More Than Just a Roof Over Our Heads

It’s no secret that housing costs in New York City have shot up faster than the latest luxury high-rise. Nowhere has this trend been felt more deeply than in the city’s rapidly gentrifying neighborhoods. Between 2010 and 2015, the average monthly rent for a one-bedroom in Harlem climbed 36 percent to $2,149, double the rate of increase for all of Manhattan.

Many residents whose families lived in neighborhoods like Harlem for generations have been forced to relocate, often to unstable, crowded conditions. As part of a recent webinar, Mailman School researchers Angela Aidala and Bob Fullilove argued that housing is much more than shelter: our living arrangements shape our health.

“Housing occupies a strategic position as an intermediate determinant of health, linking more distant economic, societal, and cultural determinants to the more immediate physical and social environments in which we carry out our day-to-day lives,” said Aidala, an associate research scientist in Sociomedical Sciences. “Where we live is where our personal, social, and economic lives come together.” 

You don’t have to be living on the street or in a shelter for your living arrangements to affect your health. Housing affordability limits where we can live—affecting housing quality, housing stability, neighborhood risks, and resources. The lack of stable, secure, adequate, housing means a lack of protected space to promote physical and psychological wellbeing. “Rather than a place of respite, restoration, and security, our housing becomes a source of chronic and at times acute stress,” Aidala says.

Organized by Marita Murrman, associate professor of Sociomedical Sciences, and presented by the Region 2 Public Health Training Center, the log-in2learn webinar is one of a regular series of federally-funded live educational lectures reaching an estimated 25,000 public health workers in state and local health departments. Webinars cover topics related to health disparities, health equity, and social determinants of health, and often touch on other issues such as environmental health and emergency preparedness.

“House-Poor” Nation

More than half of Americans who rent are considered “cost burdened,” spending more than 30 percent of their income on housing, and a third of renters are “severely burdened,” spending half their income on housing. According to a MacArthur Foundation report, 50 percent of all households report making tradeoffs to pay for housing, including less money spent on food and forgoing medical or dental care.

Families burdened by housing costs are often forced to move, an experience research finds comes with health risks. For children, frequent moves are associated with emotional, behavioral, and academic problems; teens are at increased risk of teen pregnancy, drug use, and depression.  And by moving, families often lose their social support systems; in a new neighborhood, they may not know where to find a doctor or a job, or a faith community that welcomes them.

As they relocate, many families need to share living quarters, leading to overcrowded conditions associated with poor mental and physical health. In 2013 there were nearly 1.5 million New Yorkers living in units with more than one occupant per room. In these households sleep is frequently disrupted and opportunities for both privacy and socialization are limited.

On a more intangible level, our homes and neighborhoods lend meaning to our lives. “Where we live can be a source of pride and identity, as well as agency,” said Aidala. Poor quality housing and housing insecurity takes this away, impeding our ability to form bonds with others. “Lack of control over housing is a barrier to forming stable, intimate relationships and networks of social support,” she said.

Prescription for Healthy Housing

For more than a century, public health officials have taken a keen interest in housing. Beginning in 1867, a series of New York State laws mandated fire escapes, windows and venting, and bathrooms. Subsequent decades saw scientists and advocates work to protect residents from vermin, mold, and toxins; housing-related asthma and lead poisoning continue to be major health challenges today.

Beyond these household hazards, there have been few organized efforts on the part of public health to address individual and population health issues arising from unaffordable, insecure, overcrowded and transient homes, and the socioeconomic factors that give rise to them. “Public health needs to be louder at the table,” said Aidala.

Just as researchers provide input on housing quality issues like lead paint, they can also offer evidence on the health risks related to housing location, housing community, and housing affordability. According to Aidala, research could also explore the potential of specific policies, such as whether subsidies to promote roof gardens and green building rehabilitation result in increased housing costs and attendant health risks that contribute to health disparities. “We need to analyze whether any policy decision that affects housing or neighborhood will be health promoting detrimental to community health.”

Meanwhile there are encouraging signs that housing’s connection to health is becoming more broadly appreciated. The Affordable Care Act provides funding for hospitals and managed care organizations to incorporate housing into planning for community benefit agreements. And through new insurance payment structures, physicians, working in partnership with community groups, can actually write a prescription for housing and other services. (A future webinar will explore these funding streams in more detail.)

As New York and other cities face severe shortages of affordable housing, Fullilove, professor of Sociomedical Sciences, said, policymakers, many of whom created subsidies that helped fuel gentrification, should adhere to the principle of “no planning without health assessments.” “Housing is not only a fundamental part of health,” he said, “but changes in housing patterns, often brought about by rapid neighborhood changes, also have impacts we should be concerned with.”

View Aidala and Fullilove's presentation:

https://drive.google.com/file/d/0BxYK7KiCHB2wc2NsOHo0Z2FJZjg/preview