Housing quality and health outcomes in the United States

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Housing quality and health outcomes in the United States are inextricably linked. As a matter of U.S. public health, substandard housing is associated with outcomes such as injury, respiratory infections, heavy metal (e.g. lead) poisoning and asthma. [1] It may also be associated with mental disability and with obesity and its related morbidities.

Contents

Background

According to the World Health Organization, [2] housing should provide:

The United States Department of Housing and Urban Development (HUD) 2007 American Housing Survey determined that 6 million households live with moderate or severe physical housing problems. Homes that are lacking toilets, have faulty or unreliable heating systems, or have exposed electrical wiring do not protect inhabitants from disease and injury and can cause serious psychological stress are categorized as being "severe" housing problems. [3] "Moderate" housing problems are things such as having unvented gas, oil, or kerosene as the primary heating source, or lacking a kitchen sink. Again, the lack of commonplace appliances like a furnace or sink can expose inhabitants to diseases and injury.

The U.S. Census Bureau gathers data on several factors related to the housing: plumbing, heating, hallways, upkeep, electric service and kitchen equipment. [3] [4] As many as 24 million households have lead-based paint hazards. Maintenance and upkeep of public and low-income housing remains a major issue, leading to chronic problems of water infiltration, pest infestation and unsafe physical conditions. [3] The disproportionate burden of these problems falls to children, the elderly and those with chronic illnesses, and minorities. [3]

Neighborhoods

Housing quality is also an indicator of neighborhood conditions. Neighborhoods that are seen as bad or deteriorating are often characterized by the conditions of the housing in that neighborhood. Poor neighborhood conditions can be defined as having abandoned buildings, vacant lots, no access to quality schools, and high levels of poverty. These neighborhood dynamics can contribute to a person's psychological and social stress.

In low-income neighborhoods crime and noxious noise and odors can force individuals to isolate in substandard homes, which often characterize low-income neighborhoods. The combination of avoiding outside activity and isolating in dangerous living spaces leads to negative health outcomes such as obesity, lead poisoning, and asthma. [5]

History

Housing quality has greatly improved since the beginning of the 20th century. However, today close to 6 million American live in severe or moderate housing conditions. The majority of those living in these extreme housing conditions are minorities and renters. Today's poor housing and neighborhood conditions are a symptom of historic inner city disinvestment and population lose influenced by ill-conceived federal housing policy and finance. [6]

After World War II, the Federal Housing Administration (FHA) played a major part in influencing those with the means to leave the inner city for the suburbs. [3] According to Schwartz, the FHA gave preferential treatment to insuring mortgages in the suburbs rather than the inner city. The FHA considered black neighborhoods too risky of an investment to insure mortgages. [3] The result was many middle-class families left the inner city, taking with them jobs and opportunity. This left poor black families in neighborhoods that were quickly beginning to be characterized by vacant lots, abandoned buildings, crime, and economic insecurity.[ citation needed ]

Statistics

Poor housing conditions can also be characterized by race and geography. Of the 6 million Americans who experience poor housing conditions, blacks and Hispanics fare much worse than whites.[ by whom? ] Moreover, poor housing conditions are disproportionately found in inner cities and rural areas as opposed to the suburbs. Inner city minorities have poorer health than suburban whites.[ citation needed ] Black homeowners are more likely than Hispanic and white homeowners to experience severe and moderate housing problems. 2.1% of all homeowners have moderate housing quality problems. 5.9% of black homeowners and 3.8% of Hispanic homeowners experience moderate housing quality problems. [3]

Black renters are more likely than Hispanics and whites to experience severe and moderate housing conditions. 6.9% of all renters have moderate housing quality problems. 7.9% of black renters and 7.1% of Hispanic renters. 3.1% of all renters have severe housing problems. 4.2% of black renters and 3.4% of Hispanic renters. [3]

Homeowners and renters in central cities and rural areas are more likely than homeowners and renters in the suburbs to experience severe or moderate housing problems. Of those with severe housing problems, 20% more were in central cities and 10% more were located in rural areas than in suburban areas. Of those with severe housing problems, nearly 20% more were located in central cities. [3]

Specific health outcomes

Substandard housing quality can have detrimental impacts on the physical and mental health of residents. In the United States, high-quality housing has become difficult to afford and access. Because of the inaccessibility, many individuals and families settle to build homes in spaces with poor living conditions. As of 2017, 8.3 million homes were considered homes with “worst case needs.” [7] This number is describing the amount of rental households which are occupied by individuals with extremely low incomes, and living in severely inadequate conditions. Characteristics of inadequate housing include spaces with poor ventilation or leaks, peeling paint or cracked walls and ceilings, faulty smoke alarms, as well as having deficiencies in heating, electricity and plumbing.

