Oct 21 2011
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When Dreams are Destroyed by the Foreclosure Crisis, Health Suffers Too

Craig Pollack , MD, Robert Wood Johnson Foundation Clinical Scholar alumnus (2006-2009), has been looking at the ways the nation’s housing crisis is harming the health of those affected by foreclosures. In a series of studies conducted with fellow scholars and an oped piece in the New York Times, “Foreclosures Are Killing Us,” Pollack takes an in-depth look at this issue. The Human Capital blog explored his views.

Human Capital Blog: How and when did you become interested in the subject of foreclosure and health?

Craig Pollack: As a medical student, I performed research in post-conflict Bosnia-Herzegovina. The research introduced me to the important connections between housing, displacement and health. This led to several epidemiologic studies looking at the nexus of home ownership, wealth and health in different contexts. The foreclosure crisis brought together many of these themes and was additionally compelling because of the potential implications for health disparities.

HCB: What aspects of the subject have you studied so far and what are your main conclusions?

Pollack: In our first study of foreclosure, Julia Lynch, PhD, (an associate professor of political science at Penn) and I surveyed 250 homeowners who were presenting for their initial mortgage counseling session at a Philadelphia mortgage counseling agency. Compared to a community sample and after adjusting for a range of economic factors, those facing foreclosure were more likely to report skipping going to the doctor and prescription medicines because of the cost. In addition, over a third of these homeowners had symptoms of major depression.

In the second study, homeowners who received a home foreclosure notice were matched to electronic health records at a university hospital system. In the two years prior to foreclosure, homeowners undergoing foreclosure were more likely than the control group to visit the emergency department, have an outpatient visit, and have a no-show appointment. The results reinforce that there are differences in health care utilization that are associated with foreclosure.

In the third, we performed a national survey of mortgage counselors.

Mortgage counselors help homeowners negotiate with their lender, and there is a concerted effort to get individuals into mortgage counseling early. The 395 mortgage counselors who responded said that they frequently saw clients with significant health concerns; however, they lacked training in how to appropriately triage these individuals to health services. The majority were interested in learning more about community resources.

Most recently, Dawn Alley, PhD, led the analysis of data from the Health and Retirement Study. The data demonstrate that mortgage delinquency is associated with changes in health over time among older adults.

HCB: What have been some of the more surprising findings from your research?

Pollack: I’ve been surprised by the high rates of depression and the extent to which people have been cutting back on their health spending in trying to save their home. However, it’s the personal stories that bring this research to life. I’ve heard too many stories of families who had such high hopes for their homes who have seen their dreams destroyed.

HCB: What are the broader societal implications of your findings?

Pollack: It’s critical to plan for the potential health impacts when designing ‘solutions’ to the housing crisis. We’ve argued that housing counselors should be trained to appropriately screen and refer clients for additional services. Pilot programs could, for example, test whether embedding mental health counselors at mortgage counseling agencies improves people’s health. In addition, as states negotiate settlements with the financial services industry, it is important to consider the health costs into these calculations.

HCB: You’ve worked with a number of colleagues from other RWJF programs over the years. How did you all come together around this subject?

Pollack: I began working with Julia Lynch when I was a Clinical Scholar at Penn. With the combined research in progress sessions with the Health & Society Scholars, I came to know Dawn Alley and Carolyn Cannuscio, Sc.D., Sc.M., and learned that they had been working in parallel. From there, the collaborations grew and developed.

HCB: Do you plan to continue to study the subject, and if so, how?

Pollack: There are many unanswered questions about the ways in which housing and financial strain impacts the health of homeowners, their families and communities. I’ve been working on a number of studies that attempt to elucidate the different mechanisms and pathways that may be involved. With an increasing body of evidence supporting a connection between foreclosure and health, we’ve been designing trainings for mortgage counselors and advocating for ways to help homeowners. More broadly, I’ve been working on a project that examines how different types of public housing influence the economic diversity of people’s social networks and their health.

Read an article about Pollack's study on the RWJF Human Capital Web site.

Tags: Clinical Scholars, Health & Health Care Policy, Housing/public housing, Human Capital, Media Coverage, Medical, Nursing & Dental Workforce, Research, Research & Analysis, Social determinants of health, Voices from the Field