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Bhatnagar S, Lovelace J, Prushnok R, Kanter J, Eichner J, LaVallee D, Schuster J. A Novel Framework to Address the Complexities of Housing Insecurity and Its Associated Health Outcomes and Inequities: "Give, Partner, Invest". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6349. [PMID: 37510581 PMCID: PMC10378752 DOI: 10.3390/ijerph20146349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
The association between housing insecurity and reduced access to healthcare, diminished mental and physical health, and increased mortality is well-known. This association, along with structural racism, social inequities, and lack of economic opportunities, continues to widen the gap in health outcomes and other disparities between those in higher and lower socio-economic strata in the United States and throughout the advanced economies of the world. System-wide infrastructure failures at municipal, state, and federal government levels have inadequately addressed the difficulty with housing affordability and stability and its associated impact on health outcomes and inequities. Healthcare systems are uniquely poised to help fill this gap and engage with proposed solutions. Strategies that incorporate multiple investment pathways and emphasize community-based partnerships and innovation have the potential for broad public health impacts. In this manuscript, we describe a novel framework, "Give, Partner, Invest," which was created and utilized by the University of Pittsburgh Medical Center (UPMC) Insurance Services Division (ISD) as part of the Integrated Delivery and Finance System to demonstrate the financial, policy, partnership, and workforce levers that could make substantive investments in affordable housing and community-based interventions to improve the health and well-being of our communities. Further, we address housing policy limitations and infrastructure challenges and offer potential solutions.
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Affiliation(s)
- Sonika Bhatnagar
- UPMC Insurance Services Division, 600 Grant Street, Pittsburgh, PA 15219, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
| | - John Lovelace
- UPMC Insurance Services Division, 600 Grant Street, Pittsburgh, PA 15219, USA
| | - Ray Prushnok
- UPMC Center for Social Impact, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA
| | - Justin Kanter
- UPMC Center for High-Value Health Care, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA
| | - Joan Eichner
- UPMC Center for Social Impact, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA
| | - Dan LaVallee
- UPMC Center for Social Impact, 600 Grant Street, 40th Floor, Pittsburgh, PA 15219, USA
| | - James Schuster
- UPMC Insurance Services Division, 600 Grant Street, Pittsburgh, PA 15219, USA
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Capasso L, D’Alessandro D. Housing and Health: Here We Go Again. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212060. [PMID: 34831815 PMCID: PMC8624624 DOI: 10.3390/ijerph182212060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022]
Abstract
Housing is one of the major determinants of human health and the current COVID-19 pandemic has highlighted its relevance. The authors summarize the main issues, including dimensional standards, indoor air quality, safety, accessibility, neighborhoods, and area characteristics. The authors propose an operating scheme in order to implement actions to improve residential wellbeing on a local, national, and international level.
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Affiliation(s)
- Lorenzo Capasso
- Italian Ministry of Education, USR Abruzzo (Regional Office of Abruzzi), 66100 Chieti, Italy
- Correspondence:
| | - Daniela D’Alessandro
- Department of Civil Building and Environmental Engineering, “Sapienza” University of Rome, 00100 Rome, Italy;
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Kim H. Failing the Least Advantaged: An Unintended Consequence of Local Implementation of the Housing Choice Voucher Program. HOUSING POLICY DEBATE 2020; 32:369-385. [PMID: 35400983 PMCID: PMC8993032 DOI: 10.1080/10511482.2020.1834429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/06/2020] [Indexed: 05/25/2023]
Abstract
While scholars have acknowledged that shrinking federal resources for low-income housing programs increase economic inequality across U.S. society as a whole, the question of how the allocation of these resources affects inequality among the poor has received little attention. Using a mixed methods approach, this study examines local administrative practices of distributing scare housing resources and the potential redistributive effects of those choices. Analyses of administrative and qualitative data collected from local housing agencies suggest that local administrative practices of managing a waitlist disadvantage residentially unstable applicants. Juxtaposing this finding with results from the Survey of Income and Program Participation suggests that among those who are income-eligible for program participation, poorer individuals have a greater likelihood of experiencing residential instability, thus compounding their disadvantage in the competition for a housing voucher.
