Eviction is a Public Health Crisis: San Francisco Must Treat It Like One

In San Francisco, eviction notices are usually discussed as legal disputes or housing market statistics. For the families receiving them, however, eviction subtly marks the beginning of a health crisis, whether they know it or not. 

Losing a home can mean losing access to doctors, pharmacies, schools, and community networks that make daily life manageable. For people managing chronic illness or mental health conditions, that disruption can be devastating. Housing instability is typically framed as an economic or development issue, but it should also be treated like a serious disease in the midst of a public health crisis.

The scale of housing instability in San Francisco is becoming increasingly prominent. Median rents for a one-bedroom apartment routinely exceed $3,000 per month, placing stable housing out of reach for many working residents. In 2023, the San Francisco Rent Board reported more than 1,200 eviction notices filed in the city.

At the same time, redevelopment projects and rising property values continue to shift entire neighborhoods. The Mission District and Bayview communities have experienced large waves of displacement as longtime residents struggle to keep up with rising housing costs. 

The threat of displacement becomes a worry in everyday life. City leaders have recently recognized the extent of this issue and have proposed legislation to expand tenant protections when residential buildings are demolished or substantially renovated. 

The policy would require developers to replace demolished housing units and provide relocation assistance to displaced tenants, preventing redevelopment from pushing longtime residents out of their communities. There is, however, concern that additional regulations could discourage development or delay the construction of desperately needed housing. These critics miss the crucial reality that the displacement itself carries serious health consequences.

Clinicians and researchers in San Francisco have increasingly highlighted this problem. Dr. Margo Kushel and Dr. Josh Bamberger, physicians who study homelessness and health at the University of California, San Francisco, have documented how housing instability is associated with higher rates of chronic disease, mental health conditions, and emergency department use. 

When people lose stable housing, the systems that support their health often collapse at the same time. A change of address can mean missing medical appointments, losing proximity to clinics, or struggling to safely store medications.

The concept of fundamental causes, developed by sociologists Bruce Link and Jo Phelan, holds that certain social conditions, such as income, education, and housing stability, eventually shape health outcomes across many diseases over time. These events influence access to “flexible resources”: money, knowledge, and social connections that help individuals avoid health risks or respond to illness.

When those resources disappear, health outcomes worsen multi-fold across various domains. Losing a home does not simply increase the risk of a single illness. It goes beyond that, creating a whole cascade of risks. It has been studied that people experiencing housing instability face higher rates of depression, anxiety, and chronic stress, all of which contribute to long-term health problems or exacerbate already existing health issues.

Additionally, it was found that children who experience eviction early on often experience disruptions in schooling and exposure to prolonged stress throughout the rest of their life, affecting general development and health.

Despite these risks, eviction is frequently framed as the result of individual choices rather than structural conditions. This narrative reflects another concept discussed in the context of social determinants in global health: the naturalization of inequalities. When inequalities are naturalized, they are explained as the inevitable result of personal behavior rather than as the outcome of broader social systems and policies. In housing debates, we see this when displacement is attributed to poor financial decisions or irresponsible spending. 

But this explanation ignores the inevitable structural forces shaping San Francisco’s housing market. Housing shortages, restrictive zoning policies, and global real estate investment have all contributed to rising housing costs that far outpace wages for many residents; it’s not just individual responsibility.

Shamus Roller, a housing advocate, has argued that eviction policies and redevelopment decisions ultimately determine who can remain in a city and who is forced to leave. When these structural drivers are ignored, displacement begins to appear natural or unavoidable. 

Yet housing instability is not inevitable: it is the result of policy decisions, and policy decisions can change. Recognizing eviction as a structural issue has important implications for public policy and could enact real change with the right attention. If displacement harms health, then policies that prevent eviction should be understood as public health interventions. 

Tenant protections that require relocation assistance and replacement housing units will not solve the housing crisis on their own, but they can reduce the immediate harms and potential long-term effects associated with displacement.

Critics often argue that stronger tenant protections discourage development and worsen housing shortages. San Francisco does need more housing, particularly affordable housing. Increasing supply is essential for improving long-term affordability. 

However, development strategies that ignore displacement risk deepen inequality. Building new housing while simultaneously forcing existing residents out simply reshapes the crisis rather than solving it.

A more balanced approach would pursue both goals simultaneously: encouraging housing construction while protecting tenants from displacement. Policies such as relocation assistance, replacement housing requirements, and stronger eviction protections allow cities to grow without sacrificing the stability of the communities already living there.

Public health research has long emphasized that health is shaped by the environments where people live. Stable housing provides a foundation for managing chronic illness, maintaining social networks, and accessing healthcare services. When housing becomes unstable, those foundations disappear, weakening communities facing rapid economic change. Housing policy may not look like healthcare, but in order to improve health outcomes, ensuring that people can remain in their homes may be one of the most effective interventions available.