Individuals and families living in spaces that exhibit these characteristics face a heightened risk of experiencing poor health. Residing in poorly ventilated homes can increase risks of respiratory illnesses. [8] Additionally, poor ventilation can increase the likelihood residents will be exposed to mold, and other allergens, of which can have significant health impacts, increasing the risk of experiencing negative health effects. In addition to the physical health impacts experienced by residents in poorly maintained spaces, these individuals and families also suffer from stress and anxiety caused by their living conditions. [9]

Evaluating the quality of housing, as well as recognizing its inadequacies,  is an essential aspect of ensuring the health and safety of people within their homes. Additionally, recognizing the correlation between poor housing quality and poor health helps to determine the location of investment initiatives by providing information on where funds are most needed. [7]

Asthma and respiratory illnesses

Asthma is a major reason for childhood hospitalizations as well as absenteeism from schools. Asthmatic children living in homes with cockroaches, mice and mold may be especially prone to episodes requiring medical care. Direct health care costs of asthma totaled more than $14.7 billion in 2008. [10] $5 billion annually in indirect costs, primarily from lost productivity, can be added to the total. According to the Centers for Disease Control and Prevention, [11] almost 13 million lost school days, 4 million asthma attacks and nearly 4,000 deaths yearly are associated with asthma. Water infiltration and poor ventilation increases the likelihood that moisture will be an issue in a home, which can lead to infestation of pests and to mold growth, known triggers of allergies and asthma.

Lead

High lead levels (blood levels ≥10 micrograms per deciliter) are associated with a number of poor health outcomes, including: learning disabilities, behavioral and neurological problems, and, in severe cases, death. Even relatively low blood lead levels can have negative health impacts. [12] The impact on the individual and on society in terms of lost potential can be dramatic. Those living in older, poorly maintained housing are at the greatest risk, and many of these housing units are home to low-income families [13] Even though blood levels are dropping in much of the population in the United States, the poorest children remain at the greatest risk because they are most likely to live in older, poorly maintained housing.

Unintentional injuries

Unintentional injury is the leading cause of death among children under the age of 15. Deaths from residential injuries accounted for an average of 2,822 deaths annually from 1985 to 1997. [14] The rates of death associated with residential injury are equally significant amongst those aged 65 and older. Poorly maintained stairs, sidewalks, bad lighting, and inadequate facilities for people with limited mobility or sensory impairments are all implicated in injury rates.[ citation needed ]

Chronic illness

Even after accounting for other potential contributors like income, smoking or employment status, poor housing conditions are associated with an increased risk of chronic respiratory infection. Unsanitary conditions made more severe by aging and poorly constructed structures, exacerbate the problem. Poor heating and cooling lead to an increased risk of temperature related illnesses. Heat stroke and exhaustion are a major cause of mortality and morbidity, especially for the elderly. Conversely, exposure to cold temperatures can contribute to an increased use of health services. [15]

Nutrition and obesity

“Food deserts”, areas that lack grocery stores or markets that contain healthful foods like fruits and vegetables, are primarily found in high poverty, inner-city areas where residents lack the resources to travel.[ by whom? ] These areas are also known for selling convenience foods and liquor.[ by whom? ] Rates of obesity and the related illnesses are much higher in these areas than in higher income communities with easy access to fresh foods. A correlation has been determined for a connection between food insecurity associated with housing cost burdens and under-nutrition. [16] A lack of adequate play areas for children, poor lighting or sidewalk condition can also lead to a lack of physical activity which is associated with increased obesity and associated morbidities, such as type II diabetes, cancer and cardiovascular disease.[ citation needed ]

Housing hazards

Most significant aspects of poor housing are linked to various adverse health effects ranked by highest number of people affected. These housing hazards are linked to many health effects like respiratory symptoms, asthma, lung cancer, depression, injury, hypothermia and death. [17]

  1. Air quality
  2. Hygrothermal conditions (warmth and humidity)
  3. Radon
  4. Noise
  5. House dust mites
  6. Environmental tobacco smoke
  7. Fires

Policy interventions

There are several factors policy-makers and housing quality and health advocates need to consider when thinking about potential solutions to the problems of housing quality and health.

