Heat or eat? Cold-weather shocks and nutrition in poor American families

Electricity inaccessibility across historically redlined and present-day disadvantaged areas in New York City

BACKGROUND

Electricity is crucial in sustaining livelihoods from turning the lights on at night, keeping the refrigerator running to avoid food spoilage, and powering electricity-dependent durable medical equipment such as nebulizers. Thus, electricity inaccessibility may result in adverse outcomes. Like other environmental burdens, electricity inaccessibility may be socially patterned, with disproportionate occurrence in racially and economically marginalized communities.

OBJECTIVE

To evaluate the 2017-2019 distribution of electricity inaccessibility - defined as power outages and energy insecurity - across historical and present-day measures of community racial disadvantage in New York City (NYC).

METHODS

We measured power outages with NYC 311 outage call reports and the System Average Interruption Frequency Index (SAIFI). We calculated energy insecurity as monthly average energy use, leveraging data from the New York State Energy Research and Development Authority. These three electricity inaccessibility metrics were estimated within both historical Home Owners' Loan Corporation (HOLC) graded areas (A, 'best' through D, 'redlined') and present-day racial and economic Index of Concentrations at the Extremes (ICE) census tracts quartiles.

RESULTS

Our study covered 396 HOLC areas and 2218 census tracts in NYC. Historically A-graded areas had fewer 311 outage calls and lower SAIFI. Additionally, the rate of 311 outage calls in the present-day most disadvantaged census tracts was nearly six times that of the most privileged tracts. Persistently disadvantaged areas (i.e., both poor HOLC grade and high ICE) had more power outages than consistently advantaged areas. However, the present-day most disadvantaged census tracts still had more power outages than persistently disadvantaged areas.

IMPACT

This 2017-2019 New York City (NYC) study evaluated the distribution of three electricity inaccessibility metrics in relation to community privilege and disadvantage. Uniquely, we assessed the distribution across historically redlined areas and present-day census tracts. We defined electricity inaccessibility as power outages (311 calls and power interruptions) and energy insecurity (residential energy use). We found that 311 calls and power interruptions were more common in historically redlined areas, present-day disadvantaged census tracts, and persistently disadvantaged areas. These findings indicate proxies for historical racial discrimination, such as redlining, and modern-day community disadvantages impact the access to reliable electricity in NYC.

Piloting Home Produce Delivery to Improve Food Security, Budget, and Diet in Families with Children: A Mixed-Methods Study

BACKGROUND

Few children in food insecure (FI) households meet dietary recommendations for fruit and vegetables ("produce"). Barriers include affordability, accessibility, and desirability. Home produce delivery may reduce FI, increase produce consumption, and decrease budget tradeoffs.

OBJECTIVE

Evaluate the acceptability and potential impact of delivering produce through home visiting programs on FI, diet, and budget tradeoffs.

METHODS

In this prospective pre/post mixed methods study, 51 parents engaged in home visiting programs were enrolled. Participants completed pre- and post-program surveys on FI (18-item Food Security Scale), produce consumption, and budget tradeoffs. Pre- and post-surveys were compared using McNemar's test and weighted kappas. Interview guides were based on Social Cognitive Theory and a previously published framework. Interviews were conducted in English or Spanish; thematic analysis was completed.

RESULTS

Twenty-nine (56.9%) participants completed both surveys. Most were female (96.3%) and Hispanic (79.3%) (Table 1). Food security improved in the post-period, with more participants reporting high food security (pre: 6.9%, post: 31.0%) and fewer reporting very low food security (pre: 20.7%, post: 6.9%, P < 0.01) (Table 2). Budgetary tradeoffs decreased in the post-program period (pre: 71.4%, post: 48.1%, P = 0.03). Fifteen participants were interviewed. Themes included 1) saved money, 2) increased fruit and vegetable consumption, and 3) interest in future participation.

CONCLUSION

This pilot study found that an intervention for delivery of produce through home visiting programs was acceptable to participants and resulted in potential improvements in FI and household budgets. This supports future studies to further explore the impact of this novel intervention.

New York State Climate Impacts Assessment Chapter 04: Buildings

New York State has nearly 5.3 million buildings, and all of them are vulnerable in some way to the impacts of climate change. Understanding these impacts is critical, because risks to buildings not only threaten individual lives but also pose threats to community-level resilience. This chapter examines the impacts of climate change on buildings and, by extension, the people and communities they shelter and support. It also highlights building types and populations that are at particular risk and presents adaptation strategies to protect the state's existing and future building stock from climate impacts.

New York State Climate Impacts Assessment Chapter 06: Energy

Energy plays an integral role in New Yorkers' lives. It powers the economy, moves people and goods, keeps homes and workplaces at a livable temperature, and runs critical infrastructure that keeps people healthy and safe. Reliable energy systems are easy to take for granted, but many aspects of these systems are vulnerable to weather and climate hazards. This chapter discusses how climate change is affecting and will increasingly affect New York State's energy supply, delivery, and end uses. It provides insights into current and future climate vulnerabilities as New York's energy system transitions to clean energy sources. This assessment also highlights opportunities to adapt current and future energy systems and to build resilience to climate impacts.

