‘Right to Counsel’ and the interplay between health and housing

By Dennis Archambault

It’s accepted that within the concept of public health, stable affordable housing is an essential determinant of health. The “housing first” model, as applied to those experiencing homelessness, establishes that people need food and a place to live before addressing other aspects of life like employment, education, and health maintenance. The absence of stable housing, or the risk of it, creates and exacerbates disease conditions.


Recently, Council Member Pro Tem Mary Sheffield, joined the United Community Housing Coalition and other advocate groups in mobilizing an effort to achieve a “right to counsel” in Detroit. 30,000 people in the city face eviction or landlord-tenant disputes annually. Because most landlords have attorneys and few tenants can afford to have them, these cases often favor landlords and cause many people to move or become homeless.


I had the opportunity to present the interrelationship between poor health and housing instability, as well housing instability resulting in poor health at a local conference exploring the many facets of people facing eviction or foreclosure. Renters tend to be people with low-wage jobs, or are unemployed, making rent payments difficult to begin with. If they have medical problems, their ability to work may be problematic. If they have health insurance, their co-pays and deductibles are likely to be high.


On the other hand, housing instability, such as being late on rent, having a homeless child, or moving more than two times in the past year increases the odds of negative health outcomes, lack of sufficient and nutritious food, and the ability to pay for utilities. The stress of income insecurity related to the stress of eviction can further exacerbate chronic disease and trigger autoimmune disorders. Disease then leads to health costs, complicating the ability to make house/apartment payments. According to a recent Health Affairs article, low-income families with difficulty paying rent or mortgage or utility bills are less likely to have a primary source of medical care and are more likely to postpone needed treatment. 23 percent of severely cost-burdened renters face difficulty purchasing food and go without prescribed medications.


Right to counsel is primarily a legal safeguard to preserve housing for those having difficulty with rent and mortgage payments. It can also be a point of contact for vulnerable populations, knowing that the stress of housing instability is likely to result in mental and physical health problems. For more information on the right to counsel initiative, visit the UCHC website.


Dennis Archambault is vice president of Public Affairs for Authority Health.