The Public's Health: Housing and the Public's Health | Public Health Post

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Housing is a foundational determinant of health and has been recognized as such since the early days of public health. In the 19th century, outbreaks of infectious diseases sparked interest in housing reform to address poor sanitation, crowding, and inadequate ventilation. One hundred and fifty years later, a report from the WHO commission on the social determinants of health has returned to the concept of “safe housing” as key to the health of populations.
There are ample data connecting poor housing conditions to a broad range of infectious diseases, chronic diseases, injuries, childhood development and nutrition issues, and to mental health. For example, substandard housing conditions such as poor ventilation, pest infestation, and water leaks are directly associated with the development and exacerbation of respiratory diseases, such as asthma. There are about 24 million Americans with asthma, and it is the most common chronic disease in children worldwide. About 40 percent of diagnosed childhood asthma is attributed to exposures at home.
The burden of poor housing is not distributed evenly across populations. Families with fewer resources are more likely to live in unhealthy homes, and are less likely to be able to improve the condition of their living situations. In addition, high housing costs often put families and individuals in the position of having to trade between healthy housing and other basic necessities such as food or medication.
The forces of income segregation and racial/ethnic segregation have an enormous effect on housing suitability and health. In large metropolitan areas, the percentage of families living in “poor” or “rich” neighborhoods increased from 15 percent in 1970 to 34 percent in 2012. Moreover, disparities in housing based on racial background are substantial. Approximately 7.5 percent of non-Hispanic blacks and 2.8 percent of whites live in substandard housing. Those living in poor and dangerous housing are disproportionally people of low-income and people of color; it is not surprising then that the rate of asthma in black children is nearly two times higher than the rate of asthma in white children.
Structural forces perpetuate housing inequities. Landlords and real estate agents have contributed to racial/ethnic segregation by blocking minorities from moving to predominately white neighborhoods, which often leads to the exclusion of minorities from high-quality housing, schools, and other public services. Further, predominantly minority communities receive less investment by lenders to improve housing quality and neighborhood environments.
Increased awareness of the importance of adequate housing was a priority for the previous federal administration. The current administration’s Department of Housing and Urban Development (HUD) appears determined to undo all that through budgets that reduce rental assistance, cut public housing repairs, and limit code enforcements, from lead paint and mold removal to fireproofing. Health insurers and health systems are stepping in with affordable housing to help protect their populations’ health, as HUD’s interest in “safe housing” becomes increasingly and sadly delinquent.

Michael Stein & Sandro Galea