See also

Related Research Articles

<span class="mw-page-title-main">Asthma</span> Long-term inflammatory disease of the airways of the lungs

Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.

<span class="mw-page-title-main">Indoor air quality</span> Air quality within and around buildings and structures

Indoor air quality (IAQ) is the air quality within buildings and structures. Poor indoor air quality due to indoor air pollution is known to affect the health, comfort, and well-being of building occupants. It has also been linked to sick building syndrome, respiratory issues, reduced productivity, and impaired learning in schools. Common pollutants of indoor air include: secondhand tobacco smoke, air pollutants from indoor combustion, radon, molds and other allergens, carbon monoxide, volatile organic compounds, legionella and other bacteria, asbestos fibers, carbon dioxide, ozone and particulates. Source control, filtration, and the use of ventilation to dilute contaminants are the primary methods for improving indoor air quality.

<span class="mw-page-title-main">Non-invasive ventilation</span> Breathing support administered through a face mask

Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alternated depending on whether someone is breathing in or out. It is termed "non-invasive" because it is delivered with a mask that is tightly fitted to the face or around the head, but without a need for tracheal intubation. While there are similarities with regard to the interface, NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle; CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.

<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

<span class="mw-page-title-main">Social determinants of health</span> Economic and social conditions that influence differences in health status

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

Diseases of poverty, also known as poverty-related diseases, are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.

The Hispanic paradox is an epidemiological finding that Hispanic Americans tend to have health outcomes that "paradoxically" are comparable to, or in some cases better than, those of their U.S. non-Hispanic White counterparts, even though Hispanics have lower average income and education, higher rates of disability, as well as a higher incidence of various cardiovascular risk factors and metabolic diseases.

<span class="mw-page-title-main">Housing</span> Living spaces

Housing refers to the usage and possibly construction of shelter as living spaces, individually or collectively. Housing is a basic human need and a human right, playing a critical role in shaping the quality of life for individuals, families, and communities, As such it is the main issue of housing organization and policy.

Residential segregation is the physical separation of two or more groups into different neighborhoods—a form of segregation that "sorts population groups into various neighborhood contexts and shapes the living environment at the neighborhood level". While it has traditionally been associated with racial segregation, it generally refers to the separation of populations based on some criteria.

In the United States, housing segregation is the practice of denying African Americans and other minority groups equal access to housing through the process of misinformation, denial of realty and financing services, and racial steering. Housing policy in the United States has influenced housing segregation trends throughout history. Key legislation include the National Housing Act of 1934, the G.I. Bill, and the Fair Housing Act. Factors such as socioeconomic status, spatial assimilation, and immigration contribute to perpetuating housing segregation. The effects of housing segregation include relocation, unequal living standards, and poverty. However, there have been initiatives to combat housing segregation, such as the Section 8 housing program.

The Coalition for Economic Survival (CES) is a grassroots, non-profit community organization. CES works in the greater Los Angeles area to influence policy makers to improve the lives of low and moderate income people.

<span class="mw-page-title-main">Housing inequality</span>

Housing inequality is a disparity in the quality of housing in a society which is a form of economic inequality. The right to housing is recognized by many national constitutions, and the lack of adequate housing can have adverse consequences for an individual or a family. The term may apply regionally, temporally or culturally. Housing inequality is directly related to racial, social, income and wealth inequality. It is often the result of market forces, discrimination and segregation.

Structural inequality occurs when the fabric of organizations, institutions, governments or social networks contains an embedded cultural, linguistic, economic, religious/belief, physical or identity based bias which provides advantages for some members and marginalizes or produces disadvantages for other members. This can involve, personal agency, freedom of expression, property rights, freedom of association, religious freedom,social status, or unequal access to health care, housing, education, physical, cultural, social, religious or political belief, financial resources or other social opportunities. Structural inequality is believed to be an embedded part of all known cultural groups. The global history of slavery, serfdom, indentured servitude and other forms of coerced cultural or government mandated labour or economic exploitation that marginalizes individuals and the subsequent suppression of human rights are key factors defining structural inequality.