Housing for care, connection, and health equity

Researchers and policymakers have used a four-pillar framework- condition, consistency, context, and cost-to describe the characteristics of housing that are important for health equity. We propose adding a fifth pillar: care and connection. Housing for care and connection refers to the housing design, institutional policies, and housing programs that strengthen social connections, caregiving relationships, access to resources, and a sense of self in community. Attending to these needs in housing is especially important for people who are in transition in and out of homelessness, living in poverty, are very young or very old, or living with a disability or activity limitation.

NPCC4: Climate change and New York City's health risk

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.

Heatwaves and Hardship: Shortcomings and Solutions for Enhancing the Low Income Home Energy Assistance Program to Mitigate Extreme Heat and Energy Insecurity

The Low Income Home Energy Assistance Program (LIHEAP) must adapt and evolve to keep pace with the challenges posed by climate change and increased economic strain. Urgent action is needed to improve LIHEAP to effectively address extreme heat and energy insecurity faced by low-income households and protect the health and well-being of disadvantaged groups spurred by climate change. In evaluating LIHEAP's shortcomings, we demonstrate that there is a substantial gap between program eligibility and enrollment, such that many households are not receiving this vital benefit or do so mainly when facing a crisis. We also show that LIHEAP funds overwhelmingly support cold-weather states even as record-breaking heat is a critical stressor. The spatial mismatch we unveil shows that southern states receive less LIHEAP funds despite higher cooling degree days and higher rates of energy insecurity. The importance of swift action based on sound data and up-to-date research can enhance the efficacy of LIHEAP, expand its reach, and ultimately improve the living conditions of millions of energy insecure households. We offer several recommendations to improve LIHEAP to ensure that this critical lifeline program remains an effective tool to mitigate energy insecurity and safeguard livelihoods in the face of extreme heat.

Addressing energy insecurity: Policy Considerations for enhancing energy assistance programs

Household energy consumption is crucial for a productive and safe life. Despite its importance, 33.7 million U.S. households experienced energy insecurity in 2020. This paper examines the prevalence, correlates, and effects of energy bill assistance programs, which aim to alleviate the hardship. This analysis relies on logistic regressions and the 2020 Residential Energy Consumption Survey, a nationally representative survey administered by the Energy Information Administration. Results reveal 16 percent of the energy insecure population received assistance to pay its energy bill in 2020. Several socioeconomic and housing characteristics are associated with receipt of assistance; however, logistic regression estimates suggest prior participation in energy assistance and receipt of a disconnection notice from a utility provider are indicators substantively and significantly associated with energy assistance participation that warrant attention from scholars and practitioners. Lastly, outcomes generally indicate previous participation in energy assistance does not impact the odds a household will experience energy insecurity. Based on findings, I offer three policy recommendations: 1) increase resources spent on energy assistance to align with demand; 2) enhance communication between utility providers and low-income households regarding available assistance opportunities; and 3) prioritize engagement with populations that never participated in energy assistance to facilitate successful application processes.

Improving food insecurity screening across a health system throughout the COVID-19 pandemic

BACKGROUND

Food insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the start of the COVID-19 pandemic. The American Academy of Pediatrics recommends paediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patient encounters with food insecurity screening completion at the paediatric medical home from 0% to 85% by July 2020 with extension to the paediatric emergency department (ED) and paediatric specialty clinic in the following year.

METHODS

This multicentre project occurred in three sites within our health system: a teaching safety-net, paediatric medical home; a paediatric ED; and five divisions within paediatric specialty medical clinics. A screening tool was created using the validated Hunger Vital Sign Questionnaire. A standard screening, documentation and referral process was developed. The Model for Improvement was used testing changes via Plan-Do-Study-Act cycles.

RESULTS

The percentage of households screened for food insecurity increased from a median of 0% to 30% for all sites combined. There was significant variability in screening with the ED screening a median of 24% and the medical home screening 80% by the end of the study period. A total of 9842 households (20.9%) screened were food insecure. During the study period, 895 families with 3925 household members received 69 791 pounds of food from our primary community resource using our clinic's food prescription. Of these families, 44% (398) also qualified for the US Department of Agriculture programme ensuring ongoing food distribution up to twice a month.

DISCUSSION

Using quality improvement methodology to address a critical community need, we implemented food insecurity screening across a hospital system including multiple sites and specialties and provided critical resources to households in need.

