Housing Affordability and Quality – A Community Driver of Health
Introduction
Housing affordability and quality are critical determinants of health and well-being1. When housing is unaffordable, poorly constructed or maintained, it can significantly impact residents’ health and safety. Fortunately, various approaches can improve housing stability, create healthier home environments, improve health outcomes, and increase health equity. This report summarizes discussions from a 2020 Health Policy Leadership Summit, along with subsequent updates, on the impact of housing on health, and offers potential strategies and actions to address related challenges. It is important to note that the views expressed in this report do not necessarily reflect the official views of the summit sponsors.
The Impact of Housing on Health
Housing affordability and quality have a direct impact on health2. Unstable housing situations increase the risk of poor health, affecting mental health, leading families to cut back on meals, and postponing necessary medical care2. When people face limited affordable housing options, they may be forced to live in low-quality housing with potential lead exposure, poor ventilation, overcrowding and other substandard conditions that can worsen health6. Others may be forced to relocate to areas with longer commutes or limited access to health-supporting amenities6.
Eviction can lead to homelessness, which has severe health consequences. People experiencing homelessness face accelerated ageing, with higher rates of chronic illness and earlier deaths6. Even the threat of eviction can lead to poor health, high blood pressure, depression, anxiety, and psychological distress7. Communities of colour face significant housing challenges due to systemic racial inequities7. For example, discriminatory practices like redlining and predatory lending have contributed to these inequities7…. The COVID-19 pandemic has further worsened these challenges and racial inequities, with people of colour facing higher risks of economic hardship, housing insecurity, and poor housing conditions9.
Affordability and Access
Unaffordable housing costs make it difficult for people to stay healthy10. Low-income families in unaffordable housing are more likely to cut back on meals and postpone medical care10. Housing instability is associated with worse mental health, more physical health problems, and increased healthcare utilization. Unaffordable housing can also make it difficult to move out of unsafe living conditions.
Many communities have a shortage of affordable rental housing. Half of Americans are rent-burdened, paying more than 30% of their income for rent, with rent burdens being the highest among Black and Latinx households13. New affordable housing is not keeping pace with the loss of existing affordable housing. Rental assistance programs can help, but there are far more eligible applicants than available funding16. The COVID-19 pandemic increased the risk of evictions, and although eviction moratoriums were implemented, many are expiring, leaving renters in debt17.
Some studies suggest that homeowners report better health compared to renters, but this may not hold for those whose homeownership is threatened18. A persistent homeownership gap exists between Black and white households, linked to income disparities, the racial wealth gap, and past discriminatory lending practices19.
Homeless response systems should aim to make homelessness rare, brief, and non-recurring20. Effective systems focus on quickly housing people, preventing homelessness, and aligning resources in a coordinated way. Data-driven approaches are critical to reducing homelessness.
Quality
Housing quality significantly impacts health, as most people spend the majority of their time in residential environments24. Many homes in the U.S. have health and safety hazards that can cause illness, injury, and even death24. Persistent racial disparities exist in access to safe and healthy housing. For example, people of colour have a higher prevalence of housing-related illness and injury due to increased exposure to poor housing conditions25.
Indoor housing conditions can trigger asthma attacks. Lead poisoning is another housing quality challenge, with lower-income communities and communities of colour facing higher rates27. Carbon monoxide poisoning is also a risk, and residential fires continue to cause deaths and injuries. Injuries in the home, particularly for children and seniors, can also be reduced through home improvements29. Many housing quality problems can be prevented through housing regulation, repairs, maintenance, and behaviour changes30. Programs that improve housing quality have shown positive returns on investment31.
Strategies and Actions
Housing policy must address structural inequities to expand housing access, advance racial justice, and increase health equity32. Policies and programs must also be culturally responsive and trauma-informed33. The healthcare sector is increasingly engaging with housing needs through investments, community benefit programs, and advocacy. Highlighting the connection between housing and health is essential for building support for housing policies and investments.
Several government agencies play roles in promoting safe and affordable housing. It is important to understand the interactions between federal, state, and local agencies37. There are important differences in the way that the housing and public health communities think about and approach housing.
Specific strategies and action steps to improve housing include:
- Affordability and access: Expanding tax credits and rental assistance programs, reducing eviction risks, providing emergency rental assistance, supporting bond measures and housing trust funds, promoting community land trusts, and implementing fair lending practices.
- Quality: Strengthening housing codes, implementing proactive rental inspections, promoting smoke-free multi-unit housing, controlling lead hazards, supporting housing repairs, and using Medicaid waivers to fund housing supports.
- Data Collection: Improving data collection on housing affordability and conditions.
Impact
Housing is a powerful platform for transforming communities, improving health and well-being, and advancing health equity. Key elements for effective implementation include:
- Improving data quality.
- Using disaggregated data to identify challenges and solutions.
- Fostering cross-sector partnerships and community leadership.
- Ensuring sufficient, sustainable, and flexible funding.
By leveraging these strategies, stakeholders can advance policies that increase access to affordable, stable, safe, and healthy housing, promote racial justice and health equity, and ensure more people can live healthy lives.
neighbourhoods, and avoiding large concentrations of units, can help to minimise potential negative effects on property prices.
For further reading:
Affordability of Housing That Supports Health and …
Association of Promoting Housing Affordability and Stability With …