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Affiliation(s)
- Huiyun Kim
- Minnesota Population Center, University of Minnesota
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Barboza-Salerno GE. Variability and stability in child maltreatment risk across time and space and its association with neighborhood social & housing vulnerability in New Mexico: A bayesian space-time model. CHILD ABUSE & NEGLECT 2020; 104:104472. [PMID: 32276150 DOI: 10.1016/j.chiabu.2020.104472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Modeling the spatio-temporal characteristics of substantiated child maltreatment risk has significant implications for child welfare policy. OBJECTIVE This study quantifies the spatiotemporal risk of child abuse and neglect in New Mexico at the census tract level over 9 years, identifies areas of increased risk, and evaluates the role of multiple measures of social and housing insecurity on substantiated child maltreatment referrals. PARTICIPANTS AND SETTING Child maltreatment substantiation data across 499 census tracts from 2007 to 2015 were obtained from the New Mexico Department of Public Health. METHODS Substantiated referral counts were analyzed within census tracts with Bayesian hierarchical space-time models using Laplace approximation. Standardized incidence ratios, spatial risk, and probability exceedances were calculated and mapped. RESULTS Multiple neighborhood structural factors were associated with an increased risk of substantiated child maltreatment, including the eviction rate (Incidence Density Ratio [IDR] = 1.09 [95 % CrI = 1.01-1.12]), rent burden (IDR = 1.11 [95 % CrI = 1.01-1.13]), urban tracts (IDR = 1.36 [95 % CrI = 1.05-1.77]), food desert tracts (IDR = 1.21 [95 % CrI = 1.04-1.41]), low income tracts (IDR = 1.27 [95 % CrI = 1.09-1.49]), percent of households with no vehicle access ([IDR] = 1.27 [95 % CrI = .247-6.47]), and percent of persons with a disability (IDR = 1.05 [95 % CrI = 1.03-1.06]). The racial/ethnic diversity ratio, however, was associated with lower incidence of child maltreatment allegation risk (IDR = .988 [95 % CrI = .982-.995]). CONCLUSIONS Population-based child abuse and neglect prevention and intervention efforts should be aided by the characteristics of neighborhoods that demonstrate strong spatial patterns of household and housing vulnerability, particularly in low income, racially segregated neighborhoods.
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Affiliation(s)
- Gia Elise Barboza-Salerno
- School of Public Affairs, University of Colorado Colorado Springs,1420 Austin Bluffs Parkway,Colorado Springs, CO 80919, United States.
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Swope CB, Hernández D. Housing as a determinant of health equity: A conceptual model. Soc Sci Med 2019; 243:112571. [PMID: 31675514 DOI: 10.1016/j.socscimed.2019.112571] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/14/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
Abstract
Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.
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Affiliation(s)
- Carolyn B Swope
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Diana Hernández
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA
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Ortiz SE, Johannes BL. Building the case for housing policy: Understanding public beliefs about housing affordability as a key social determinant of health. SSM Popul Health 2018; 6:63-71. [PMID: 30225335 PMCID: PMC6138994 DOI: 10.1016/j.ssmph.2018.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The current housing crisis in the U.S. requires the consideration and promotion of policies that improve the circumstances of severe housing cost burdens. Building public awareness of the health impacts associated with housing affordability may be a key prerequisite for policy change. METHODS Quantitative and qualitative data from a national survey were used to investigate public understandings about housing affordability as a key driver of health. Quantitative and qualitative findings were integrated to test whether any relationships existed between respondents' considerations and concerns about housing affordability and their perceptions about housing affordability as a social determinant of health. FINDINGS These data support four key findings. First, understandings of the relationship between affordable housing and health are partisan and income-based driven, with Republicans and high-income respondents less likely to acknowledge the effects of housing affordability on health. Second, varied frames of communication about the relationship between housing affordability and health may produce significantly different reactions among political and income subgroups.Third, while there is considerable agreement that housing affordability promotes health when using forced-choice measures, connections between affordable housing and health are not readily volunteered. Finally, the themes of personal responsibility and stability and security significantly resonate with Republicans and high-income earners. CONCLUSIONS Contextualizing the issue of housing affordability within various domains in ways that effectively resonate with the American public and policymakers and across political and income spectra, is highly imperative.
