Can you explain the connection between health and housing? Is it just about things like lead paint or is it bigger?
Research undeniably connects housing as a determinant of health, but the relationship is not linear nor easily defined. The connection between health and housing includes environmental factors like lead poisoning, water contamination and unsafe living conditions & reaches beyond. Generally, the research focuses on the concluding effects of affordability, safety & quality, stability & access, as well as environmental impacts of housing to determine the connections to health outcomes.
The health impact of not having a stable home (homelessness and consistent housing)
The health impact of conditions inside of a home (safety and quality)
The health impact of financial burden to gain or maintain housing/high-cost housing (affordability)
The health impact of neighborhoods (neighborhood, environmental, and social characteristics)
What do you mean by housing characteristics?
The U.S. Census Bureau defines housing characteristics as a basic way to understand housing markets and changes in housing throughout the nation. The research around housing as a determinant of health outcomes uses the various characteristics of housing (i.e., homelessness, public housing etc.) to address questions about the implications for renters, owners, property managers, developers and other stakeholders in the housing market.
- Homelessness (unsheltered, sheltered, cars, couch surfing, non-housing hotels)
- Institutional Housing (Prisons, etc.)
- Public Housing
- Affordable Housing
- Mixed Use Housing
- Low Visibility Housing
We hear about an affordable housing crisis. What does that mean and how does it affect health?
The cost of deteriorating housing affordability is measured both in how much households must spend on housing and in understanding who is (and isn’t) able to reasonably afford to buy homes in their communities. To illustrate the affordable housing crisis & the subsequent effect on health, researchers define “severely cost burdened renters” as those paying more than 30% (up to 50% in some markets) of their income on rent and utilities. In a recent survey, among severely cost-burdened renters, 45% did not follow a doctor's treatment plan due to costs as compared to 34% of all other respondents; 54% delayed care due to costs. Today, nearly ½ of America’s renters are cost burdened, and nearly a ¼ are severely cost burdened. The number of American households that are severely cost-burdened because of rent is expected to reach 13.1 million in 2025 according to recent findings.
Who are the stakeholders in the housing ecosystem?
We can broadly define the stakeholders in the housing ecosystem as the global community & economic actors—everyone is affected and deserves access to safe, quality, affordable housing. Generally, we define the stakeholders as those in the ecosystem who have impact or are impacted by changes in related policies, systems or environments. Stakeholders include but are not limited to: housing developers; government and non-governmental agencies; renters & owners; business & industry; and, community member groups.
What are barriers to stable housing? (evictions, cost)
Housing stability is not limited to only chronic homelessness, but also varying stages like couch-surfing, falling behind on rent, or moving residence frequently. People who have varying degrees housing instability are more likely to experience poor health compared with peers the same age who do not have housing stability challenges.
- Living without stable housing is detrimental to health & substantial risk increase in areas of both physical and mental health—having a place to live can both improve health and decrease health care costs.
- Studies conducted have shown the negative effect of foreclosures on mental health outcomes; others connect the stress of unstable housing resulting to employment, education and social network disruptions.
How does neighborhood quality and housing work to impact health?
Quality and safety, in both the neighborhood and within the home, define the environmental factors that can be correlated to health outcomes. Quality and safety research refer to the housing and neighborhood conditions that affect health adversely. For example, some substandard conditions that contribute to asthma have been identified such as water leaks, poor ventilation, dirty carpets, and pest infestation. Promising research has drawn a connection between improved health outcomes and improving housing safety & quality.
What are some innovations we see here in the US or around the world to address stable affordable housing?
The bright side is that there are lots of innovative approaches in different housing markets that have and are working, being experimented with, and in development to address the affordable housing crisis. Creative solutions to housing availability exist like tiny homes, shared housing startups, pre-fabricated and manufactured homes; likewise, affordability solutions such as down-payment assistance programs, co-operatives and co-ownerships, and community land trusts to name a few.
Some examples include:
- “Tiny Homes” in place of one large single-family home in Georgia-- Clarkston, GA has plans to re-do city zoning codes to allow for more sustainable housing solutions: taller apartments, tiny homes communities, and creating a more walkable city. "The houses range from around 250 to 500 square feet–compared to around 2,400 square feet for a typical new American house–and are expected to cost between $100,000 and $125,000. The average house in the county goes for around $285,000"
- “Teachers Villages” "Teacher Villages": workforce housing developments targeting teachers to help alleviate community drain in the profession.
- "One is fully operational and leased in Newark, New Jersey, and the other opened on May 1 in Hartford, Connecticut.
- “CUBO” bamboo pre-fab houses in Manila, Philippines-- Modular housing that can be manufactured in a week--captures rainwater and reduces heat gain; elevated stilts to prevent flooding. •
- "The house, known as CUBO, uses engineered bamboo, and can be put together in four hours at a cost of 60 pounds per square meter, "
- “PadSplit” shared housing solutions in high-cost housing markets: "Rather than building new buildings, PadSplit works with property owners who are renting out single-family homes. The property owners agree to fix up the houses to a certain standard, and then PadSplit helps them add walls to create new rooms–if there’s a formal dining room or an extra den, for example, those will be converted into bedrooms. Then the company screens potential residents and rents out each room, including utilities, internet, and laundry, for around $550 a month."
How are health care stakeholders involved?
Studies have looked at the role of health care providers, medical insurance companies and government in terms of reducing health care expenditures for certain populations, i.e., positive outcomes of housing the homeless, continuing care for young adults aging out of the foster care system and elderly aging in place policies. Other innovations that are consumer facing have included prescription meal delivery programs, natural disaster preparation and recovery, and more. May need to source more info for this question
What are strategies AHA is considering regarding improved housing and neighborhoods? (I’ll take this one)
We hear about disaster recovery and housing issues? Tell me how those issues are being addressed?
In the wake of many recent hard-hitting natural disasters in the U.S., the research concern related to housing has primarily focused on preparation, resiliency and post-disaster aftermath/recovery, with implications that there are correlated health impacts. Largely, research points to a need for long-term assistance efforts in affected communities; impact on residents’ financial health to recover, etc.
How might increasing numbers of disasters impact the long term viability of housing?
Climate change is putting everyone at greater risk for natural disasters, including flooding, wildfires and drought. Low-income and minority communities are especially vulnerable. As the risk for natural disaster increases, the risk for housing stability directly increases. Affected communities experience a loss of affordable housing units (with no change in population) which reasonably results in higher counts of homeless and housing unstable citizens; greater pressure on community resources; negative physical and mental health effects.