County Health Rankings Show Burden of Severe Housing Cost Tied to Poor Health

 Report also reveals low-income families and families of color face greatest burden from housing costs.

    • March 19, 2019
A woman stands on the porch of her home.

Princeton, N.J. and Madison, Wis.—Through this year’s County Health Rankings, we see how widespread the burden of severe housing cost is across the nation—facing hundreds and thousands of families and communities and this has important implications for our health. More than 1 in 10 households lives with the burden of severe housing costs, and across and within counties there are stark differences in affordability, depending on who you are, how much money you make, and where you live. While good health depends on jobs, education, transportation, health care, and more, all of these factors are linked to where we live—our home. In places where severe housing cost burden is high, there are more children in poverty, more people who are food insecure, and more people in poor health.

As housing expenses have outpaced local incomes, many families experience the burden of severe housing cost—meaning they pay more than half their income on housing. While severe housing cost burden has actually decreased for homeowners in the past decade, this improvement does not hold true for renters with as many as 1 in 4 impacted. Low-income renters face steep hurdles to health with 1 in 2 households spending more than half their income on rent. When the vast majority of a family’s paycheck goes to housing, it leaves little money left for other essentials that contribute to good health, such as healthy food, medicine, or transportation to work and school. High housing costs can force some families to live in unsafe or overcrowded housing, to move away from neighborhoods where they have family connections and opportunities for good education and jobs. And too many households are just one unforeseen event—an illness, job loss, or financial crisis—away from losing their homes, and all the stability our homes provide.

“Our homes are inextricably tied to our health,” said Richard Besser, MD, RWJF president and CEO. “It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing. This leaves them with fewer dollars to keep their families healthy. Imagine the stress and pain that come with unplanned moves. We are all healthier and stronger together when everyone has access to safe and affordable housing, regardless of the color of their skin or how much money they make.”

Residential Segregation & Severe Housing Cost Burden

The 2019 County Health Rankings Key Findings Report examines housing affordability by place and by race.

Its analysis looked at large urban and smaller metro counties—places with residential segregation of Black and White residents—and found that counties that are more segregated have higher rates of severe housing cost burden, both for White and Black households. However, Black residents face greater barriers to opportunity and health than Whites in these counties. Nearly 1 in 4 Black households spends more than half their income on housing compared to 1 in 10 White households. And that burden is further increased for Black households due to differences in incomes. The median household income for White residents in these communities is $56,000 compared to $33,000 for Black residents.

Segregation, and how it has shaped the social and economic conditions of neighborhoods over time, is fundamental in understanding the stark differences in health between Blacks and Whites. Compared to Whites, Blacks living in residentially segregated places are more likely to be cut off from well-resourced schools and good paying jobs. They also face higher rates of child poverty, infant mortality, and poor health. Many of the differences we see in more residentially segregated communities stem from the history of discriminatory policies and practices that limited the opportunities of Black people to choose where to live, such as redlining or denying housing loans to Black families. While most explicit policies and practices have been outlawed, racial discrimination persists in many forms, and this continues to have an impact on community and resident health and well-being.

In addition to the county-level data, the County Health Rankings & Roadmaps also features What Works for Health, a database of more than 400 evidence-informed strategies to support local changemakers as they take steps toward expanding opportunities and improving health. Each strategy is rated for its evidence of effectiveness and likely impact on health disparities. The Take Action Center also provides valuable guidance for communities who want to move with data to action.

“All communities have the potential to be places where everyone enjoys full and equal opportunity. But the data show that’s not happening in most communities yet. Children of color face a greater likelihood of growing up in poverty, and low-income families struggle to pay rent and get enough to eat,” said Sheri Johnson, PhD, Acting Director of County Health Rankings & Roadmaps. “It is time to do the difficult work of coming together to undo policies and practices that create barriers to opportunity. The Rankings can help communities ground these important conversations in data, evidence, guidance, and stories about challenges and success.” Visit to learn more.


About the University of Wisconsin Population Health Institute

The University of Wisconsin Population Health Institute advances health and well-being for all by developing and evaluating interventions and promoting evidence-based approaches to policy and practice at the local, state, and national levels. The Institute works across the full spectrum of factors that contribute to health. A focal point for health and health care dialogue within the University of Wisconsin-Madison and beyond, and a convener of stakeholders, the Institute promotes an exchange of expertise between those in academia and those in the policy and practice arena. The Institute leads the work on the County Health Rankings & Roadmaps and the RWJF Culture of Health Prize. For more information, visit

About the Robert Wood Johnson Foundation

For more than 45 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working alongside others to build a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. For more information, visit Follow the Foundation on Twitter at or on Facebook at

Media Contacts

Melissa Blair

Robert Wood Johnson Foundation (609) 627-5937

2019 Annual Message

Our Homes Are Key To Our Health

In a Culture of Health, everyone has an opportunity to reside in an affordable, safe, stable home. In this year’s annual message, RWJF President and CEO Rich Besser highlights housing as a key factor of thriving communities.

Read the annual message

Learn How We Work Toward

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