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Affiliation(s)
- Selena E. Ortiz
- Gregory H. Wolf Assistant Professor of Health Policy and Administration, Department of Health Policy and Administration, The Pennsylvania State University, 604 N Donald H. Ford Building, University Park, PA 16802, United States
| | - Bobbie L. Johannes
- Department of Health Policy and Administration, The Pennsylvania State University, 601 Donald H. Ford Building, University Park, PA 16802, United States
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Pacheco JA, Pacheco CM, Lewis C, Williams C, Barnes C, Rosenwasser L, Choi WS, Daley CM. Ensuring healthy American Indian generations for tomorrow through safe and healthy indoor environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2810-22. [PMID: 25749318 PMCID: PMC4377934 DOI: 10.3390/ijerph120302810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 12/18/2022]
Abstract
American Indians (AI) have the highest rate of severe physical housing problems in the U.S. (3.9%). Little information exists about the environmental hazards in AI homes. The purposes of this paper are to discuss challenges that were encountered when recruiting AI for a home-and employment-based environmental health assessments, highlight major successes, and propose recommendations for future indoor environmental health studies. The Center for American Indian Community Health (CAICH) and Children's Mercy Hospital's Center for Environmental Health and Allergy and Immunology Research Lab collaborated to provide educational sessions and healthy home assessments for AI. Through educational trainings, more than 240 AI were trained on the primary causes of health problems in homes. A total of 72 homes and places of employment were assessed by AI environmental health specialists. The top three categories with the most concerns observed in the homes/places of employment were allergens/dust (98%), safety/injury (89%) and chemical exposure (82%). While some information on smoking inside the home was collected, these numbers may have been underreported due to stigma. This was CAICH's first endeavor in environmental health and although challenges arose, many more successes were achieved.
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Affiliation(s)
- Joseph A Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Christina M Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Charley Lewis
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Chandler Williams
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
| | - Charles Barnes
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1008, Kansas City, KS 66103, USA.
- Department of Allergy, Asthma, and Immunology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas City, MO 64108, USA.
| | - Lanny Rosenwasser
- Department of Allergy, Asthma, and Immunology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas City, MO 64108, USA.
| | - Won S Choi
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1008, Kansas City, KS 66103, USA.
| | - Christine M Daley
- Center for American Indian Community Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1030, Kansas City, KS 66103, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66103, USA.
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd. MS 1008, Kansas City, KS 66103, USA.
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Rauh VA, Landrigan PJ, Claudio L. Housing and health: intersection of poverty and environmental exposures. Ann N Y Acad Sci 2008; 1136:276-88. [PMID: 18579887 DOI: 10.1196/annals.1425.032] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The importance of adequate housing for the maintenance of health and well-being has long been a topic of scientific and public health policy discussion, but the links remain elusive. Here we explore the role of the residential environment in the etiology of illness (specifically asthma) and the persistence of socioeconomic health disparities. Housing conditions, shaped by social forces, affect exposure to physical and chemical "toxicants," thereby translating social adversities into individual illness and population health disparities. We discuss the mediating role of housing in determining health outcomes at multiple levels (social-structural, neighborhood, and individual family). To date, little attention has been paid by most environmental health scientists to the social-structural conditions underlying gross inequities in the distribution of toxic exposures, with even less attention to the processes whereby these social conditions may directly affect susceptibility to the toxic exposures themselves. This chapter goes beyond traditional medical and environmental science models to incorporate a range of social and physical determinants of environmental pollutions, illustrating how these conditions result in health and illness. We focus here on childhood asthma as an example of a serious public health problem that has been associated with low income, minority status, and characteristics of the home environment. We end the chapter with a discussion of the environmental justice movement and the role of housing as a potential agent of change and focus of interventions aimed to reduce the harmful effects of environmental pollutants.
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Affiliation(s)
- Virginia A Rauh
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 60 Haven Ave., B-2, New York, NY 10032, USA.
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Anderson LM, Charles JS, Fullilove MT, Scrimshaw SC, Fielding JE, Normand J. Providing affordable family housing and reducing residential segregation by income. A systematic review. Am J Prev Med 2003; 24:47-67. [PMID: 12668198 DOI: 10.1016/s0749-3797(02)00656-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.
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Affiliation(s)
- Laurie M Anderson
- Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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