A Blueprint for Well-Being: Building the Evidence for Health-Promoting Housing Policy

6.5.2019
Commentary
Father and daughter swing outside house

When it comes to the social determinants of health, the link between housing and health is arguably the most well developed. People intuitively understand that poor housing conditions like mold or lead paint can lead to serious health issues. And that a lack of safety features like carbon monoxide detectors or a blocked fire escape could mean disaster for a resident.

But housing operates through many more nuanced mechanisms to shape health and well-being. For example, researchers have found that housing assistance frees up resources for other investments in health (e.g. healthy food, activities that promote child development, regular check-ups, etc.) and that housing location can impact health through environmental pollutants, the availability of neighborhood amenities, or quality of schools.

But many facets of the housing-health relationship remain underexplored. How does the current housing affordability crisis widen health inequities across race and income? What are the wide-ranging effects of housing subsidies on children’s well-being or on positive aging for low-income seniors? How does housing instability and gentrification take a toll on our mental health?

Policies for Action is trying to answer some of these questions, and create actionable evidence for those shaping housing policies at the local, state, and federal levels.

The health benefits of subsidized housing

P4A projects at Boston University and the Urban Institute have found that living in federally subsidized housing is associated with fewer days missed of school, a lower likelihood of being unhappy or depressed, and more positive behavior among children. A higher amount of assistance is associated with lower levels of delaying care due to cost among adults, as well as lower levels of very low food insecurity.

Researchers at Providence Portland Medical Center are currently analyzing a new policy experiment for distributing Section 8 housing vouchers in Vancouver, WA. While the health impacts are forthcoming, their analysis finds that only 25-30 percent of housing voucher recipients are even able to obtain housing, and it takes about two months to find. In a forthcoming study, we’ll be looking at how states are trying to minimize discrimination by landlords against people with housing vouchers.

Making housing healthier from the ground up

A project at the University of Florida and University of Illinois is examining how states are using health-promoting criteria to assess and award Low-Income Housing Tax Credits (LIHTC). Preliminary results indicate that over half of states are incorporating healthy housing provisions into their LIHTC program and another third are considering doing so.

Researchers at NYU Wagner Graduate School of Public Service are studying the effects of a New York Housing Authority renovation project to detect changes in occurrences of asthma, anxiety or depression, upper respiratory infection, or injury. Their early findings suggest no immediate changes to the likelihood of having one of these conditions, but that when taken together, there are significant improvements in health overall.

These health conditions are being tracked as part of a housing sensitive condition index—an innovative project that would enable Medicaid and housing authorities to improve the quality of housing in ways that promote health.

Housing trends and their impacts on health

The same project at NYU Wagner Graduate School of Public Service is also looking at the health effects of gentrification (defined here as upward movement in rents, mean income, and educational attainment levels in a previously low-income neighborhood). They have found scant evidence that gentrification is associated with more moves by low-income families, and that those who do move are not moving to worse neighborhoods as measured by poverty rate or crime. Findings on health impacts are coming soon, and suggest that children moving from gentrifying neighborhoods have more anxiety. 

Finally, researchers at the Urban Institute recently explored how strategies for integrating health and housing are evolving, especially as the health care industry takes a bigger role in addressing the social determinants of health. They documented six diverse case studies, including a collaboration between a public health department and a housing authority; a hospital and a community development organization, and a national insurer and local nonprofits.

Conclusion

When it comes to understanding the complex, life-long impacts of housing on health, we are still truly in our infancy. What we do know is this: the U.S. policy responses to Americans’ need for safe, stable, affordable housing have been woefully lackluster.

Federal housing vouchers are limited and serve only a quarter of those who meet the eligibility criteria. Half of renter households and a third of owner households are rent burdened. And recent reporting has implicated underfunding of the federal home inspection system with the failure to address serious health and safety violations in some public housing units.

Solving these problems will require policy action at the local, state, and national levels. But the path forward is not always clear. Researchers at Temple University recently published a landmark study exploring 23 legal levers that may impact health equity in housing, and found that the evidence base regarding the impact of these levers is minimal, and the number of quality, rigorous scientific studies is even smaller.

But as the evidence grows, and as states and localities work to leverage policy to advance fair, safe, affordable housing, our experts will be there to analyze their impacts on population health and health equity.

 

Photo by Monkey Business Images/Shutterstock

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