<span class="mw-page-title-main">Mixed-income housing</span>

The definition of mixed-income housing is broad and encompasses many types of dwellings and neighborhoods. Following Brophy and Smith, the following will discuss “non-organic” examples of mixed-income housing, meaning “a deliberate effort to construct and/or own a multifamily development that has the mixing of income groups as a fundamental part of its financial and operating plans” A new, constructed mixed-income housing development includes diverse types of housing units, such as apartments, town homes, and/or single-family homes for people with a range of income levels. Mixed-income housing may include housing that is priced based on the dominant housing market with only a few units priced for lower-income residents, or it may not include any market-rate units and be built exclusively for low- and moderate-income residents. Calculating Area Median Income (AMI) and pricing units at certain percentages of AMI most often determine the income mix of a mixed-income housing development. Mixed-income housing is one of two primary mechanisms to eliminate neighborhoods of concentrated poverty, combat residential segregation, and avoid the building of public housing that offers 100% of its housing units to those living in poverty. Mixed-income housing is built through federal-, state-, and local-level efforts and through a combination of public-private-non-profit partnerships.

The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

Childhood chronic illness refers to conditions in pediatric patients that are usually prolonged in duration, do not resolve on their own, and are associated with impairment or disability. The duration required for an illness to be defined as chronic is generally greater than 12 months, but this can vary, and some organizations define it by limitation of function rather than a length of time. Regardless of the exact length of duration, these types of conditions are different than acute, or short-lived, illnesses which resolve or can be cured. There are many definitions for what counts as a chronic condition. However, children with chronic illnesses will typically experience at least one of the following: limitation of functions relative to their age, disfigurement, dependency on medical technologies or medications, increased medical attention, and a need for modified educational arrangements.

<span class="mw-page-title-main">Housing insecurity in the United States</span>

Housing insecurity is the lack of security in an individual shelter that is the result of high housing costs relative to income and is associated with poor housing quality, unstable neighborhoods, overcrowding, and homelessness.

<span class="mw-page-title-main">Eviction in the United States</span> Landlord removals of rental housing tenants in the North American country

Eviction in the United States refers to the pattern of tenant removal by landlords in the United States. In an eviction process, landlords forcibly remove tenants from their place of residence and reclaim the property. Landlords may decide to evict tenants who have failed to pay rent, violated lease terms, or possess an expired lease. Landlords may also choose not to renew a tenant's lease, however, this does not constitute an eviction. In the United States, eviction procedures, landlord rights, and tenant protections vary by state and locality. Historically, the United States has seen changes in domestic eviction rates during periods of major socio-political and economic turmoil—including the Great Depression, the 2008 Recession, and the COVID-19 pandemic. High eviction rates are driven by affordable housing shortages and rising housing costs. Across the United States, low-income and disadvantaged neighborhoods have disproportionately higher eviction rates. Certain demographics—including low income renters, Black and Hispanic renters, women, and people with children—are also at a greater risk of eviction. Additionally, eviction filings remain on renters' public records. This can make it more difficult for renters to access future housing, since most landlords will not rent to a tenant with a history of eviction. Eviction and housing instability are also linked to many negative health and life outcomes, including homelessness, poverty, and poor mental and physical health.

<span class="mw-page-title-main">Poverty and health in the United States</span>

Poverty and health are intertwined in the United States. As of 2019, 10.5% of Americans were considered in poverty, according to the U.S. Government's official poverty measure. People who are beneath and at the poverty line have different health risks than citizens above it, as well as different health outcomes. The impoverished population grapples with a plethora of challenges in physical health, mental health, and access to healthcare. These challenges are often due to the population's geographic location and negative environmental effects. Examining the divergences in health between the impoverished and their non-impoverished counterparts provides insight into the living conditions of those who live in poverty.

Gentrification in the United States is commonly associated with an influx of higher-income movers into historically divested neighborhoods with existing, working-class residents, often resulting in increases in property prices and investment into new developments. Displacement and gentrification are also linked, with consequences of gentrification including displacement of pre-existing residents and cultural erasure of the historic community. In the United States, discussions surrounding gentrification require critical analysis of race and other demographic data in examining the inequalities and disparities between existing residents, the community, new buyers, and developers caused by gentrification.

