Megan Sandel, M.D., M.P.H., an expert on the impact of housing on child health, says journalists would do well to broaden the conversation about health care to include questions about social support – especially support for safe, affordable and stable housing. This tip sheet includes key stories to pursue and critical insights on the housing-as-health-care trend.
By Megan Sandel
Trace unhealthy housing to its source
The impact of housing on health has been recognized for two centuries, but poor housing does not just happen. It’s connected to policies that drive unhealthy choices and outcomes.
Some policies and programs are put in place to try to ensure safe housing. Sanitary codes were designed 100 years ago to solve cholera, typhoid and tuberculosis. Now codes have been developed to solve rodent and mold infestations. However, unequal enforcement of codes creates health disparities. Few stories on poor housing and health ever connect poor housing more broadly to unhealthy or unenforced policies. Reporters can look to policies around housing codes, housing subsidies and neighborhood safety for stories on the health of both individuals and communities.
Move beyond asthma
Stories of children with asthma who can’t breathe at home because of mold are a real problem, but it’s only a small piece of how housing impacts health. Housing also has an enormous impact on educational attainment and economic stability, which in turn have their own impact on health. It’s hard to do well in school if you move from school to school because you moved three times in a year. It’s difficult to do well in a job if you are moving, your kids are sick or you are paying too much rent.
Educational attainment and economic stability are two of the biggest predictors of future health. Connections are rarely made between housing, education, income and wealth, but there are many stories of how this cycle is fed.
Ask “How often do you move?”
To be truly healthy, housing must be three things: stable, of good quality and affordable. Both media and public policy focus more on the latter two, but almost never deal with stability.
Investing in one area without considering the other two potentially undermines the health benefit of any solution (i.e. low quality, affordable housing in bad neighborhood is the like giving the wrong dose of the right medication). Asking individuals “How often do you move?” and threading the connections between housing stability and health is an area where there are many untold stories.
| STABILITY Low frequency of moves |
QUALITY Safe conditions |
AFFORDABILITY Cost |
| Social networks form; Less violence in neighborhoods | Less asthma, Less stress; Better parenting; Fewer emotional problems | Less tradeoffs between housing and food / keeping heats and lights on |
Look at whether the health problem is a housing problem
Safe, affordable housing costs less than hospitalizing someone. We pay more for worse health outcomes. There is a lot of discussion about how expensive it would be to provide affordable, stable, quality housing, but studies show housing is less expensive than treating the consequences of poor housing. For example, health care spends $10,000 per year on antiretroviral drugs for a person with HIV, yet they are not that effective in people who are homeless, so we hospitalize them and spend much more money.
The conversation about health care and health care spending should include whether a little more social spending and creating a few more partnerships outside health care, is cheaper and healthier than treating symptoms.
Megan Sandel is an associate professor at the Boston University School of Medicine and Public Health and former pediatric medical director of Boston’s Healthcare for the Homeless program. She co-authored the first national report on housing and child health and has worked with public health authorities to create links between housing inspection offices and the health care system.
