Where You Live Has a Huge Impact on Your Health



we've often talked about social determinants of health and healthcare triage that's because they have an enormous impact on health but while we're willing to spend enormous amounts of money on things like drugs and procedures that might make small contributions to an individual's health we are often resistant to paying for big things that matter like housing this is in spite of the fact that housing can often have a huge impact on health over the next few weeks we're gonna be making our fourth deep dive into health policy issues especially those that touch on social determinants of health and health equity thanks to the support of the Robert Wood Johnson Foundation we're gonna talk about housing today we're gonna talk about why that's important to health that's the topic of this week's healthcare triage here's one of the biggest issues when it comes to affordable housing it's much easier for landlords to make money renting high-cost housing than low-cost house this isn't an easy problem to fix you can take time and money to get through the permitting process to build and that raises costs zoning requirements can restrict the number of units in a building or how small they can get there's also the NIMBY effect not in my backyard where community members actively resist the construction of low-income housing nearby because they fear that this will lower their property values or bring an increase in crime The Situation's worsening wages have been pretty flat for a long time but the price of housing has not been there's much more demand than supply between 2005 and 2015 the share of renters whose rent constituted at least 30% of their income went from 45 to 48 percent the share of low-income renters who had to pay at least 30 percent of their income in rent went up 24 percent from 18 million to more than 23 million households but the share receiving assistance dropped depending upon where you live affordability can vary greatly in plenty of places across the country even a very low-income household might be severely cost burden this means that a household with an income no more than 30% of the ami might have to pay more than half their income on housing costs this leaves very very little for other things like food or heat but before we talk about fixing problems it's important to understand why housing is important for health in the summer of 2018 health Fair's published a number of briefs written by experts on housing we're going to lean on them heavily in these episodes the first to them which is an overview of the literature was written by Lauren Taylor a doctoral candidate at the Harvard Business School she describes four pathways by which housing affects health stability quality and safety affordability and neighborhood let's dive into each this stability pathway refers to people who fall behind on their rent need to move frequently or are living temporarily another's housing basically we're talking about people who face housing instability research has shown that each of these difficulties it's independently associated with an increased risk of adverse health and material hardship just being behind on the rent significantly increases the odds of a caregiver like a parent being in fair or poor health having depressive symptoms and having a child who is hospitalized or in fair or poor health instability is also associated with behavioral emotional and school problems and children in teens it's associated with an increased risk of drug use depression and pregnancy a systematic review published in 2015 described the literature around home foreclosure and health thirty five unique studies were identified more than 90 percent of them showed that foreclosure was bad for health including mental health at the individual and community level another systematic review published in PLoS ONE that year found similar results on the flip side there's also evidence that gaining access to stable housing is associated with better health and lower healthcare costs study published in 2016 by the Center for outcomes research and education in Portland Oregon used Medicaid claims data link to survey data to explore these links researchers studied 145 housing properties and found that after Medicaid covered people with unstable housing moved into a fordable housing their total Medicaid expenditures declined by 12% their use of primary care went up 20% and their use of the emergency department declined by 18 percent healthcare expenditures declined by more than $100 per member per month study published in Health Affairs in 2017 found that HUD housing assistance all types lumped together was also associated with improved outcomes getting assistance was associated with the 5% absolute decrease in the uninsurance rate as well as reduced rates of unmet needs for health care due to costs the affordability pathway refers to the often skewed balance between housing costs and other necessary expenditures in 2015 almost 39 million families in the United States had to spend more than 30% of their income on housing HUD defined such families as cost burden and acknowledges that such families find it harder to afford food clothing transportation and health care about 19 million households pay more than 50% of their income in housing making them severely cost burden and future trends and housing costs are going in the wrong direction parents will often try to live in areas with resources like good schools or parks even if they're more expensive than they can really afford this forces them to skimp on other necessary purchases study published in the American Journal of Public Health in 2011 found that people who fall behind in their mortgage have less access to health relevant resources and are more likely to get depressed have food insecurity and are less likely to adhere to their medications conversely families with affordable rent payments spend more on insurance food and education they're also more likely to save for buying a future home the safety and quality pathway refers to the ways in which low quality housing affects health for years we've known that lid and housing is bad for kids leading to brain damage and other issues there are still many areas of the country where letters in the environment and in homes in unsafe levels overcrowded housing is associated with lower academic achievement behavior problems and poor physical health and children homes with water leaks or substandard ventilation or with pest infestations can worsen asthma and allergic disease and it's not just kids study of hundreds of elderly people in 2015 showed the decreasing exposure to high or low temperatures improve blood pressure significantly failing to do so leaves many older people at risk we also have evidence that improving the safety and quality of housing makes a difference the Boston Children's Hospital community asthma initiative focused on removing asthma triggers and housing it found that there was a hundred and thirty three percent return on investment in the first three years after the intervention if we add in missed school and work days the ROI is a hundred eighty five percent the intervention not only improved health it saved money a similar study in adults showed that reducing asthma triggers improved lung functioning reduced emergency department visits and hospitalizations and lowered the need for medications kids who benefited from the low income Home Energy Assistance Program so reductions in the risk of being underweight with no increase in overweight they were also less likely to be hospitalized a systematic review of efforts to improve the home environments of elderly people led to a 21 percent reduction in the risk of Falls among those at high risk for Falls the absolute reduction was 26% meaning that the number needed to treat is four that's huge finally the neighborhood pathway refers to the ways in which community resources affect health access to grocery stores that sell healthy food makes it more likely the people eat better improving the safety and cleanliness of a neighborhood can impact both mood and health kids relax safe ways to get to school are more likely to suffer from pedestrian or bike injuries residential segregation can also be bad for health neighborhoods with predominantly low-income residents and/or people of color have suffered from historical disinvestment resulting in more limited access to good schools employment and health care and poor health outcomes that accumulate throughout the life course for example segregation has been associated with worse outcomes in pregnancy and higher mortality for african-americans all of these pathways are important but it's important to acknowledge they don't all have an equal basis in evidence the research on the affordability pathway which is perhaps the most obvious spending more on rent means less on other things isn't all that robust nor do we have a lot of data show us how to fix it the evidence base for stability and safety and quality is much more detailed although we should acknowledge the most of its from urban areas the neighborhood pathway has some powerful randomized controlled trial supporting it what can we do to fix all this though what policies can we consider over the next few weeks we'll be discussing those tuned in did you like this episode it's part of a series and you should watch the whole thing click here to see the playlist that you can do that also go to patreon.com/scishow character actors support the show we'd especially like to thank our research associate Joe sevenths and our surgeon Admiral Sam