The Mortality Effects of Winter Heating Prices

This paper examines how the price of home heating affects mortality in the United States. Exposure to cold is one reason that mortality peaks in winter, and a higher heating price increases exposure to cold by reducing heating use. Our empirical approach combines spatial variation in the energy source used for home heating and temporal variation in the national prices of natural gas and electricity. We find that a lower heating price reduces winter mortality, driven mostly by cardiovascular and respiratory causes. Our estimates imply that the 42% drop in the natural gas price in the late 2000s, mostly driven by the shale gas boom, averted 12,500 deaths per year in the United States. The effect appears to be especially large in high-poverty communities.

"Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank

For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.

Early life exposure to cold weather shocks and growth stunting: Evidence from Tanzania

This study examines the effects of early life and in utero exposure to cold weather shocks on the incidence of growth stunting for children under age five in Tanzania. We find that an increase of 10 percentage points in the proportion of days with temperatures below 15 degrees Celsius (one standard deviation below the long-term average) is associated with an increase in the probability of stunting and severe stunting by 2.0 and 1.4 percentage points (equivalent to 5.5 and 9.7 percent of the mean stunting and severe stunting), respectively. The results also show strong effects of in utero exposure during the second trimester of pregnancy on child stunting and wasting. In terms of the mechanisms, we find that the effects on disease environment, food insecurity, and reduced agricultural productivity are the possible channels driving the results.

Energy poverty: an overlooked determinant of health and climate resilience in Canada

OBJECTIVE

Despite Canada being an important energy producer, not all Canadians can access or afford adequate levels of energy services at home to meet their needs, maintain healthy indoor temperatures, and live a decent life-a situation known as energy poverty. Depending on the measure, 6-19% of Canadian households face energy poverty. Health risks associated with energy poverty are documented in countries with milder climates. This study explores, for the first time in the Canadian context, the association between energy poverty and health.

METHODS

Cross-sectional data are from the 2018 Canadian Housing Survey. Analyses are conducted on a sample weighted to represent 14 million Canadian households. The associations between expenditure-based and self-reported measures of energy poverty and self-rated general and mental health were assessed using logistic regression models, adjusted for potential confounding variables.

RESULTS

The odds of rating one's general (OR: 1.48; 95%CI: 1.29, 1.70) and mental (OR: 1.21; 1.04, 1.41) health as poor are significantly higher for Canadian adults in households with a high share of energy expenditure to income. The likelihood of poor general and mental health was significantly higher for those dissatisfied with the energy efficiency of their dwelling, and with their ability to maintain a comfortable temperature both in the winter and in the summer.

CONCLUSION

Exposure to energy poverty is associated with significantly increased likelihood of poor general and mental health. Given the high proportion of Canadian households facing energy poverty, with demonstrated implications for population health, tackling energy poverty is essential for an equitable energy transition and for climate resilience.

Food Insecurity: A Barrier to Reproductive Justice Globally

Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.

Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities

This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.

Pay (for it) as you go: Prepaid energy meters and the heat-or-eat dilemma

The "heat-or-eat" dilemma, a trade-off typically between food consumption and heating, may elevate public health concerns during the 2022 energy-price crisis. Our paper contributes to the literature by exploring the role of domestic energy prepayment meters (PPMs) in the heat-or-eat dilemma, focusing on the association between PPM use and fruit and vegetable consumption. Using a representative sample of 24,811 individuals residing in Great Britain (January 2019-May 2021), we find robust evidence of lower fruit and vegetable consumption amongst individuals using PPMs, compared to those using post-payment energy bill payment methods. On average, our point estimates suggest that individuals using a PPM consume 2.7 fewer portions of fruit and vegetables per week. Our findings hold when bounding analysis is employed to account for omitted variable bias. Using a suite of IV approaches to further alleviate endogeneity concerns we found that our ordinary least squares results are consistent as opposed to IV models. Further robustness analyses highlight the deleterious impact of PPMs on people's healthy eating habits relevant to the consumption of enough fruit and vegetables. Our results suggest that targeted support for PPM users may have beneficial effects on people's fruit and vegetable consumption patterns.

Behavioral and financial coping strategies among energy-insecure households

When households struggle to pay their energy bills and avoid being disconnected from the grid, they may accrue debt, forgo expenses on food, and use space heaters or ovens to warm their homes. These coping strategies can introduce significant physical and financial risks. In this study, we analyze an original survey with a representative sample of low-income households during the first year of the COVID-19 pandemic, from June 2020 to May 2021. We evaluate the prevalence of a wide range of coping strategies and empirically estimate the determinants of these strategies. We find that more than half of all low-income households engage in at least one coping strategy, and many use multiple strategies. Households with vulnerable members, including young children or those who rely on electronic medical devices, and households that live in deficient housing conditions, are more likely to use a range of coping strategies, and many at once. Our findings have direct implications for public policy improvements, including modifications to the US Weatherization Assistance Program, the Low-Income Home Energy Assistance Program, and state utility disconnection protections.

