The Housing and Health Connection

By Cari Wade Gervin
Friday, July 1, 2022

As the affordable housing crisis worsens across the country, research shows that ensuring housing stability has a big impact on health outcomes.

One of the five focal social determinants of health in the U.S. Department of Health and Human Services Healthy People 2030 initiative is neighborhood and built environment, and one of the top goals in that determinant is to reduce the proportion of families who spend more than 30% of income on housing. But with rents up nationally by 11% in the past year and over 30% in some larger cities, that goal looks farther away than ever. And that’s a big problem for people’s health, according to recent research. On the other hand, access to housing can lead to improved health outcomes.

Supportive Housing Decreased ER Visits

One study conducted by the Urban Institute focused on a supportive housing program in Denver. Over two years, the randomized trial found the “housing first” approach — which places no preconditions like sobriety before providing housing for unhoused people — improved access to psychiatric care and medication management and decreased emergency hospital visits.

“This population was cycling between homelessness and jail, and most of their health care, if they were getting any, was within the jail … so there was no long-term follow-up care,” says Sarah Gillespie, Associate Vice President, Metropolitan Housing and Communities Policy, Urban Institute. “What this study showed is that you can stop that cycle by using housing first and connecting people through an assertive community treatment plan.”

Rental Assistance for Diabetes Treatment

Ongoing research at Yale University in partnership with the U.S. Department of Housing and Urban Development is looking at whether affordable housing can improve Type 2 diabetes outcomes. Pilot research seemed to indicate that housing stability via rental assistance improved diabetes self-management and control. The full study will be completed in 2025.

What Physicians Need to Know

Asking about housing stability may not be the first thing on a physician’s mind during a patient visit, but it might be worth taking the time to discuss it.

“We have highlighted something that the VA does, which is every time someone receives care at the VA, they get a screener that asks them, ‘Do you have a place to live? Are you worried about not having a place to live next week?’” says Devlin Hanson, Principal Research Associate at the Center on Labor, Human Services, and Population at the Urban Institute. “It’s also important to think about the definition of homelessness — like couch surfing, right? Maybe you are staying with a friend, but you’re staying with a different friend every few nights. That’s considered homelessness.”

Hanson also noted that things like cancellation fees can be a real hardship for unhoused or housing insecure patients.

“If one of your patients is living on the street, experiencing homelessness, making and keeping appointments is a very hard thing to do,” Hanson says.