We are concerned health professionals calling on you to take immediate action to protect public health in the following ways during the COVID-19 pandemic:

- Enact a moratorium on evictions, foreclosures, and encampment sweeps
- Turn vacant units into safe homes for those who need them
- Cancel payment requirements and suspend utility rate increases
- Invest in quality, stable, affordable housing for all

Decades of public data demonstrate that access to stable, safe and affordable housing is critical for health and well-being. Today, we face the unprecedented dual crises of coronavirus and its economic fallout. As of mid-May, 1.5 million people in the United States were infected with COVID-19 and over 36 million people were unemployed. These numbers are steadily increasing.

In April, more than one-third of apartment renters were unable to pay rent on time; figures for the coming months could be even higher once stimulus checks are spent. As rent, mortgages, and other payments continue to come due, failure to act now will have dire immediate and long-term consequences for the health of individuals, families, and communities across the United States, especially for those already experiencing economic and social marginalization.

We are writing to ask that you use your power — including using your authority as emergency response decision-makers and agencies with enforcement capacities — to take immediate action to protect the health and safety of all residents in your jurisdiction by doing the following:

1. Enact a moratorium on evictions, foreclosures, and encampment sweeps. Ensure permanent refuge.

“Sheltering in place” has been one of the key methods used nationally and globally to reduce coronavirus transmission. However, millions are facing economic insecurity which decreases renters and homeowners’ ability to pay rent and mortgages, thereby increasing the risk of eviction, foreclosure, and homelessness and decreasing ability to shelter in place. In addition to increasing risk of COVID-19, housing instability results in a wide variety of physical and mental health conditions and is particularly harmful for kids’ well-being and educational outcomes.

Establishing moratoriums on evictions, foreclosures and encampment sweeps are minimum critical first steps needed to help keep people sheltered during the duration of the COVID-19 crisis, even when shelter-in-place orders have been removed.

Everything possible must be done to keep people in their homes and prevent further disruption to individuals and families. Providing comprehensive support to those “sheltering-in-place” outside including temporary shelter, food, water, access to sanitation, and support services helps people experiencing homelessness be safer until they are housed.

To address these issues, local and state/territorial decision makers should ensure that all people can:
- Be able to stay in their homes.
- Be provided adequate housing.
- Be allowed to safely shelter-in-place whether they are housed or unhoused.
- Be able to maintain belongings to ensure personal and public health and safety.

Examples of government-subsidized emergency rental assistance in Chicago (IL), Hillsboro (OR), and St. Paul (MN). And numerous resources exist to help you develop establish moratoriums, including an Eviction Moratorium Model Ordinance Template, this map of state and local moratoriums and emergency tenant protections, and a scorecard of COVID-19 housing policies.

2. Turn vacant units into safe homes for those who need them

All people experiencing homelessness are more at risk of the worst impacts of COVID-19 -- and not just those who have tested positive already. The latest national data shows that people who are homeless and contract coronavirus are:
- 2x as likely to be hospitalized
- 2-4x as likely to require critical care, and
- 2-3x as likely to die than others in the general public who are housed

COVID-19 has quickly spread in congregate living spaces including homeless shelters, as well as among people who are incarcerated in jails, prisons, and ICE detention centers. For example, 8 of the 10 largest COVID-19 outbreaks in the US have happened in correctional facilities. In Texas, 70% of people in prisons who have been tested have tested positive.

As some jurisdictions implement critical health-protecting measures such as creating expanded housing for residents experiencing homelessness and/or decarcerating prisons, jails and detention centers, government procurement of hotel rooms (and other vacant units) is an approach that can create an environment to protects people’s health as they experience these transitions, and decreases transmission in the broader community. This can and should be done without conditions for accessing housing (e.g. removing barriers based on proof of COVID-19 exposure or positive status) and without the use of law enforcement to enforce shelter-in-place requirements.

To that end, local and state decision makers should turn vacant units — in hotels, dorms, offices, unoccupied homes — into safe homes for people experiencing:
- Homelessness
- Intimate partner violence
- Release from incarceration and detention
- Others needing healthy housing now

Hotel rooms have been procured for people needing them in numerous jurisdictions including Denver, Tucson, Minnesota (statewide), Chicago, and San Francisco. The National Low-Income Housing Coalition has also compiled national, state and local policies and federal guidance around this topic.

3. Cancel payment requirements and suspend utility rate increases

Prior to COVID-19, 47% of U.S. renters were already cost-burdened and 25% were severely cost-burdened (spending respectively more than 30% and 50% of income on housing) and two-thirds of renters had less than $400 in emergency savings. Although stimulus checks have helped stabilize some for a month or two, the unprecedented rates of rapid unemployment are increasing risks of eviction, foreclosure and homelessness for millions.

As described above, loss of housing translates into direct risks to health, including physical and mental health impacts and impacts to child health and well-being. When housing costs are high compared to incomes, people are likely to cut back on other basic needs like health care, medications and food.