References

  1. ↑ Krieger, J., & Higgins, D., Housing and health: Time again for public health action, American Journal of Public Health, pp. 758-768 (2002)
  2. ↑ Health principles of housing, World Health Organization, Geneva (1990). Retrieved October 28, 2011 from http://whqlibdoc.who.int/publications/1989/9241561270_eng.pdf
  3. 1 2 3 4 5 6 7 8 9 Schwartz, A. F., Housing Policy in the United States (2010).
  4. ↑ Routledge. U.S. Department of Housing and Urban Development, American Housing Survey (2007). Retrieved from U.S. Department of Housing and Urban Development: http://www.huduser.org/DATASETS/ahs/ahsdata07.html Archived 2012-04-04 at the Wayback Machine
  5. ↑ Bashir, S. A. (2002). Home is where the harm is: Inadequate housing as a public health crisis. American Journal of Public Health, 92 (5), 733-738.
  6. ↑ Mallach, A., Facing the urban challenge: The federal government and America’s older distressed cities, The Brookings Institution, Washington, D.C. (2010).
  7. 1 2 Boch, Samantha J.; Taylor, Danielle M.; Danielson, Melissa L.; Chisolm, Deena J.; Kelleher, Kelly J. (2020-03-01). "'Home is where the health is': Housing quality and adult health outcomes in the Survey of Income and Program Participation". Preventive Medicine. 132: 105990. doi:10.1016/j.ypmed.2020.105990. ISSN   0091-7435. PMC   7024670 . PMID   31954138.
  8. ↑ "Census of Population and Housing, 1980 [United States]: County Migration by Selected Characteristics, 1975-1980". ICPSR Data Holdings. 1986-06-06. doi:10.3886/icpsr08471.v1 . Retrieved 2023-12-15.
  9. ↑ Pevalin, David J.; Reeves, Aaron; Baker, Emma; Bentley, Rebecca (2017-12-01). "The impact of persistent poor housing conditions on mental health: A longitudinal population-based study". Preventive Medicine. 105: 304–310. doi:10.1016/j.ypmed.2017.09.020. hdl: 2440/115987 . ISSN   0091-7435.
  10. ↑ National Institutes of Health. (2007). Morbidity and Mortality: 2007 Chart Book on Cardiovascular, Lung and Blood Disease. Retrieved from National Heart, Blood, and Lung Institute: http://www.nhlbi.nih.gov/resources/docs/07-chtbk.pdf
  11. ↑ Centers for Disease Control and Prevention. (2011, September 9). Vital Signs: Current cigarette smoking among adults - United States 2005-2010. Retrieved October 15, 2011, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6035a5.htm
  12. ↑ Canfield, R., Henderson, C., Cory-Slechta, D., Cox, C., Jusko, T., & Lanphear, B., Intellectual impairment in children with blood lead concentration below 10 micrograms per deciliter, New England Journal of Medicine, pp. 1517-26 (2003)
  13. ↑ Jacobs, D., Clickner, R., Zhou, J., Viet, M., Marker, D., Rogers, J., et al., Prevalence of lead-based paint in U.S. housing. Environmental Health Perspectives, A559-A606 (2002)
  14. ↑ Nagaraja, J., Menkedick, J., Phelan, K., Ashley, P., Zhang, X., & Lamphear, B., Deaths from residential injuries in U.S. children and adolescents, 1985-1997, Pediatrics, pp. 454-461 (2005).
  15. ↑ Evans, J., Hyndman, S., Stewart-Brown, S., Smith, D., & Petersen, S., An epidemiological study of the relative importance of damp housing in relation to adult heath, J Epidemiol Community Health, pp. 677-686 (2000).
  16. ↑ Meyers, A., Frank, D., Roos, N., et al., Housing subsidies and pediatric undernutrition, Archives of Pediatric Adolescent Medicine, pp. 1079-1084 (1995).
  17. ↑ J., Raw, G.; E., Aizlewood, Claire; M., Hamilton, Ruth; Establishment., Building Research; Regions., Great Britain. Department of the Environment, Transport and the (2001-01-01). Building regulation, health and safety : a report concerning the influence on the health and safety of building users of fabric and services controlled or controllable by regulation of buildings. BRE, DETR. OCLC   51081525.{{cite book}}: CS1 maint: multiple names: authors list (link)
  18. ↑ Matte, T.D. & Jacobs D. E., Housing and health – current issues and implications for research and programs, Journal of Urban Health, 77(1), pp. 7-25 (2000).
  19. ↑ Stone, M.E. (2006). Housing affordability: One-Third of a nation shelter-poor. A Right to HOUSING: Foundation for a New Social Agenda. Philadelphia, PA: Michael E. Stone.
  20. ↑ Rosenbaum, E. (1996). Racial/Ethnic differences in home ownership and housing quality, 1991*. Social Problems, 43 (4), 403-426.
  21. ↑ Jacobs, J. E., Wilson, J., Dixon, S.L., Smith, J. & Evens, A. (2009). The relationship of housing and population health: A 30-Year retrospective analysis. Environmental Health Perspectives, 117 (4), 597-604.
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