Impact of Substandard Housing on Health

Substandard housing is not housing that is old or outdated. It is housing that poses a risk to the health and physical well-being of its occupants, neighbors and visitors. Substandard housing brings increased risk of disease and decreased mental health to the families and individuals who live there.

Substandard housing conditions most frequently seen in Philadelphia include holes, cracks, peeling paint, leaking roofs and broken basic systems like heating.¹

Nationally, the number of substandard homes is on the rise for the first time since 1940 as owners deferred maintenance during the Great Recession that brought per house spending by owners down 28% between 2007 and 2011.²

Low-income families are most likely to live in unhealthy and substandard housing and are least able to finance the repairs needed to remedy the conditions. As a result, substandard housing contributes to disparities in health between low- and high-income Philadelphians.³

Resources

• Lauren A. Taylor, “Housing And Health: An Overview Of The Literature,” Health Affairs Health Policy Brief, June 7, 2018. DOI: 10.1377/hpb20180313.396577  “The impact of housing on health is now being widely considered by policy makers. 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. This brief outlines the literature and provides high-level direction for future research and policy agendas.”
• Boston Medical Center. “Housing instability negatively affects the health of children and caregivers: New research finds one in three low-income renters face housing instability, at greater risk of poor health and other hardships.” ScienceDaily. ScienceDaily, 22 January 2018

• Helen Hughes, Elizabeth Matsui, Megan Tschudy, Craig Pollack, Corinne Keet, Can Housing Explain Racial Disparities in Childhood Asthma?  www.HowHousingMatters.org (published 2017 posted January 18, 2018) “This study conducted a secondary analysis of the 2011 American Housing Survey, which interviewed 33,201 households with children ages 6 to 17 about childhood asthma and emergency department (ED) visits for asthma and then conducted a logistic regression to determine the association between race, material hardship, asthma diagnosis, and ED visits.”

• Elizabeth Zeldin and Emily Blank, Incorporating Health Into Physical Needs Assessments, June 2017.
  A new tool called the Integrated Physical Needs Assessment provides affordable housing owners with a comprehensive protocol to assess the range of options available to upgrade their buildings with a health focus.

