series of legal battles.
These legal challenges highlight a narrow — and dangerous — conception of public health held by some courts, one which fails to recognize how social conditions such as housing can compound the impact of a virus. To protect our nation’s health, this misunderstanding of public health must be remedied.
Even before the COVID-19 pandemic, there was an eviction crisis in the United States. Estimates suggest landlords across the country file 3.7 million eviction cases each year — leaving considerable impacts on health and well-being in their wake.
The eviction process is regulated by a patchwork of state/territory and local laws and court rules that govern the judicial process, but little is known about the ways in which these laws affect the likelihood of evictions.
A new database, launched by the Legal Services Corporation (LSC) in partnership with the Center for Public Health Law Research, captures the entire eviction legal process, from pre-filing to post-judgment, in different communities around the country.
But this action protects only a subset of tenants who meet specific qualifications and, crucially, know to fill out a CDC Affidavit and submit it to their landlords. And despite skyrocketing COVID-19 case counts, most state eviction moratoriums have now lifted, leaving tenants vulnerable to displacement and homelessness.
Justice is good for health [and] . . . health is the byproduct of justice.
— Norman Daniels, Bruce Kennedy & Ichiro Kawachi (Boston Review, 2000)
Among the most salient lessons to be learned from the coronavirus pandemic are that unjust laws produce unjust health outcomes, and that justice is just plain good for America’s health.
Health justice is the moral mandate to protect and advance an equal opportunity for all to enjoy greatest health and well-being possible. Health justice means that no one person or group of people are granted or excluded from the means of pursuing health on an inequitable basis. To achieve health justice, societal institutions such as governments and health care providers must act to advance equality, by increasing fairness and decreasing unfairness of their current and historic impacts on populations.
Image from “Mapping Inequality,” American Panorama, ed. Robert K. Nelson and Edward L. Ayers.
By Courtney Anderson
Only 10-20% of health outcomes are attributed to health care. Social, economic, and environmental factors thus account for the vast majority of population and individual health outcomes. And housing encompasses many of these factors, as it largely determines the built environment and exposure to stressors.
Section 801 of the Fair Housing Act declares, “It is the policy of the United States to provide, within constitutional limitations, for fair housing throughout the United States.” This Act was the culmination of racial justice protests, resistance to discrimination and violence, and other aspects of the civil rights movement. Despite the stated intention of this Act, housing remains unequal across the nation.
Mr Justice Chamberlain in the Queen’s Bench Division of the High Court of Justice ruled recently that a patient, known as MB, who had occupied an NHS bed for over a year, must vacate it and instead receive care in the community. Her room could be required urgently by COVID-19 patients and there would be an increased risk of MB contracting COVID-19 if she remained in hospital.
Inclusionary zoning (IZ) laws are one such approach, and are intended to create affordable housing through collaboration between public and private developers. These laws create requirements and incentives for developers, such as unit size minimums and establishing income eligibility criteria. IZ laws counter preceding ‘exclusionary zoning’ policy where large-lot zoning is used to prevent low-income integration into rising developments. Contrary to the original intent, IZ laws have been criticized for creating potential financial disincentives to develop in low-income areas and increasing housing price inflation.
To combat this risk, states like New Jersey, Massachusetts, and California have added additional incentives such as density bonuses, expedited approvals, and fee waivers. These have been presented to developers as part of state ordinances and regulations. Under its Affordable Housing Act, Illinois seeks to create grants, mortgages, and loans to rehabilitate, develop, operate, and maintain housing for low-income and very-low-income families. The Act requires local governments to create affordable housing plans based upon their municipalities’ median incomes. For example, based upon population median incomes and housing values, the town of Evanston, Illinois is required to provide 4,993 affordable housing units to accommodate its population of 75,472 who have an area median income of $63,327.
The Cook County Health Department in Illinois just published a dataset to LawAtlas.org as part of a yearlong legal epidemiology project funded by the CDC Public Health Law Program and ChangeLab Solutions. The health department created a policy surveillance dataset tracking IZ laws in 10 municipalities across the country, concentrating on residential areas around Cook County and the Chicago Metropolitan area: Boulder, Colorado; Burlington, Vermont; Cambridge, Massachusetts; Evanston, Illinois; Highland Park-Lake County, Illinois; Irvine, California; Lake Forest-Lake County, Illinois; San Diego, California; Santa Fe, California; Stamford, Connecticut.
One common provision of IZ policies are set-asides. These are ordinances that require developers to reserve a portion of the new development for low-income residents. Through its policy surveillance project, the health department found that nine of the jurisdictions have implemented mandatory IZ policies and six jurisdictions have established preferences for who can live in set-aside units. The percentage of set-aside required for low-income housing varies by jurisdiction – from 10 percent in two jurisdictions, up to 25 percent in one. Of the 10 jurisdictions studied, one (Stamford, Connecticut) doesn’t require any set-aside, and nine allow for alternatives to set-asides, such as fee-in-lieu (nine jurisdictions), land dedication (six jurisdictions), and alternative proposals (four jurisdictions). For those jurisdictions with fee-in-lieu alternatives, seven provide those payments to Affordable Housing Funds.
While extensive literature provides evidence for a positive association between levels of wealth in an area and the levels of health in that area, more research is needed to establish the efficacy of IZ laws. Governments are increasingly implementing relevant policies to combat the negative effects of gentrification and IZ policies could be part of the mix, particularly when used in conjunction with efforts to preserve existing community culture beyond property interest, as neighborhoods provide important social support networks for residents. “Revitalization without displacement” is a rising standard for preserving the positive economic benefits of gentrification without destroying communities through displacement. This policy advocates increasing the total population by filling vacancies and increasing housing densities and preserving community bonds. Experts consider ‘social mix’ to be a common good.
The ten policies in this dataset are just the tip of the iceberg, but they do offer an interesting, important look into the complexity and variation of these laws.
Florence Nightingale once said, “The connection between health and the dwellings of the population is one of the most important that exists” — a statement that is as true today as it was at the turn of the 20th century. A decent dwelling and diverse communities, where there is access to transportation, good schools, shops, parks, socioeconomic mixture, social capital and collective efficacy, and economic opportunity are all features necessary for both a high-level and equitable distribution of well-being.
The promise of healthy housing and communities, however, falls short in the United States. Much of the housing in the U.S. is expensive, unsafe, and inadequate in supply. Read More