Your Home, Your Health: The Hidden Costs of Housing Insecurity

Inadequate housing significantly impacts public health, leading to various health issues and increased mortality rates. | Image Credit: Bussarin - stock.adobe.com

Lack of housing has significant impacts on public health that are being considered further by policy makers.¹ Adequate housing is associated with improved overall health outcomes and reduced health care costs.

The 4 pathways that connect housing and health are:

1. Stability

2. Quality and safety

3. Affordability

4. Neighborhood

Stability

Housing instability impacts populations in various ways. For instance, moving homes 3 or more times in 1 year is related to negative health outcomes among children.² Frequent moves increase risks of chronic conditions and poor physical health. Homelessness is defined as the most serious form of housing instability.

A study of people living in a New York City homeless shelter found that 6% had diabetes, 17% had hypertension and asthma, 35% had major depression, and 53% had a form of substance use disorder. Homeless populations also have an increased risk of premature mortality. Health impacts of housing instability can begin early in life, and effects are identifiable among pregnant women who have greater chances of having low birthweight babies and preterm delivery.

Unstable housing opportunities lead to many people living in shelters or on the streets, where trauma is often inflicted, leaving long-standing impacts on their psychological well-being.¹ Residential instability is also linked with teen pregnancy, early drug use, and depression.

A review examined 35 different studies and found personal experience with foreclosure was associated with worsened health outcomes such as depression, anxiety, increased alcohol use, psychological distress, and suicide.³ It is important to note that Black and Latino families experience foreclosure rates more than any other ethnic or racial groups in the US. Excess foreclosures have occurred in the context of decades of systemic, government-led policies that were created to block the accumulation of wealth.

Quality and Safety

Environmental factors within homes are linked with poor health conditions as well. Lead exposure can incite irreversible damage in the brain and nervous systems of small children.¹ Substandard housing can describe the suboptimal physical condition of an individual’s home and the quality of the social/physical environment where the home is located.⁴ Lead, mold, asbestos, poor air quality, and overcrowding can all add to negative health impacts, especially chronic disease and injury. Children are disproportionately affected by inadequate conditions due to their weaker immune systems and hand-to-mouth activity, ultimately increasing exposures to pollutants.

Homes with stairs, narrow doorways, steps, balconies, and certain windows can cause serious injuries from falls, primarily among older adults and/or individuals with physical disabilities. Typically, housing is cheaper in older homes, but these often come with more health risks, leading to worsened health outcomes. Low-income families are often unable to keep up with housing maintenance, which can further the already existing poor conditions inside the home.

A survey study found additional housing characteristics linked to poorer health status, high medical use, and higher likelihood of hospitalization.⁵ These results remained the same even after controlling for other factors like disability status and neighborhood safety. Additional poor housing conditions were associated with higher likelihood of being hospitalized and a high number of medical visits after controlling for socioeconomic and other contextual housing characteristics.

Affordability

When households become “cost burdened,” they are closer to becoming homeless.⁶ Households that spend 30% or more of their income on housing are considered cost burdened, and those that spend more than 50% are severely cost burdened. Cost burdens also prohibit communities from investing and accessing health-generating goods.¹

Some families spend exorbitant amounts of money on housing to live in areas with access to health-promoting features. Due to the lack of affordable housing options, many families are experiencing serious financial strains.

A study that compared low-income families vs families with high incomes found that the former were less likely to have a usual health care source and those that did have a usual source had reduced rates of having a usual provider.⁷ Low-income populations also reported greater rates of problems paying family medical bills, fear regarding enough accessible food, and worries about paying bills or debts over the next 30 days.

Homeowners who experienced an insufficient supply of food were more likely to say they went without prescribed medications compared with those who did not struggle financially.¹ Limited housing options are a growing problem as the market values increase while wages remain stagnant along with rental assistance programs. More specifically, rental costs have fluctuated since the COVID-19 pandemic, creating a gap in housing that is leading to higher rates of homelessness, evictions, overcrowding, and unaffordable rents.⁸

In 2022, over 100,000 students across the nation reportedly lived in extended-stay hotels as a form of housing, which means these children are considered homeless under federal law.⁹ For instance, 40% of homeless students in some counties near Atlanta, Georgia, lived in this type of shelter. Inspections of Atlanta-area extended-stay hotels have revealed ventilation issues, insect infestations, mold, and other health threats.

