Use of health impact assessments in the housing sector to promote health in the United States, 2002-2016

Housing Instability and Socioeconomic Disparities in Health: Evidence from the U.S. Economic Recession

While a number of studies have observed the effects of housing instability on health outcomes, fewer have emphasized pre-existing socioeconomic disparities in health and the influence of housing instability on subsequent health outcomes in the wake of the economic recession. Using national data on six adult health indictors and foreclosure data aggregated by census tract, this study examines the association between neighborhood housing insecurity and health outcomes, particularly focusing on various income levels and racial groups in about 200 U.S. metropolitan areas after the 2008 housing crisis. Results suggest that high levels of housing instability induced by high levels of foreclosed properties in certain neighborhoods were strongly associated with more health problems among residents, but the results varied according to the income level and the dominant racial group in these neighborhoods. With regard to income levels, adverse health conditions in lower income neighborhoods remained longer and became stronger than those in higher income neighborhoods. The findings also show variation among racial groups: While multiple health problems plagued all income levels in white tracts, more severe and worsening pre-existing health problems appeared in lower income minority tracts. In addition, neighborhood housing instability generated by mortgage foreclosures was strongly associated with heart-related diseases, particularly in middle-income White neighborhoods, and mental health problems, particularly in upper-income Hispanic tracts. Finally, among multiple health indicators, mental health problems were the most common health conditions during the U.S. economic recession. In light of the socioeconomic disparities in health, policy makers should establish effective policy tools that integrate health and urban and housing planning.

Building health equity through housing policies: critical reflections and future directions for research

Housing may be at once the most powerful and underused tool at our disposal to improve population health. Using examples from the USA, we argue that current levels of housing insecurity are the result of clear and inequitable policy choices, leading to the entrenchment of health inequities-particularly, across race and class. Solutions to housing insecurity must, therefore, be structural. The COVID-19 pandemic has opened a window of opportunity for these structural housing policy reforms. Through justice- and action-oriented research, health researchers can inform the development and implementation of housing policies that advance health equity. We offer a series of recommendations to better position our field to achieve this goal.