For most Americans, a home provides safety, security, and shelter. Housing typically represents a family’s single largest expenditure and its major source of wealth. And statistics show that people in the United States spend about 90 percent of their time indoors—with an estimated two-thirds of that spent in the home.
It is not surprising, then, that housing-related factors have the potential to help—or harm—the health of Americans in significant ways. In fact, research suggests that housing should be an important consideration in efforts to address complex and urgent health concerns such as child mortality and the rise in preventable pregnancy-related deaths in the U.S. over the past 30 years.
The data indicate links between homelessness among pregnant women and increased risk of low birth weights and preterm deliveries. Separate studies suggest there is a meaningful relationship between the quality of housing and birth outcomes.
Policymakers, community-based groups, government agencies, and health providers increasingly recognize housing as a key driver of health outcomes. For example, in December 2019 Delaware announced six evidence-based grants to community organizations aimed at narrowing the state’s wide variance in birth outcomes between black women and white women; more than twice as many black infants die before their first birthday than white infants, according to Delaware’s vital statistics data. The grants were the first of their kind in the state; two specifically target housing issues as a root cause of infant mortality.
In Michigan, Governor Gretchen Whitmer’s recently announced fiscal year 2021 budget proposal includes $11.7 million to improve health outcomes by creating a screening tool to identify health-related social needs—such as food security and housing stability—and make referrals to community-based resources.
The health care industry is also taking steps to address these challenges. Earlier this year, CVS Health announced it had invested $67 million in affordable housing in 2019, helping to produce more than 2,200 homes with supportive services for residents who may be victims of domestic violence, experiencing homelessness, affected by chronic illness, or requiring behavioral health and substance use treatment. The units are located in 24 U.S. cities in six states.
Such efforts are important because research has linked the lack of affordable housing to inadequate nutrition, especially among children. For example, one study found that children from low-income families with housing subsidies showed increased growth compared with children whose families were on a subsidy waiting list.
Still, housing is just one of many interrelated factors that contribute to the health and well-being of mothers and their children. Local, state, and national organizations looking for effective solutions to improve infant and maternal health should look across multiple sectors such as housing, transportation, and education.
Complex public health issues require combined expertise and resources from across sectors—including ones not traditionally associated with health care. With evidence-based, interagency strategies, states can more effectively address the many drivers of residents’ well-being and provide opportunities for all people to be as healthy as possible.
Stacey Millett directs the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.