Housing and Health: An Overview of the Literature
There is strong evidence characterizing housing’s relationship to health. Housing stability, quality, safety, and affordability all affect health outcomes, as do physical and social characteristics of neighborhoods.
What's the Issue?
The impact of housing on health is now being widely considered by policymakers. Housing is one of the best-researched social determinants of health, and selected housing interventions for low-income people have been found to improve health outcomes and decrease health care costs. As a result, many health care systems, payers, and government entities are seeking to better understand the totality of the health and housing literature to determine where they might intervene effectively.
Existing evidence on housing and health can be understood as supporting the existence of four pathways by which the former affects the latter: 1) health impacts of not having a stable home (the stability pathway); 2) health impacts of conditions inside the home; 3) health impacts of the financial burdens resulting from high-cost housing (the affordability pathway); and 4) health impacts of neighborhoods, including both the environmental and social characteristics of where people live (the neighborhood pathway).
This brief reviews each of the pathways in turn, including examples of both observational studies of housing deficits and interventional studies of possible solutions.
The weight of evidence is unevenly distributed among the four pathways. There is a great deal of evidence in both the stability and the safety and quality pathways of the risks associated with housing deficits and the potential health gains of providing housing or improving conditions inside the home. However, much of this research is concentrated in urban areas, and suburban and rural areas are frequently neglected. In addition, many of the studied interventions targeted people who were extremely high utilizers of health care without including a control group, which leaves the findings vulnerable to questions about regression to the mean. Finally, researchers reported health impacts more frequently than cost impacts for health systems, payers, or society. More financial analyses of housing interventions are therefore warranted, including examinations of costs related to social services and the criminal justice system.