Daily Food Insecurity Predicts Lower Positive and Higher Negative Affect: An Ecological Momentary Assessment Study

Food insecurity (FI) is a dynamic phenomenon, and its association with daily affect is unknown. We explored the association between daily FI and affect among low-income adults during a 2-seasonal-month period that covered days both pre- and during the COVID-19 pandemic. A total of 29 healthy low-income adults were recruited during fall in 2019 or 2020, 25 of whom were followed in winter in 2020 or 2021. Daily FI (measured once daily) and affect (measured 5 times daily) were collected over the 2nd−4th week in each month. Time-Varying-Effect-Models were used to estimate the association between daily FI and positive/negative affect (PA/NA). Overall, 902 person-days of daily-level data were collected. Daily FI was associated with lower PA in the 3rd and 4th week of fall and winter and with higher NA in the second half of winter months. Similar patterns of FI-affect relations were found pre- and during COVID-19 in the second half of a given month, while unique patterns of positive affect scores in the 2nd week and negative scores in the 1st week were only observed during COVID days. Our study supports a time-varying association between FI and affect in low-income adults. Future large studies are needed to verify the findings; ultimately, better understanding such associations may help identify, target, and intervene in food insecure adults to prevent adverse mental health outcomes.

Daily food insecurity is associated with diet quality, but not energy intake, in winter and during COVID-19, among low-income adults

BACKGROUND

Food insecurity (FI) is a dynamic phenomenon. Experiences of daily FI may impact dietary outcomes differently within a given month, across seasons, and before or during the COVID-19 pandemic.

OBJECTIVES

The aims of this study were to investigate the association of short-term FI with dietary quality and energy 1) over six weeks in two seasonal months and 2) before and during the COVID-19 pandemic.

METHODS

Using an ecological momentary assessment framework on smartphones, this study tracked daily FI via the 6-item U.S. Adult Food Security Survey Module and dietary intake via food diaries in 29 low-income adults. A total of 324 person-days of data were collected during two three-week long waves in fall and winter months. Generalized Estimating Equation models were applied to estimate the daily FI-diet relationship, accounting for intrapersonal variation and covariates.

RESULTS

A one-unit increase in daily FI score was associated with a 7.10-point (95%CI:-11.04,-3.15) and 3.80-point (95%CI: -6.08,-1.53) decrease in the Healthy Eating Index-2015 (HEI-2015) score in winter and during COVID-19, respectively. In winter months, a greater daily FI score was associated with less consumption of total fruit (-0.17 cups, 95% CI: -0.32,-0.02), whole fruit (-0.18 cups, 95%CI: -0.30,-0.05), whole grains (-0.57 oz, 95%CI: -0.99,-0.16) and higher consumption of refined grains (1.05 oz, 95%CI: 0.52,1.59). During COVID-19, elevated daily FI scores were associated with less intake of whole grains (-0.49 oz, 95% CI: -0.88,-0.09), and higher intake of salt (0.34 g, 95%CI: 0.15,0.54). No association was observed in fall nor during the pre-COVID-19 months. No association was found between daily FI and energy intake in either season, pre-COVID 19, or during-COVID-19 months.

CONCLUSION

Daily FI is associated with compromised dietary quality in low-income adults in winter months and during the COVID-19 period. Future research should delve into the underlying factors of these observed relationships.

The unintended effects from halting nuclear power production: Evidence from Fukushima Daiichi accident

This paper provides novel evidence of the unintended health effects stemming from the halt in nuclear power production after the Fukushima Daiichi nuclear accident. After the accident, nuclear power stations ceased operation and nuclear power was replaced by fossil fuels, causing an increase in electricity prices. We find that this increase led to a reduction in energy consumption, which caused an increase in mortality during very cold temperatures, given the protective role that climate control plays against the elements. Our results contribute to the debate surrounding the use of nuclear as a source of energy by documenting a yet unexplored health benefit from using nuclear power, and more broadly to regulatory policy approaches implemented during periods of scientific uncertainty about potential adverse effects.

The Association of Energy Poverty with Health and Wellbeing in Children in a Mediterranean City

Children have been identified as being particularly vulnerable to energy poverty (EP), but little empirical research has addressed the effect of EP on children’s health and wellbeing, especially in southern Europe. In this work we aimed to provide an in-depth description of the distribution of EP by sociodemographic, socioeconomic and housing characteristics, as well as to analyse the association between EP and health and wellbeing in children in Barcelona. We performed a cross-sectional study using data from the Barcelona Health Survey for 2016 (n = 481 children under 15 years). We analysed the association between EP and health outcomes through prevalence differences and prevalence ratios (PR) and their 95% confidence interval (CI), using Poisson regression models with robust variance. In Barcelona, 10.6% of children were living in EP and large inequalities were found by sociodemographic, socioeconomic and housing characteristics. EP was strongly associated with poor health in children (PR (95% CI): 7.70 (2.86, 20.72)). Living in EP was also associated with poor mental health (PR (95% CI): 2.46 (1.21, 4.99)) and with more cases of asthma (PR (95% CI): 4.19 (1.47, 11.90)) and overweight (PR (95% CI): 1.50 (1.05, 2.15)) in children. It is urgent to develop specific measures to avoid such serious and unfair health effects on children.

