· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
The Ellis Act is a California housing law that allows a landlord to evict their tenants if they wish to go out of business. This is commonly invoked when a landlord wishes to sell the business to someone who will redo it and re-lease the units at market rate, often many times what the prior tenants were paying or could afford. Evictions have increased in San Francisco several-fold in the last 10 years, with Ellis act being one of the leading causes. Eviction is known to have profound health effects, and even in my extremely short experience as a medical student I had several patients who were recently evicted and became hospitalized due to worsening chronic illness.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
An evaluation of the health impacts of Ellis Act evictions would contribute to the growing body of knowledge about the health impacts of eviction, and build evidence for why the policy should be disbanded.
· Specify the outcomes and populations you think most affected or least affected by the policy.
Evictions have been shown to be associated with suicide, food insecurity, worsening chronic disease, . The populations most affected, as demonstrated by community organizations and activists, are families, elderly people, people of color, people who are already marginally housed, and people of lower socioeconomic status. Additionally, specific neighborhoods in San Francisco, namely the Mission, Castro, and Bayview, have disproportionately higher rates of evictions.
· Propose a study design to evaluate the policy.
Using hospitalization length as a proxy for worsening chronic disease, a case-control study of a sample of people who are hospitalized to look at the association between any eviction and length of stay in the hospital.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
I think that studying a state-wide policy in a more local context would raise questions about generalizability, and whether an entire state policy should be removed based on one city-based study.