• Redy, Amanda and Jacobs, David;Building Justice Genetic Code ZIP Code and Housing Code all affect Health and Equality, CityLimits.org (October 2016)
  “..Where you live, as it turns out, can impact health through a variety of pathways including the physical condition of the home (and its design), the attributes of the surrounding neighborhood, and its affordability.”
• Evidence Matters, Leveraging the Health-Housing Nexus; Office of Policy Development and Research (PD&R) U.S. Department of Housing and Urban Development Secretary Julián Castro
  Article Highlights:
  *Housing aspects, ranging from physical quality to neighborhood conditions, affect health in multiple ways, and research has established links between housing and a range of health outcomes.
  *Targeted interventions at the nexus of health and housing, such as addressing asthma triggers and providing supportive housing to those experiencing homelessness, can improve health outcomes while reducing long-term healthcare expenditures.
  *The Patient Protection and Affordable Care Act has created new opportunities to combine housing and health funds and test new coordinated models of care.
• Megan Sandel, MD, MPH; John Cook, PhD, MAEd; Ana Poblacion, MSc; Richard Sheward, MPP; Sharon Coleman, MS, MPH; Janet Viveiros, MPP; and Lisa Sturtevant, PhD – Housing as a Health Care Investment Affordable Housing Supports Children’s Health
  Affordable and stable housing plays a critical role in supporting the health and wellbeing of children. Research from Children’s HealthWatch shows public investment in housing—including housing for homeless families and rental assistance for food-insecure families—improves the health outcomes of vulnerable infants and young children and lowers health care spending.
• Amanda Saul, Cheryl Gladstone, Maggie Weller, Keri Vartanian, Bill Wright, Grace Li, Center for Outcomes Research and Education (CORE) and Enterprise Community Partners – 2016 -Health in Housing: Exploring the Intersection Between Housing and Health Care
  This study directly explores the link between affordable housing and health care through the lens of several national health reform metrics: better connection to primary care, fewer emergency department visits, improved access to and quality of care, and lower costs.
• Ellen E. Kersten, Kaja Z. LeWinn, Laura Gottlieb, Douglas P. Jutte, and Nancy E. Adler, San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children In Older Public Housing, Health Aff December 2014 33:2230-2237.
  San Francisco children living in non-redeveloped public housing are 39 percent more likely to repeatedly visit emergency rooms compared to those in improved public housing units. The researchers were not able to identify which aspects of housing played a role in the children seeking emergency care but did find that providing better housing fosters better health in children and reduces spending on acute health services.
• Andrew F. Beck, Bin Huang, Raj Chundur, and Robert S. Kahn, Housing Code Violation Density Associated With Emergency Department And Hospital Use By Children With Asthma, Health Aff November 2014 33:111993-2002.
  Study tracked links between community housing code violations — infractions such as the presence in homes of mold and cockroaches — and the hospitalizations of more than 4,300 children, aged 1 to 16 between 2009 and 2012. Study found that children who lived in areas with higher numbers of housing code violations were nearly twice as likely to be re-hospitalized or to revisit the emergency department within 12 months, compared to those who lived in areas with fewer housing violations.
• Rebekah Levine Coley, Tama Leventhal, Alicia Doyle Lynch, and Melissa Kull, Poor Housing Is Tied to Children’s Emotional and Behavioral Problems, MacArthur Foundation (2013).
  Living in unsafe or unsanitary homes is related to greater emotional and behavioral problems among children and adolescents, and poor housing quality is also related to poorer school performance for older children.
• Mary Cunningham, Graham MacDonald, Housing as a Platform for Improving Education Outcomes among Low-Income Children, Urban Institute (May 2012).
  Discusses evidence that improvements to housing quality can positively affect children’s safety and health outcomes, leading to better school attendance rates, improved attentiveness in class and better grades and test scores. Notes that much of the literature that links housing, health, and poor educational outcomes only proves correlation, not causation.
• M Davidson, M Roys, S Nicol, D Ormandy and P Ambrose, The Real Cost of Poor Housing (Feb 2010).
  Economic model estimates the total health cost of poor housing in England to be over £600 million per year. The total cost to society each year may be greater than £1.5 billion.
• Pollack, C., Egerter, S., Sadegh-Nobari, T. et al, “Where We Live Matters for Our Health: The Links Between Housing and Health.” Issue Brief 2: Housing and Health. RWJF Commission to Build a Healthier America, 2008.
  Brief examines how poor quality and inadequate housing contributes to health problems such as infectious and chronic diseases, injuries, and poor childhood development. The authors then discuss promising strategies to improve America’s health by ensuring that all Americans have healthier homes.
• Pollack, C., Egerter, S., Sadegh-Nobari, T. et al, “Where We Live Matters for Our Health: The Links Between Housing and Health.” Issue Brief 2: Housing and Health. RWJF Commission to Build a Healthier America, 2008.
  Examines the many ways in which housing can influence health and discusses promising strategies to improve America’s health by ensuring that all Americans have healthier homes.
• Bashir SA, Home is where the harm is: inadequate housing as a public health crisis, Am J Public Health. 2002 May;92(5):733-8.
  Overcrowding and poor-quality housing have a direct relationship to poor mental health, developmental delay, heart disease, and even short stature.
• James Krieger and Donna L. Higgins, Housing and Health: Time Again for Public Health Action, Am J Public Health. 2002 May; 92(5): 758–768.
  Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Public health requires healthier homes.
• Kochera, A., “Falls Among Older Persons and the Role of the Home: An Analysis of Cost, Incidence, and Potential Savings from Home Modification.” Issue Brief 56. AARP Public Policy Institute, 2002.
  Reviews literature on the effectiveness of home modification programs designed to prevent falls and the health care savings a reduction in fall injuries provides.
• Cummins, S. and Jackson, R., “The Built Environment and Children’s Health 6.” 2001.
  A high quality environment is essential for children to achieve optimal health and development. Housing conditions can cause or prevent illness, disability and injury.
• Philippa L Howden-Chapman, Tarani Chandola, Mai Stafford and Michael Marmot, The effect of housing on the mental health of older people: the impact of lifetime housing history in Whitehall II, BMC Public Health 2011, 11:682.
  Housing quality and financial problems are important in explaining older people’s mental health. Older people spend more than 90% of their time indoors, mostly in their homes, so to improve older people’s health, the study finds that housing quality is important.
• Rebecca Cohen, The Impacts of Affordable Housing on Health: A Research Summary, Center for Housing Policy, Center for Housing Policy (May 2011).
  Summary of key research on the link between affordable housing and health. Discusses effectiveness of home interventions such as window and carpet replacement and integrated pest management, as well as code enforcement for improving indoor health hazards.