Objectively measured chronic disease risk among food pantry patrons

OBJECTIVES AND DESIGN

This cross-sectional, observational study examined the prevalence of objectively measured chronic disease risk factors among a diverse group of food pantry patrons.

SAMPLE AND MEASUREMENT

Public health nurses performed biometric screenings in community settings for 1,685 unduplicated adults attending food pantries.

RESULTS

Over three fourths of participants (81.1%) were overweight or obese. High cholesterol and high blood pressure were detected in 38.4% and 37.7% of participants, respectively. Over half (58%) of the participants were referred to a local community health clinic for follow-up services.

CONCLUSION

Interventions should target food pantry patrons to reduce the prevalence of chronic disease conditions among this vulnerable population.

Strengthening the Public Health Impacts of the Supplemental Nutrition Assistance Program Through Policy

The US Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of the US nutrition safety net. Each month, SNAP provides assistance to 40 million low-income Americans-nearly half of them children. A number of changes could strengthen the public health impacts of SNAP. This review first presents a framework describing the mechanisms through which SNAP policy can influence public health, particularly by affecting the food security, the diet quality, and, subsequently, the health of SNAP participants. We then discusspolicy opportunities with the greatest potential to strengthen the public health impacts of SNAP, organized into three areas: (a) food production and distribution, (b) benefit allocation, and (c) eligibility and enrollment. For each section, we describe current policy and limitations of the status quo, suggest evidence-based opportunities for policy change to improve public health, and identify important areas for future research.

The association of energy poverty with health, health care utilisation and medication use in southern Europe

Energy poverty (EP) is defined as the inability of a household to secure a socially and materially required level of energy services in the home. The main objective of this study was to analyse the association between EP and distinct indicators of health status, health services utilisation and medication use in southern Europe, using the city of Barcelona as a case study. We conducted a cross-sectional study using the data of the Barcelona Health Survey for 2016 (n = 3519, 53.3% women). We calculated EP percentages according to age, country of birth and social class. We analysed the association between EP and 26 health-related indicators through prevalence ratios (PR), and quantified the impact of EP on health at the population level by calculating the percentage of population attributable risk (PAR%). In Barcelona, 13.3% of women and 11.3% of men experienced EP. The most frequently affected groups were people born in low- and middle-income countries, those from more disadvantaged social classes, and women aged 65 years and older. We found a strong association between EP and worse health status, as well as higher use of health services and medication. For example, compared with women without EP, those with EP reported poor mental health 1.9 (95% CI: 1.6-2.4) times more frequently. Compared with men without EP, those with EP reported poor mental health 2.1 (95% CI: 1.6-2.8) times more frequently. The combination of high EP prevalence and the strong association between EP and negative health outcomes resulted in high PAR%, indicating the striking impact of EP on health and health services at the population level. EP is an important public health problem in southern European urban contexts that should be included in policy priorities in order to address its structural causes and minimise its unfair and avoidable health effects.

A conceptual model for understanding the rapid COVID-19-related increase in food insecurity and its impact on health and healthcare

Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.

Economic influences on population health in the United States: Toward policymaking driven by data and evidence

Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States.

Do Where The Elderly Live Matter? Factors Associated with Diet Quality among Korean Elderly Population Living in Urban Versus Rural Areas

This study aimed to examine whether there is an area difference on diet quality among the Korean elderly population. The effect of personal factors on diet quality is also estimated and compared between rural and urban areas. A cross-sectional data from the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES) was used for this study. The participants were older adults aged ≥ 65 years (n = 3207) who participated in the KNHANES. Urban and rural areas classified the region and the Korean Healthy Eating Index (KHEI) assessed the diet quality. Personal factors that were related to diet quality included socio-demographic factors, health behaviors, and health conditions. This study found that the diet quality was different between urban and rural areas in the Korean elderly population, showing a higher mean of KHEI scores in urban areas than rural areas (67.3 for urban seniors, 63.6 for rural seniors, p < 0.001), and the regional difference was still significant, even after adjusting for the personal factors (p < 0.001). Different sets of personal factors were found to be significant that explain the diet quality of participants between areas, such as economic resources, walking exercise, and perceived oral health status in urban areas, and age and food insecurity in rural areas. In conclusions, this study found that there was a regional disparity in diet quality and some personal factors affecting diet quality were dependent on areas, which implied that regional environment with diverse contexts could influence diet quality. These findings emphasize the need to provide targeted intervention programs that take into account both the characteristics of individuals and local food environments in order to improve the overall diet quality in older adults.

