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Housing and health

Health and housing (woman in protective gear washing windows)

Housing and neighborhoods are critically important for health and well-being. A significant body of research demonstrates the connections between housing and health, showing the influence of housing affordability, stability, quality and neighborhood conditions on the health of individuals and communities. This brief provides an overview of these four primary connections and highlights resources to help decision makers leverage housing as a platform to improve the health of communities.

Affordability

High housing costs can strain household finances, leaving households with inadequate resources to obtain critical health supports, including healthcare services, prescription medications, and nutritious food. Households with high housing costs have been shown to delay necessary medical care and report poorer self-rated health status. Renters are even more likely than homeowners to self-report unaffordable housing and cost-related healthcare nonadherence. Households that lack affordable housing are also more likely to move frequently, making it more difficult to maintain continuity of healthcare services and healthcare coverage.

Policies and programs that increase access to affordable housing can play a role in fostering health and well-being by helping households free up financial resources. For example, research has shown that households that receive HUD housing assistance may experience lower rates of uninsurance and unmet health care needs due to cost. Emerging research examines potential opportunities to leverage the LIHTC program for improving population health,  by expanding access to affordable housing and increasing access to health supportive neighborhoods.

Housing stability

Housing stability is essential for health and well-being, especially for young children. Diverse forms of housing instability associated with negative health outcomes include evictionsovercrowding, and the most severe form of instability, homelessness. Crowding and multiple moves are particularly detrimental for the health and educational outcomes of children. The stress of housing instability has been also shown to negatively impact the mental health and well-being of child caregivers in rental households. In addition to the emotional stress caused by unstable housing,  households that experience instability have more difficulty maintaining healthy behaviors and managing chronic health conditions.

Interventions that help households stay stably housed have the potential to protect health by reducing financial and emotional stress and helping households maintain consistent connections to critical supports including healthcare providers, schools, and social networks. Local rental subsidy programs that provide emergency cash assistance and/or provide access to free legal assistance may be effective in keeping families and individuals in their homes. Additionally, collaboration between healthcare, social service, and homeless service providers can help protect continuity of care and coordination of services for individuals and households that experience homelessness.

Housing quality

A wealth of research documents the links between housing quality and health. Substandard housing can expose residents to allergens,  toxins, and hazards that compromise health and safety. Studies have consistently documented an association between chronic respiratory illness and exposure to household conditions such as leaks, inadequate ventilation, mold, and rodents. The presence of lead paint in housing has been shown to impede neurological development during childhood. Physical hazards and structural inadequacies such as unprotected windows, exposed heating sources,unsafe water temperatures are linked to increased risk of injury, particularly among children. Substandard housing is disproportionately represented in low-income and minority communities, contributing to disparities in both health and housing. Unequal housing conditions and disparities in code enforcement have been shown to contribute to asthma disparities by income and race. Policies and programs that strengthen code enforcement and incentivize good housing management practices have the potential to benefit resident health.

Neighborhood resources and conditions

Neighborhood resources and conditions can have a profound impact on health and well-being. The physical, social, and economic conditions of neighborhoods influence both health behaviors and health outcomes. Neighborhood variations in the availability of affordable healthy foods and safe public green space can contribute to disparities in health behaviors, management of chronic health conditions, and health outcomes. The social and economic conditions of neighborhoods can also influence health. Exposure to concentrated poverty, violence and crime compromise health and safety. Research examining HUD’s Moving to Opportunity program has demonstrated positive physical and mental health impacts for families who relocated to lower poverty neighborhoods.

Taking action

The multiple connections between housing and health provide a variety of opportunities for housing officials to advance both housing and health outcomes in localities. The following resources provide policy and program strategies for city and state leaders and practitioners to consider:

The Health and Housing Starter Kit
ChangeLab Solutions

Promising Health and Housing Collaborations
National Housing Conference

Emerging Strategies Integrating Health and Housing
The Urban Institute

Advancing Health and Equity through Housing: A Messaging Guide
National League of Cities

Chart Book: Housing and Health Problems Are Intertwined. So Are Their Solutions.
Center on Budget and Policy Priorities

Building Connective Tissue for Effective Housing-Health Initiatives
Brookings Institution

Partnering with Health Systems on Affordable Housing Investments
American Planning Association

The following research summaries provide additional information about the connections between housing, neighborhoods and health:

Housing and Health: An Overview of the Literature
Health Affairs

Housing Instability Literature Summary
HealthyPeople 2030

Housing and Health Issue Brief
Robert Wood Johnson Foundation Commission to Build a Healthier America

The Impacts of Affordable Housing on Health: A Research Summary
National Housing Conference

Creating the Healthiest Nation: Health and Housing Equity
American Public Health Association

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