Housing FAQ

Where we live affects various parts of our lives, including education and health outcomes. 
Here are some common questions about housing ecosystems:

What’s the connection between health and housing? Is it just about things such as lead paint or is it bigger ?

Research clearly shows housing is a determinant of health, but the relationship is not linear or easily defined. The connection between health and housing includes environmental factors such as lead poisoning, water contamination and unsafe living conditions. Generally, research has focused on the effects of affordability, safety, quality, stability and access, as well as environmental impacts of housing on health outcomes. Examples include:

• The health impact of not having a stable home (homelessness and consistent housing)
  
  
• The health impact of conditions inside a home (safety and quality)
  
  
• The health impact of the financial burden to gain or maintain housing/high-cost housing (affordability)
  
  
• The health impact of neighborhoods (neighborhood, environmental and social characteristics)

What do you mean by housing characteristics?

The U.S. Census Bureau defines housing characteristics to understand housing markets and changes in housing throughout the nation. Research related to housing as a determinant of health outcomes uses various characteristics of housing to address questions about the implications for renters, owners, property managers, developers and other stakeholders in the housing market. Examples include:

• Homelessness (unsheltered, sheltered, cars, couch surfing, non-housing hotels, etc.)
  
  
• Institutional housing (prisons, etc.)
  
  
• Public housing
  
  
• Affordable housing
  
  
• Mixed-use housing
  
  
• Low-visibility housing

What does an affordable housing crisis mean and how does it affect health?

The cost of deteriorating housing affordability is measured in how much households must spend on housing and in understanding who is and isn’t able to reasonably afford to buy homes in their communities. To illustrate the affordable housing crisis and the subsequent effect on health, researchers define “severely cost-burdened renters” as those paying more than 30% (up to 50% in some markets) of their income on rent and utilities. In a recent survey, among severely cost-burdened renters, 45% didn’t follow a doctor's treatment plan due to costs as compared to 34% of all other respondents; 54% delayed care due to costs. Nearly half of America’s renters are cost burdened and nearly a quarter are severely cost burdened. The number of American households severely cost burdened because of rent is expected to reach 13.1 million in 2025, according to recent findings. 

Who are the stakeholders in the housing ecosystem?

Stakeholders in the housing ecosystem are the global community and economic actors — everyone is affected and deserves access to safe, quality, affordable housing. Generally, stakeholders are those in the ecosystem who have impact on or are impacted by changes in related policies, systems or environments. Stakeholders include but are not limited to: housing developers; government and non-governmental agencies; renters and owners; business and industry; and community member groups.

What are barriers to stable housing?

Housing stability isn’t limited to only chronic homelessness, but also includes varying stages such as sedentary lifestyle, eviction, falling behind on rent or moving frequently. People who have varying degrees of housing instability are more likely to experience poor health compared with those who don’t have housing stability challenges. 
Living without stable housing is detrimental to health and a substantial risk increase to physical and mental health. Having a place to live can improve health and decrease health care costs.  Studies have shown the negative effect of foreclosures on mental health outcomes; others connect the stress of unstable housing to employment, education and social network disruptions.   

How does neighborhood quality and housing impact health?

Quality and safety, in the neighborhood and within the home, define environmental factors that can correlate to health outcomes. Quality and safety research refer to the housing and neighborhood conditions that affect health adversely. For example, some substandard conditions that contribute to respiratory distress have been identified, including water leaks, poor ventilation, dirty carpets and pest infestation. Promising research has found a connection between improving housing safety and quality and improved health outcomes. 

What innovations in the United States or around the world address stable affordable housing?

A lot of innovative approaches in different housing markets are working, being experimented with or in development to address the affordable housing crisis. Creative solutions to housing availability include tiny homes, shared housing startups and prefabricated and manufactured homes. Affordability solutions include down payment assistance programs, co-operatives and co-ownerships, and community land trusts. 
Some examples include: 

• “Tiny homes” instead of one large single-family home — Clarkston, Georgia plans to re-do city zoning codes to allow for more sustainable housing solutions with taller apartments and tiny home communities, creating a more walkable city. “The houses range from around 250 to 500 square feet — compared to around 2,400 square feet for a typical new American house — and are expected to cost between $100,000 and $125,000. The average house in the county goes for around $285,000.” 
  
  
• “Teachers Villages” — Workforce housing developments target teachers to help alleviate community drain in the profession. One is fully operational and leased in Newark, New Jersey, and another opened in May 2019 in Hartford, Connecticut.
  
  
• “CUBO” bamboo pre-fab houses in Manila, Philippines — Modular housing that can be manufactured in a week captures rainwater and reduces heat gain; elevated stilts prevent flooding. “The house, known as CUBO, uses engineered bamboo, and can be put together in four hours at a cost of 60 pounds per square meter.”
  
  
• “PadSplit” shared housing solutions in high-cost housing markets — “Rather than building new buildings, PadSplit works with property owners renting single-family homes. Property owners agree to fix up the houses to a certain standard, and then PadSplit helps them add walls to create new rooms; for example, a formal dining room or extra den can be converted into bedrooms. Then the company screens potential residents and rents out each room, including utilities, internet and laundry for around $550 a month.”

How are health care stakeholders involved? 

Studies have looked at the roles of health care providers, medical insurance companies and government in reducing health care expenditures for certain populations, i.e., outcomes of housing the homeless, continuing care for young adults aging out of the foster care system and elderly aging in place policies. Other consumer innovations include prescription meal delivery programs and natural disaster preparation and recovery. 

What strategies is the AHA considering to help improve housing and neighborhoods? 

The AHA is committed to supporting our partners in housing and related areas through advancing policy agendas, continuing to build an evidence base of effective solutions and addressing the health needs of those in housing-insecure situations. Specifically, we want to partner with faith-based organizations that build housing opportunities, health systems that add housing to their solutions and community initiatives that address homelessness. We also support neighborhoods providing access to transportation, quality parks/streets/sidewalks, healthy food and job opportunities.

How are disaster recovery and its effect on housing issues being addressed?

After many recent hard-hitting natural disasters in the United States, research related to housing has primarily focused on preparation, resiliency and post-disaster aftermath/recovery, with implications that correlate to health impacts. Largely, research points to a need for long-term assistance efforts in affected communities, impact on residents’ financial health to recover, etc.

How might increasing numbers of disasters impact the long-term viability of housing?

Climate change is putting everyone at greater risk for natural disasters, such as flooding, wildfires and drought. Low-income and minority communities are especially vulnerable. As the risk for natural disasters increases, the risk for housing instability directly increases. Affected communities lose affordable housing units (with no change in population), which results in more homeless and housing unstable citizens, greater pressure on community resources and negative physical and mental health effects.