Income Shocks and Partnership Formation: Evidence from Malawi

The ever-increasing prevalence of negative shocks experienced by poor, vulnerable households often induces extreme measures as ways to recover from the negative effects on income. Child marriage is one of the coping mechanisms households may use. This study examines whether young people in households that experience a negative shock are more likely to marry than those not experiencing a shock, and whether this effect differs by lineage system. I show that marrying off daughters is, in fact, a coping mechanism used by patrilineal households after experiencing a shock and that these effects are potentially strongest for young women who are already out of school. Conversely, I find no significant effect for young men. Additionally, I find suggestive evidence of an increased likelihood of young women engaging in transactional sexual relationships after a shock as an individual-level coping mechanism. Understanding the mechanisms leading to the increased incidence of these phenomena provides valuable information that can help combat such practices.

Early-life exposure to weather shocks and child height: Evidence from industrializing Japan

In this study, we estimate the long-run effects of early-life exposure to weather shocks on the height of primary school children. To estimate the global impacts on almost the entire child population in an industrializing country, we utilize both a unique nationwide multi-dimensional longitudinal dataset of Japanese children aged 6-11 and official monthly statistics on meteorological conditions in the 1920s. We observe that the exposure to cold waves in early-life exerted stunting effects on both the boys and girls. In the coldest regions in the northeastern area of Japan, the stunting effects of cold weather shocks on the boys and girls are estimated to be approximately 0.8 and 0.6 cm, respectively. Our observation indicates that prenatal (postnatal) exposure is important for the boys (girls). Our results suggest that the marginal effects of cold waves are stronger in the warmer regions than in the colder regions.

Aligning Programs and Policies to Support Food Security and Public Health Goals in the United States

Food insecurity affects 1 in 8 US households and has clear implications for population health disparities. We present a person-centered, multilevel framework for understanding how individuals living in food-insecure households cope with inadequate access to food themselves and within their households, communities, and broader food system. Many of these coping strategies can have an adverse impact on health, particularly when the coping strategies are sustained over time; others may be salutary for health. There exist multiple opportunities for aligning programs and policies so that they simultaneously support food security and improved diet quality in the interest of supporting improved health outcomes. Improved access to these programs and policies may reduce the need to rely on individual- and household-level strategies that may have negative implications for health across the life course.

Social Assistance Payments and Food Insecurity inAustralia: Evidence from the HouseholdExpenditure Survey

It is widely understood that households with low economic resources and poor labour market attachment are at considerable risk of food insecurity in Australia. However, little is known about variations in food insecurity by receipt of specific classes of social assistance payments that are made through the social security system. Using newly released data from the 2016 Household Expenditure Survey, this paper reports on variations in food insecurity prevalence across a range of payment types. We further investigated measures of financial wellbeing reported by food-insecure households in receipt of social assistance payments. Results showed that individuals in receipt of Newstart allowance (11%), Austudy/Abstudy (14%), the Disability Support Pension (12%), the Carer Payment (11%) and the Parenting Payment (9%) were at significantly higher risk of food insecurity compared to those in receipt of the Age Pension (<1%) or no payment at all (1.3%). Results further indicated that food-insecure households in receipt of social assistance payments endured significant financial stress, with a large proportion co-currently experiencing “fuel” or “energy” poverty. Our results support calls by a range of Australian non-government organisations, politicians, and academics for a comprehensive review of the Australian social security system.

Estimating the Short-Term Effects of the Earned Income Tax Credit on Child Health

The Earned Income Tax Credit (EITC) is the largest US poverty-alleviation program, yet few studies examine its effects on the health of recipients' children. We employed quasiexperimental techniques to test the hypothesis that EITC refund receipt is associated with short-term improvements in child health. The data set included children in families surveyed in the Third National Health and Nutrition Examination Survey (n = 7,444). We employed a difference-in-differences approach, exploiting the seasonal nature of EITC refund receipt. We compared children of EITC-eligible families interviewed immediately after refund receipt (February to April) with those interviewed during other months (May to January), differencing out seasonal variation among non-EITC-eligible families. We examined outcomes that were likely to be affected immediately after refund receipt, including general health, nutrition, metabolic and inflammatory biomarkers, and test scores. There were improvements in physician-reported overall health after refund receipt but no changes in infection, serum metabolic or inflammatory markers, or test scores, and there were contradictory findings for food insufficiency. In summary, EITC refunds are not strongly associated with most short-term health outcomes among recipients' children, although numerous previous studies have demonstrated impacts on longer-term outcomes. This highlights the importance of examining the effects of public policies on beneficiaries and their children using varying study designs.

Inpatient Medicaid Usage and Expenditure Patterns After Changes in Supplemental Nutrition Assistance Program Benefit Levels

Introduction

Food insecurity worsens health outcomes and is associated with increased health care usage and expenditures. The Supplemental Nutrition Assistance Program (SNAP) reduces but does not eliminate recipients’ food insecurity. We sought to determine whether inpatient Medicaid usage and expenditure patterns responded to an April 2009 increase in SNAP benefit levels and a subsequent November 2013 decrease.

