Housing and Health

Where we live is at the very core of our daily lives.

Most Americans spend about 90 percent of their time indoors, and an estimated two-thirds of that time is spent in the home. Very young children spend even more time at home, and are especially vulnerable to household hazards. Factors related to housing have the potential to help—or harm—our health in major ways. This issue brief focuses on three important and interrelated aspects of housing and their links to health: the physical conditions within homes; conditions in the neighborhoods surrounding homes; and housing affordability, which not only shapes home and neighborhood conditions but also affects the overall ability of families to make healthy choices.

How Does Housing Affect Health?
Healthy homes promote good physical and mental health. Good health depends on having homes that are safe and free from physical hazards. In contrast, poor quality and inadequate housing contributes to health problems such as chronic diseases and injuries, and can have harmful effects on childhood development. Poor indoor air quality, lead paint, and other hazards often coexist in homes, placing children and families at great risk for multiple health problems. For example:

• Lead poisoning irreversibly affects brain and nervous system development, resulting in lower intelligence and reading disabilities.
• Substandard housing such as water leaks, poor ventilation, dirty carpets and pest infestation can lead to an increase in mold, mites and other allergens associated with poor health.
• Cold indoor conditions have been associated with poorer health, including an increased risk of cardiovascular disease. Extreme low and high temperatures have been associated with increased mortality, especially among vulnerable populations such as the elderly.
• Residential crowding has been linked both with physical illness, such as tuberculosis and respiratory infections, and with psychological distress among both adults and children.

Neighborhood Conditions and Health
Along with conditions in the home, conditions in neighborhoods where homes are located also can have powerful effects on health. Social, physical and economic characteristics of neighborhoods have been increasingly shown to affect short- and long-term health quality and longevity.

A neighborhood’s characteristics may promote health by providing places for children to play and for adults to exercise that are free from crime, violence and pollution. Access to grocery stores selling fresh produce—as well as having fewer neighborhood liquor and convenience stores and fast food outlets—can make it easier for families to find and eat healthful foods. Social and economic conditions in neighborhoods may improve health by affording access to employment opportunities and public resources including efficient transportation, an effective police force and good schools.

Not all neighborhoods enjoy these opportunities and resources, however, and access to neighborhoods with health-promoting conditions varies with household economic and social resources. Concentration of substandard housing in less advantaged neighborhoods further compounds racial and ethnic as well as socioeconomic disparities in health.

Housing Affordability and Health
Housing is commonly considered to be “affordable” when a family spends less than 30 percent of its income to rent or buy a residence. The shortage of affordable housing limits families’ and individuals’ choices about where they live, often relegating lower-income families to substandard housing in unsafe, overcrowded neighborhoods with higher rates of poverty and fewer resources for health promotion (e.g., parks, bike paths, recreation centers and activities).

The lack of affordable housing affects families’ ability to meet other essential expenses, placing many under tremendous financial strain. High housing-related costs place a particular economic burden on low-income families, forcing trade-offs between food, heating and other basic needs. One study found that low-income people with difficulty paying rent, mortgage or utility bills were less likely to have a usual source of medical care and more likely to postpone treatment and use the emergency room for treatment. Another study showed that children in areas with higher rates of unaffordable housing tended to have worse health, more behavioral problems and lower school performance.

Public and Private Housing Policies
Substandard housing is much more of a risk for some families than others; housing quality varies dramatically by social and economic circumstances. Families with few financial resources are most likely to experience unhealthy housing and typically least able to remedy them, contributing to disparities in health across socioeconomic groups. In light of evidence about the many ways housing can affect health, strategies must be multifaceted ─ focusing on physical quality of housing, health-promoting conditions in neighborhoods, and access to affordable housing for all. The below approaches include strategies affecting multiple aspects of housing and involve a range of actors, from local to state to national government and non-governmental agencies and groups.

• Sustaining and expanding Healthy Homes initiatives at the federal, state and local levels, including public-private collaborative programs
• Support for high utilities costs through the Low Income Home Energy Assistance Program and similar programs that assist households with unaffordable heating, cooling, and electricity bills
• Strengthening enforcement of fair housing laws, including the Fair Housing Act and other state and local regulations prohibiting racial discrimination in housing markets
• Exploring private initiatives, such as Habitat for Humanity, to create affordable, healthy housing
• Continuing federal involvement in lending and fairness standards for banking and loan institutions, and improving banking and lending procedures to create equal opportunities for credit
  

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