28 Comments

  1. We had to re-upload this one, as I put up the wrong version of the video. Sorry to blow up your feed, and thanks for watching! -stan

  2. The sad thing is nothing is going to change any time soon. In America we have an entire political party that's OBSESSED with punishing the poor. To them, if you can't afford basic things, it's your own damn fault and you should hurry up and die so the deserving rich (read: white people) can consume the resources your useless ass is wasting with your HUD and food stamps. In short: fuck America.

  3. Someone send this to Ben Carson

  4. WHO ALWAYS WATCH BUT NEVER TRY

  5. That feel when spending 30% of your income on rent is supposed to be high… Two years ago I was spending 70% of my income on rent (and utilities). And that was with two roommates.

  6. "But the system we have works well enough!" -most native Tennesseans.
    Or rather, they don't want to pay the income tax. It's funny how a lot of the poor people here are so against paying like $50/mo of their 25k/yr when they'd probably get $200/mo in benefits.

  7. start ur own bizniz

  8. Can we discuss these topics in the framing of the pitfalls of capitalism? Please?

  9. 5:53 The liberal war on lead is taking jobs away from hard working American lead workers

  10. Great video on a broad topic of discussion. Isn't most of the data for stability and safety being based on urban areas because most of the people in the US live in urban areas (according to the last census)?

  11. Definitely going to share this. It’s not just relevant to the US, but also other countries like the UK. We keep talking about various issues in isolation, such as exclusions from schools and containing the rising costs of healthcare as the population ages. We need to start thinking about all of these issues more holistically.

  12. MAYBE SOME should try moving OUT OF CALI

  13. i spend >50% of my income on housing part of that is my lazyness part is living in so cal

  14. Yes!!! Coming from a Population Health major, social determinants of health are SO important. This is what your future generation of health care professionals will be working on.

  15. If you live in public housing, and people keep breaking windows, it very negativity effects your health.

  16. opportunityatlas.org

  17. This is all correlation, while the data is interesting, it doesn’t really lead to any action.

  18. My mom bought me your book for Christmas.
    She hasn't given it to me yet.
    She keeps lending it to ALLLLLLLLLL her friends…

  19. Duhhh

  20. It’s good to know we are discussing important issues in this country like whether to call a trans person he or she and not focusing on something important like this that is devastating people financially like myself.

    In all seriousness though, as long as there is money to made form peoples’ basic human necessities (food shelter water) there will be those that exploit it that dominate the market. This will not change until we fundamentally change our economic system and make it impossible for these people to exploit basic needs.

  21. I'm still remodeling, but I just switched to an ionic air filter and a dehumidifier but I wasn't expecting results so soon. All week I've been more awake, had less sniffles, and better sleep.

  22. Love the videos!

  23. % spent on housing isnt a good measure, e.g. if you live in an urban core, your rent may be higher but transportation and other living costs will be way lower than if you lived in the middle of nowhere

  24. My landlord REQUIRES that we don't remove the wall-to-wall carpeting in the bathroom.
    So like, that's PROBABLY impacting my health.

    I swear there's something about being a landlord that just turns some people into absolute sociopaths.

  25. It's not that hard to figure out. If you have a stable place to live, aren't worried about getting kicked out, and have a healthy environment, you're less stressed. Less stress on the body usually means you're healthier. Your mental health is better too. When you have your basics cover, you can invest in bettering yourself, your family, and your community.

  26. First Comment!
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    Love From New Jersy!!!!!

  27. Yep every other paycheck = rent, but still fairly well off.

  28. le first

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