Health Beyond Health Care: Housing
Planners, public health experts, community development leaders, architects and many others have come together over the past decade to focus on housing as a framework for a healthy life. A report released earlier this year by the Robert Wood Johnson Foundation’s (RWJF) Commission to Build a Healthier America made the link between health and housing clear:
“Living in unhealthy homes and communities can severely limit choices and resources. Healthy environments—including safe, well-kept housing and neighborhoods with sidewalks, playgrounds and full-service supermarkets—encourage healthy behaviors and make it easier to adopt and maintain them.”
Housing also impacts health when people spend so much on their rent or mortgage that they don’t have enough left over to pay for critical expenses such as food and medicine. According to the MacArthur Foundation—which released its second annual “Housing Matters” survey last month—during the past three years more than half of all U.S. adults have had to make at least one sacrifice in order to cover their rent or mortgage, including:
- Getting an additional job
- Deferring saving for retirement
- Cutting back on health care and healthy foods
- Running up credit card debt
- Moving to a less-safe neighborhood or one with worse schools
Ianna Kachoris, a MacArthur Foundation program officer who oversees its How Housing Matters to Families and Communities research initiative, said that the quality and safety of a home make a significant impact on a person’s overall quality of life. Among the housing specifics that can impact health are lead or mold; the need to move frequently; having to live with many other people to make housing affordable; and concern over being able to afford the rent, the mortgage or needed housing repairs. The survey also found that accessing affordable quality housing in their communities is difficult for many people, including families with average income, young people just getting started in the labor force and families who want to live in quality school districts.
In the last decade or so, leaders in the field of architecture have begun to look at the impact that building and community design can have on community health. For example, the American Institute of Architects (AIA) New York Chapter partnered with several New York City agencies, research architects and city planners to create the city’s Active Design Guidelines. These provide architects and urban designers with strategies for creating healthier buildings, streets and urban spaces, and are based on the latest academic research and best practices in the field.
This spring, the AIA also established a new design and health agenda—kicked off at an April summit—to demonstrate the vital role that architects and other design professionals can play in enhancing both the physical and mental health of the public. The summit was organized around five areas of impact:
- Safety and social equity
- Sensory environments
- Access to nature
- Physical activity
- Environmental integrity
The summit went beyond stemming the tide of non-communicable diseases—such as obesity, diabetes and asthma—and toward promoting “continuous well-being,” according to Daniel Friedman, the summit’s moderator. Friedman chaired the 2014 AIA Design and Health Leadership Group, and is also an architecture professor at the College of Built Environments at the University of Washington.
“We have a partnership here,” said Acting Surgeon General Rear Admiral Boris Lushniak, MD, MPH, who delivered the summit’s keynote address. “[I]f you are an architect, you are a public health worker. I can’t change things for the better without you.”
>>Bonus Content: NewPublicHealth has recently written about several innovative housing ideas that aim to keep people in safe, affordable housing:
- The Bon Secours Health System is funding dozens of affordable housing units in Baltimore for low-income families and seniors. The units provide access to health care, green spaces and healthy foods. The program also includes support services, such as GED classes and a financial counseling program that tenants are referred to if they are late with their rent.
- In Denver, the city’s housing authority has converted a former Veterans Administration hospital into a long-term transitional housing site for formerly homeless veterans. The program includes supportive services such as substance abuse programs and job training. It also provides assistance for finding permanent housing when veterans are ready.
>>Bonus Link: The AIA has developed an interactive infographic, “Designing Community, Shaping Health,” that features eight “design hotspots” that explore design choices and health consequences, such as where to place staircases in an apartment or office building to foster physical activity.