Neighborhood

Environmental impacts in neighborhoods can benefit or hinder public health outcomes in many ways.¹⁰ Access to transportation, primarily to work, and safe spaces that do not have high rates of violent crime can improve health outcomes. Researchers have found neighborhoods with grocery stores with nutritious foods and safe areas to exercise promote healthier outcomes among individuals.¹

Neighborhoods exposed to higher levels of pollution have higher rates of health issues like asthma, obstetric and peripartum disparities, and gaps in HIV viral suppression.¹¹ Systemic racist policies like redlining contribute to these negative health impacts, including minority populations’ access to care, risk of disease or other fatal conditions, morbidity, and perpetuation of racist ideologies.

The CDC reported neighborhood characteristics that directly affect cardiovascular disease outcomes dependent upon where an individual lives.¹² It released a list of 15 indicators that can impact the neighborhood and the health of the individuals living there. Some indicators include rurality, public assistance, food swamps/deserts, green space, and liquor store density.

Policy

National initiatives by various stakeholders have attempted to address the public housing issues that exist in society.¹ Health care sectors, businesses, community-based organizations, foundations, and government are all responsible for improving these conditions across the US.

The health consequences of inadequate housing are undeniable. As policy makers and stakeholders delve deeper into this critical issue, it becomes increasingly clear that more comprehensive and innovative solutions are needed.

References

1. Taylor LA. Housing and health: an overview of the literature. Health Affairs. June 7, 2018. Accessed December 11, 2024. https://www.healthaffairs.org/content/briefs/housing-and-health-overview-literature

2. Housing instability. Health.gov. 2019. Accessed December 11, 2024. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/housing-instability

3. Tsai AC. Home foreclosure, health, and mental health: a systematic review of individual, aggregate, and contextual associations. PLoS One. 2015;10(4):e0123182. doi:10.1371/journal.pone.0123182

4. Quality of housing. Health.gov. 2019. Accessed December 11, 2024. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/quality-housing

5. Boch SJ, Taylor DM, Danielson ML, Chisolm DJ, Kelleher KJ. 'Home is where the health is': housing quality and adult health outcomes in the survey of income and program participation. Prev Med. 2020;132:105990. doi:10.1016/j.ypmed.2020.105990

6. Impact of housing instability on physical and mental health. University Health. 2019. Accessed December 11, 2024. https://www.universityhealth.com/public-health/factors-shaping-health/economic-stability/housing

7. Haley J, Long J, Kenney G. Parents with low incomes faced greater health challenges and problems accessing and affording needed health care in spring 2021. Urban Institute. January 3, 2022. Accessed December 11, 2024. https://www.urban.org/research/publication/parents-low-incomes-faced-greater-health-challenges-and-problems-accessing-and-affording-needed-health-care-spring-2021

8. Chart book: housing and health problems are intertwined. so are their solutions. Center on Budget and Policy Priorities. June 29, 2022. Accessed December 11, 2024. https://www.cbpp.org/research/health/housing-and-health-problems-are-intertwined-so-are-their-solutions

9. Extended-stay hotels, a growing option for poor families, can lead to health problems for kids. CBS News. October 8, 2024. Accessed December 11, 2024. https://www.cbsnews.com/news/extended-stay-hotels-poverty-kids-health/

10. Neighborhood and built environment. CDC. March 27, 2023. Accessed December 12, 2024. https://www.cdc.gov/prepyourhealth/discussionguides/neighborhood.htm

11. Santoro C. The health-related consequences of redlining. AJMC^®. October 3, 2024. Accessed December 12, 2024. https://www.ajmc.com/view/the-health-related-consequences-of-redlining

12. Neighborhood characteristics. CDC. September 1, 2023. Accessed December 12, 2024. https://www.cdc.gov/dhdsp/health_equity/neighborhood.htm