“Housing” refers to the dwellings where people reside. They may be rented or owned, permanent or temporary, and could be an apartment, single-family home, recreational vehicle, trailer, or some other type of shelter. Housing affects health via the “4 C’s”: (1) cost, (2) conditions, (3) consistency, and (4) context (Swope & Hernández, 2019).
Cost refers to whether people can pay for housing without being overly burdened (Swope & Hernández, 2019; Taylor, 2018). The National Housing Act of 1937 set targets for the proportion of people’s income that should be spent on rent. What started as 20% increased to 30% in 1981 and has served as the general rule of thumb (Swartz & Wilson, 2008). Since then, however, economics have changed. According to the 2018 five-year American Community Survey estimates, nearly one-third of U.S. households paid more than 30% of their income for their housing, and more than a third of those households made less than $20,000 annually (U.S. Census Bureau, 2018). When housing markets demand a greater share of one’s income for shelter, particularly for households with lower incomes, families’ health is put at risk. Food, medications, insurance, and childcare – all of which can be important for a family to thrive – may be sacrificed to maintain one’s home. Unsurprisingly, studies have found links between unaffordable housing and adverse physical and mental health outcomes (Swope & Hernández, 2019).
When housing is too expensive, residents may be forced into housing of lower quality (affecting their housing conditions) or relocate entirely (affecting the consistency of their housing). Conditions are the characteristics and quality of the housing unit and environment. Poor housing conditions such as lack of heat, pests, toxic exposures (e.g., lead), and general dilapidation can all harm physical and mental health (Swope & Hernández, 2019).
Consistency is about residential stability and whether residents can remain in their housing as long as they want to. Neighborhood investments that lead to gentrification can drive up housing costs, forcing current lower-income residents to relocate involuntarily (Swope & Hernández, 2019). The resulting displacement may lead to houselessness, severing critical social ties, toxic stress, and negative coping strategies, all of which can harm physical and mental health. Foreclosure, the seizing of a home because of the inability to repay mortgage loans, has been associated with adverse physical and psychological health outcomes for the individuals experiencing it and others in their neighborhoods (Arcaya, 2018; Swope & Hernández, 2019). Since the financial and housing crisis began in 2007, over 9.4 million homes in the U.S. have experienced foreclosure or related mechanisms (Arcaya, 2018).
- Arcaya, M. C. (2018). Neighborhood Foreclosures and Health. In D. T. Duncan & I. Kawachi (Eds.), Neighborhoods and Health (Second, pp. 293–319). Oxford University Press.
- Keene, D. E., & Geronimus, A. T. (2011). “Weathering” HOPE VI: The Importance of Evaluating the Population Health Impact of Public Housing Demolition and Displacement. Journal of Urban Health, 88(3), 417–435. https://doi.org/10.1007/s11524-011-9582-5
- Swope, C. B., & Hernández, D. (2019). Housing as a determinant of health equity: A conceptual model. Social Science & Medicine, 243, 112571. https://doi.org/10.1016/j.socscimed.2019.112571
- Taylor, L. (2018). Housing and Health: An Overview of the Literature. Health Affairs Health Policy Brief. https://doi.org/10.1377/hpb20180313.396577
- S. Census Bureau. (2017). 2017 National—Housing Quality—All Occupied Units. https://www.census.gov/programs-surveys/ahs.html
- S. Census Bureau. (2018). American Community Survey, 2018 American Community Survey 5-Year Estimates, Table S2503. Financial Characteristics. https://data.census.gov/cedsci/table?t=Financial%20Characteristics&g=0100000US&tid=ACSST5Y2018.S2503&hidePreview=false
- Schwartz, M., & Wilson, E. (2008). Who can afford to live in a home?: A look at data from the 2006 American Community Survey. US Census Bureau, 1-13.
