Connecting Housing and Health

Connecting Housing and Health

Mark Shroder, Associate Deputy Assistant Secretary for Research, Evaluation, and Monitoring

“The more you look into health and health inequalities, [the more] you realize that a lot of it is not due to a particular disease — it's really linked to underlying societal issues such as poverty, inequity … and housing,” said Dr. Helene Gayle, chief executive officer of the Chicago Community Trust, one of the country’s largest community foundations. Over the past decade, public health, housing, and community development researchers have come to recognize the importance of education, transportation, and the social determinants of health. Housing is perhaps the most vital of all these determinants.

Where we live plays a role in our health, but the magnitude of that role — and how it should shape the institutions established to improve the housing conditions of the vulnerable — are still frontier topics in policy and research. The latest issue of Cityscape contains a symposium with 10 original contributions on the housing-health connection guest-edited by Veronica Helms Garrison of HUD and Craig Evan Pollack of the Bloomberg School of Public Health at Johns Hopkins University. The authors take on pertinent questions for public health and affordable housing policy:

• Is it efficient to provide onsite wellness services to elderly residents of subsidized housing projects?
  Kandlikov and her coauthors report that a services demonstration in Vermont achieved initial efficiencies, including decreased expenditures for residents in some housing projects.

• Is it productive to furnish community health workers to project-based subsidized housing to offer assessments, planning, and case management to residents?
  Freeman and her coauthors find increased levels of self-reported wellness improvement and program satisfaction in New York City.

• Do tenants benefit when a public housing agency (PHA) requires work as a condition of residence in public housing? Do these requirements promote health?
  Frescoln and her coauthors discover that work requirements in Charlotte, North Carolina, where the public housing population had multiple health problems at baseline, did not appear to exacerbate those problems but also did not appear to reduce them. Is it intrinsic to state public health responsibilities that housing and health partners participate in the development of housing assistance programs?
  Bailey and her coauthors summarize the evolution of 19 state and local housing assistance programs that specifically address health and housing aspects.

• Is it useful for housing developers to consult public professionals in the design process?
  De Scisciolo, Egger, and Ayala discuss five community development plans that engaged health partners to prioritize health for future tenants.

• Is it worthwhile for PHAs to establish and promote relationships with public health partners?
  Lucas reviews the experience of 39 large PHAs and examines how they can promote health partnerships and programs.

• Is it effective to implement chronic disease management programs in subsidized housing projects?
  Keene and her coauthors highlight the successes of a diabetes self-management program in assisted housing.

• Is it detrimental to maternal and child health to experience homelessness during infancy?
  Cutts and her coauthors suggest that homelessness during infancy is associated with adverse health impacts for both mothers and children.

• Is it advantageous to health behaviors when an individual receives housing assistance?
  Antonakos and Colabianchi examine health behaviors and receipt of housing assistance. The authors find changes in smoking behaviors but no associations for other behaviors.

• Is it harmful to population health when neighborhoods experience vacancy?
  Wang and Immergluck find that high vacancy rates are associated with neighborhood health.

The 10 articles highlighted in the current issue of Cityscape can foster new ideas about the complex relationship between housing and health. As outlined in this research, federal, state, and local health and housing providers can partner in various ways to impact individual, community, and population health.