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REVIEWED BY: MICHAEL MILLER, JR., MA

EVICTED: POVERTY AND
PROFIT IN THE AMERICAN
CITY
Crown Publishing Group
MATTHEW DESMOND
422 pages

I bought Matthew Desmond's Pulitzer Prize- winning book, Evicted: Poverty and Profit in the American City, sensing that it was something I needed to read. The book, however, remained unread on my shelf for about a year. I'm not totally sure why. Perhaps I anticipated some of the hard truths that it would reveal and, somewhere, deep down, I recognized that I wasn't ready to confront them just yet.

I was right.

The book was not an easy read, due to its subject matter. After embedding himself in low-income housing communities in Milwaukee, Wis., Desmond tells the stories of eight families he encountered. Through these sad, gut-wrenching and occasionally funny stories, the reader gets to know both the landlords and tenants from their own perspectives. Desmond, a sociologist at Princeton, offers glimpses into the motivations and struggles of those who seek housing and those who provide it. His comfortable prose serves as a fantastic primer on low-income housing.

For example, Scott is one of the renters Desmond profiles in Evicted. He is a former nurse, who, after a back injury, became addicted to pain medications. After getting caught diverting drugs while working at a nursing home, he loses everything: his nursing license, his apartment and his way in life. After struggling with the roller coaster of addiction and multiple attempts to reconnect with his family, he finds himself confronted with a difficult choice: pay for addiction treatment or pay the rent?

Desmond also tells the story of Sherrena, a landlord who owns multiple properties on Milwaukee's North Side. Early in Evicted, Desmond shares her struggle with the decision to evict Lamar, one of her tenants. Lamar has no legs and has multiple kids that live with him. He also didn't pay his rent. This puts the landlord, Sherrena, in a difficult position. Without wiggle room in her business model, the loss of a month's rent has a direct impact on her ability to pay her mortgage.

As you continue reading Evicted, you learn that Sherrena owns about three dozen properties and estimates her net worth at $2 million. With all her tenants at or below the poverty line, Sherrena nets about $10,000 a month. Desmond quotes her saying, "The 'hood is good. There's a lot of money there."

It is likely that, as you read Evicted, you will feel some empathy for both the renters and landlords Desmond profiles. The landlords are simply trying to hold people accountable when a contract is broken. On some level, it seems fair to evict someone who doesn't pay their rent. However, when you begin to understand the perspective of renters who are paying significant portions of their income to rent substandard apartments, the landlords may also be breaking their ends of the contracts in these situations. Zoom out a bit from these perspectives, and the system-level injustices become visible. Suddenly, it is crystal clear that systemic change is desperately needed.

On the surface, this book is about housing, but it is really a book about poverty. Desmond makes a compelling case that eviction is a cause of poverty, not a symptom. Evicted speaks to the power of policy. The stories of eviction and poverty we hear and read about today occur by design. Generations of African Americans and other minorities have been negatively impacted by redlining — when lenders would target areas with a high concentration of people of color and refuse to lend in those areas. Other factors, like certain zoning restrictions and federal mortgage practices, have shaped a system where landlords can sometimes unfairly profit from the poverty of some of our most vulnerable neighbors.

Desmond does offer some hopeful solutions in the book's epilogue. In a balanced, thoughtful approach, he acknowledges good work that has already been accomplished. For example, he cites the reduced number of slums, housing quality improvements and programs to address affordability like the housing choice voucher program (a federal program that allows low-income individuals to rent in the private housing market). He also is realistic about work that needs to be done. He notes that the U.S. government spends more on tax benefits for affluent families than it does on housing assistance for families who live in poverty. He then makes a compelling case for a universal expansion to the housing voucher program.

After making clear the implications of a stable home to food security, health care access and mental health, he shares a simple idea: we can ensure the availability of legal services for low-income families who find themselves in housing court. He makes the argument by pointing out that by providing an attorney to those who typically arrive in court unrepresented, we could "prevent homelessness, decrease evictions and give poor families a fair shake."

This is where hospitals and health systems should be paying attention. Housing policy has a significant impact on the patients for whom we care, those we employ and the health of the communities we serve. Hospital ministries should seriously consider leveraging their local political capital to advocate for housing policy that promotes the common good.

In 2017, Desmond created the Eviction Lab at Princeton. This lab collects and publishes nationwide eviction data which can be viewed and compared on the neighborhood, city or state levels. This could be a great source of data for tax-exempt hospitals that are conducting community health needs assessments or simply seeking to better understand the communities they serve. Eviction data can help drive community health strategies and advocacy priorities. (See www.evictionlab.org.)

The topic of housing can be daunting. As the health care industry continues to explore how to address housing as a social determinant of health, it would be easy to get overwhelmed and let the topic gather dust on a shelf. Don't wait to confront the topic. This could be an effective avenue for your hospital ministry to promote the common good, contribute to improved health outcomes and live out its mission.

MICHAEL MILLER, Jr., is system vice president, mission and ethics for St. Louis-based SSM Health.