People whose utility service is shut off, or who are threatened with disconnection, face stress, hunger, respiratory illness, and heat and fire risks. Early childhood health and development can be compromised. Energy insecurity threatens the lives of people with chronic illness and those living on life-support.

To address these issues, local and state decision makers should:
- Cancel rent, mortgage, and utility payments for all through the duration of the public health and economic crisis for all renters, homeowners, and small businesses, and ensure a 3+ month recovery period.
- Ensure that utilities like water, gas, electric, phone, and internet are provided as a public good, especially during a public health crisis. Indefinitely suspend any proposed rate increases and utility service shut-offs for all households, regardless of ability to pay.

Examples of policies can be found in New York, Denver, Seattle, and Oakland. And model ordinances to cancel rent are available locally and for states.

4. Invest in quality, stable, affordable housing for all

There are numerous ways to make these kinds of investments. Investing in community land trusts have been found to increase housing and financial stability and promote social cohesion, particularly among communities historically experiencing health and social inequities, which contribute to overall health and well-being.

Rent control helps stabilize housing, reduce displacement and its health impacts, and increases access to permanently affordable housing helps reduce stress and related adverse health outcomes, reduce exposure to unhealthy housing conditions, decrease overcrowding and infectious disease transmission and ensure resources for other aspects of well-being including health care, food, transport and education.

And proactive rental inspections can help protect tenants from lead poisoning, exposure to pests, mold and other allergens, and from retaliations by landlords when requesting repairs or filing complaints about rental conditions.

To invest in homes that protect and promote public health, local and state decision-makers can:
- Convert publicly owned vacant land into community land trusts — such as in VT, NJ, TX, MN, MA, FL
-Remove housing from speculative markets and converting into permanently affordable, community-controlled housing
- Prevent displacement during development
- Establish enforceable rent control, tenant protections, and proactive rental inspections — such as in OR, CA, CO, NY, IL.

Additionally, see the following resources here:
- Guide for Proactive Rental Inspections
- Policies to promote development without displacement

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Our government must demonstrate and exercise urgency in meeting the health and material needs of those who are most marginalized and vulnerable, including allowing people to stay housed, preventing additional homelessness, and protecting currently unhoused people. In most places across the US, people who are undocumented are also particularly at risk of losing homes and businesses as they are ineligible for economic relief or unemployment benefits.

Some states and localities have taken strong short-term steps to protect their residents and support those most vulnerable to the ongoing harms of this crisis, including the passage of eviction and utility shut-off moratoriums.

Eviction and shut-off moratoriums are critical first steps and a baseline for protecting public health, but unfortunately they are only stop-gap measures. As the unprecedented economic downturn continues, tenants, homeowners, and many community business owners will continue to struggle to make ends meet even as communities rebuild once it is safe to do so. All eviction moratoriums passed so far require back rent be paid, some as soon as shelter in place orders lift. This could mean widespread evictions, and home and business losses as soon as moratoriums expire. What is needed is an increase in protections for renters and homeowners from economic and pandemic volatility and an increase in quality, stable and affordable housing for all, today and into the future.

In this current state of emergency, we believe we have a duty to speak out as public health professionals and healthcare providers wherever we see community health at risk.

At its core, the practice of public health centers on defending the health of all and preventing harms and illness before they take place.

It is clearer now than ever that our health is interconnected, and we encourage you to take swift action to protect community health and prevent further traumas to already marginalized communities. In this critical time, we are counting on you to use the power that you have to prioritize the health and safety of our communities.

Sincerely,

APHA Caucus on Homelessness, Executive Committee
The Arizona Alliance for Livable Communities
Beloved Community Consulting
Berkeley Free Clinic
Berkeley Media Studies Group
Brigham & Women's Hospital
Brookline Department of Public Health
California Nurses Association/National Nurses United
Center for Health and Social Care Integration
Charles Hamilton Houston Institute for Race and Justice, Harvard University
Collaborative for Health Equity Cook County
Colorado Association of Local Public Health Officials
Challenged Conquistadors, Inc.
Champaign-Urbana Public Health District
ChangeLab Solutions
Detroit People's Platform
Do No Harm Coalition
Doctors for America
Doctors for Camp Closure
Engaging Peace, Inc.
FXB Center for Health & Human Rights, Harvard University
HealthBegins
Health by Design
The Health & Housing Consortium, Inc.
Health Resources in Action
Human Impact Partners
Indiana Public Health Association
Institute for Community Health
Lakeview Strategic Services
McNary Group
National Health Care for the Homeless Council
National Latinx Psychological Association
Native American Coalition of North Dakota
Partners in Health
Pinnacle Prevention
Positive Women's Network - USA
The Praxis Project
Progressive Doctors
Psychologists for Social Responsibility
Public Health Justice Collective
Regional Asthma Management and Prevention
The Sidewalk Project
Vallejo Housing Justice Coalition

[Names of 600+ health workers]