Methods

Interrupted time series models estimated responses to the 2009 and 2013 SNAP changes in the Medicaid population, compared responses between Medicaid and Medicare recipients, and compared responses between Medicaid recipients with different likelihoods of having a disability. Analyses used 2006 through 2014 Healthcare Cost and Utilization Project National (previously Nationwide) Inpatient Sample data.

Results

After the 2009 SNAP increase, Medicaid admission growth fell nationally from 0.80 to 0.35 percentage points per month (a difference of –0.45; 95% CI, –0.72 to –0.19), adjusting for enrollment. After the 2013 SNAP decrease, admission growth rose to 2.42 percentage points per month (a difference of 2.07; 95% CI, 0.68 to 3.46). Inflation-adjusted monthly Medicaid expenditures followed similar patterns and were associated with $26.5 billion (in 2006 dollars) in reduced expenditures over the 55 months of the SNAP increase, and $6.4 billion (in 2006 dollars) in additional expenditures over the first 14 months after the SNAP decrease. Effects were elevated for Medicaid compared with Medicare recipients and among people with a high likelihood of having a disability.

Conclusion

Although alternative causal explanations warrant consideration, changes in SNAP benefit levels were associated with changes in inpatient Medicaid usage and cost patterns.

Encountering energy precarity: Geographies of fuel poverty among young adults in the UK

This paper develops the notion of "energy precarity" in order to uncover the governance practices and material conditions that drive and reproduce the inability of households to secure socially- and materially-necessitated levels of energy services in the home. The overarching aim is to foreground a geographical approach towards the study of domestic energy deprivation, by emphasizing the complex socio-spatial and material embeddedness of fuel poverty. The paper operationalizes these ideas via a field-based study of a group that has received limited attention in research and policy on fuel poverty: young adults living in privately rented accommodation. In evoking the experiences of such individuals, I employ energy precarity as a means of unpacking the spaces where energy deprivation is produced, experienced and contested. Among other findings, I highlight that people's fluid lifestyles and specific end-use energy demand patterns mean that energy deprivation metaphorically and physically overflows the limits of home, creating multiple performativities of precarity that have received very little attention to date.

The health impacts of energy performance investments in low-income areas: a mixed-methods approach

Background

Cold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.

Objectives

To determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.

Design

A mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.

Setting

Low-income areas across Wales.

Participants

Residents who received energy efficiency measures through the intervention programme and matched control groups.

Main outcome measures

Primary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.

Methods

Anonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.

Data sources

The Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.

Results

The study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.

Limitations

This was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.

Conclusion

Although there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.

Future work

Our research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.

Funding

The National Institute for Health Research Public Health Research programme.

Food Acquisition through Private and Public Social Networks and Its Relationship with Household Food Security among Various Socioeconomic Statuses in South Korea

This study was conducted to understand food acquisition practices from social networks and its relationship with household food security. In-depth interviews and a survey on food security were conducted with twenty-nine mothers and one father in metropolitan areas of South Korea. Many families acquired food from their extended families, mainly participants’ mothers. Between low-income and non-low-income households, there was a pattern of more active sharing of food through private networks among non-low-income households. Most of the low-income households received food support from public social networks, such as government and charity institutions. Despite the assistance, most of them perceived food insecurity. We hypothesized that the lack of private social support may exacerbate the food security status of low-income households, despite formal food assistance from government and social welfare institutions. Interviews revealed that certain food items were perceived as lacking, such as animal-based protein sources and fresh produce, which are relatively expensive in this setting. Future programs should consider what would alleviate food insecurity among low-income households and determine the right instruments and mode of resolving the unmet needs. Future research could evaluate the quantitative relationship between private resources and food insecurity in households with various income statuses.

Very Low Food Security in US Households Is Predicted by Complex Patterns of Health, Economics, and Service Participation

Background: Very low food security (VLFS) happens at the intersection of nuanced and complex patterns of risk characteristics across multiple domains. Little is known about the idiosyncratic situations that lead households to experience VLFS.Objective: We used classification and regression tree (CART) analysis, which can handle complex combinations of predictors, to identify patterns of characteristics that distinguish VLFS households in the United States from other households.Methods: Data came from 3 surveys, the 2011-2014 National Health Interview Survey (NHIS), the 2005-2012 NHANES, and the 2002-2012 Current Population Survey (CPS), with sample participants aged ≥18 y and households with income <300% of the federal poverty line. Survey participants were stratified into households with children, adult-only households, and older-adult households (NHIS, CPS) or individuals aged 18-64 y and individuals aged ≥65 y (NHANES). Household food security was measured with the use of the 10-item US Adult Food Security Scale. Variables from multiple domains, including sociodemographic characteristics, health, health care, and participation in social welfare and food assistance programs, were considered as predictors. The 3 data sources were analyzed separately with the use of CART analysis.Results: Household experiences of VLFS were associated with different predictors for different types of households and often occurred at the intersection of multiple characteristics spanning unmet medical needs, poor health, disability, limitation, depressive symptoms, low income, and food assistance program participation. These predictors built complex trees with various combinations in different types of households.Conclusions: This study showed that multiple characteristics across multiple domains distinguished VLFS households. Flexible and nonlinear methods focusing on a wide range of risk characteristics should be used to identify VLFS households and to inform policies and programs that can address VLFS households' various needs.

