Foreclosures are a bona fide public health crisis

By Craig E. Pollack and Julia F. Lynch
The New York Times

After slowing down in the first half of the year, the rate of homes entering foreclosure is rising again. First-time default notices were served on 78,000 homes in August, a 33 percent increase from July. A $1 billion federal program to help jobless and underemployed homeowners ended Friday. Foreclosure notices were filed against a record 2.9 million properties last year, and an additional 1.2 million in the first half of this year.

Foreclosure is not just a metaphorical epidemic, but a bona fide public health crisis. When breadwinners become ill, they miss work, lose their jobs, face daunting medical bills — and have trouble making mortgage payments as a result.

foreclosure

But that is only part of the story. A growing body of research shows that foreclosure itself harms the health of families and communities. In our 2008 survey of 250 people undergoing foreclosure in the Philadelphia area, 32 percent reported missing doctor’s appointments and 48 percent said they let prescriptions go unfilled, significantly higher rates than others in their community. A paper released last month by the National Bureau of Economic Research found that people living in high-foreclosure areas in New Jersey, Arizona, California and Florida were significantly more likely than those in less hard-hit neighborhoods to be hospitalized for conditions like diabetes, high blood pressure and heart failure.

More than one-third of homeowners in our study had symptoms of major depression. The N.B.E.R. study found significantly more suicide attempts in high-foreclosure neighborhoods. For every 100 foreclosures, it found a 12 percent increase in anxiety-related emergency-room visits and hospitalizations by adults under 50. Losing a home disrupts social ties to neighbors, schools, jobs and health care providers — ties that under better circumstances promote good health. Neighborhoods suffer, not just homeowners.

Most programs to stem the tide of foreclosures rely on mortgage counselors at nonprofit groups supported by federal grants, who work closely with homeowners and banks to try to find a financial resolution.

These counselors have become, of necessity, crisis counselors — in a national survey of 395 mortgage counselors we conducted in January, 37 percent said they had worked with at least one homeowner in the past month who was considering suicide — but they need to be trained to quickly and efficiently screen for illnesses like depression. In fact, health care should be part of a comprehensive approach to foreclosure prevention; for example, mental health caseworkers should be embedded in mortgage counseling agencies.

Screening and treatment may actually help some families keep their homes. Studies of unemployed people have shown that treating depression can improve the chances of landing a new job. Such treatment might also help homeowners undertake the daunting documentation and financial planning that foreclosure prevention programs demand.

In a time of fiscal strain and rising need, where will the money come from? For one thing, the settlement negotiations with the financial services industry over mortgage fraud and abuse should include money for health care. Millions of Americans are locked into mortgages they can’t afford. If we can’t help them stay in their homes, the least we can do is help them stay alive.

Craig E. Pollack is an assistant professor of internal medicine at Johns Hopkins. Julia F. Lynch is an associate professor of political science at the University of Pennsylvania.

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