Impact of energy efficiency interventions in public housing buildings on cold-related mortality: a case-crossover analysis

Background

Interventions to mitigate fuel poverty and particularly energy efficiency façade retrofitting (EEFR) have demonstrated positive impacts on health but the impacts of EEFR interventions on cold-related mortality have not been studied in depth. We evaluated the impact of EEFR interventions in Barcelona on the association between cold outdoor temperatures and mortality (from all natural causes and from neoplasms, circulatory system and respiratory system causes) from 1986 to 2012.

Methods

A time-stratified case-crossover analysis was used. Relative risks (RR) for death related to extreme cold (lowest fifth percentile) in the no-intervention and intervention groups were obtained for temperature lag windows covering the day of the death and the previous 20 days (0-2, 3-5, 6-8, 9-11, 12-14, 15-17, 18-20). The statistical significance of the observed changes was evaluated using the RR for the cold temperature-intervention interaction.

Results

In men, interventions significantly increased the extreme cold-death association for the lag window 15-17 [interaction RR 2.23, 95% confidence interval (CI) 1.14-4.36]. The impacts were stronger for respiratory system causes and in men aged 75 or older. In women, on lag window 0-2, the extreme cold-death association was not significantly reduced when analysing all natural causes of death (interaction RR 0.46, 95% CI 0.21-1.01), but it was reduced significantly when analysing only deaths from neoplasms, circulatory system and respiratory system causes together. The impacts were stronger in women who died from circulatory system causes, in women with no education and in those aged 75 or older.

Conclusions

EEFR interventions had differentiated effects on cold-related mortality in men and women. Differentiated effects were also observed by cause, educational level and age.

The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study

BACKGROUND

Research suggests that living in fuel poverty and cold homes contributes to poor physical and mental health, and that interventions targeted at those living in poor quality housing may lead to health improvements. However, little is known about the socio-economic intermediaries and processes that contribute to better health. This study examined the relationship between energy efficiency investments to homes in low-income areas and mental and physical health of residents, as well as a number of psychosocial outcomes likely to be part of the complex relationship between energy efficiency measures and health outcomes.

METHODS

A quasi-experimental field study with a controlled pretest-posttest design was conducted (intervention n = 364; control n = 418) to investigate the short-term health and psychosocial impacts of a domestic energy efficiency programme that took place across Wales between 2013 and 2015. Survey data were collected in the winters before and after installation of energy efficiency measures, including external wall insulation. The study used a multilevel modelling repeated measures approach to analyse the data.

RESULTS

The energy efficiency programme was not associated with improvements in physical and mental health (using the SF-12v2 physical and mental health composite scales) or reductions in self-reported respiratory and asthma symptoms. However, the programme was associated with improved subjective wellbeing (B = 0.38, 95% CI 0.12 to 0.65), as well as improvements in a number of psychosocial outcomes, including increased thermal satisfaction (OR = 3.83, 95% CI 2.40 to 5.90), reduced reports of putting up with feeling cold to save heating costs (OR = 0.49, CI = 0.25 to 0.94), fewer financial difficulties (B = -0.15, 95% CI -0.25 to -0.05), and reduced social isolation (OR = 0.32, 95% CI 0.13 to 0.77).

CONCLUSION

The study showed that investing in energy efficiency in low-income communities does not lead to self-reported health improvements in the short term. However, investments increased subjective wellbeing and were linked to a number of psychosocial intermediaries that are conducive to better health. It is likely that better living conditions contribute to improvements in health outcomes in the longer term. Better understanding of the impacts on recipients of energy efficiency schemes, could improve targeting of future fuel poverty policies.

Housing Policies and Health Inequalities

A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed. Housing conditions related to fuel poverty are associated with poorer health and are unevenly distributed across Europe. We found possible positive effects of façade insulation interventions on cold-related mortality in women living in social housing; but not in men. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most vulnerable groups and be adaptable to their needs.

Cool? Young people investigate living in cold housing and fuel poverty. A mixed methods action research study

Background

Living in cold housing conditions and risk of fuel poverty presents a range of physiological and psychosocial health risks. Limited research has specifically investigated the effects of fuel poverty on children and young people, and even less has been conducted with youth input into the research process.

Methods

The Cool? Study used mixed methods, participatory action research carried out with youth researchers involved at all stages through questionnaire design, analysis, qualitative design, e-interviewing and dissemination of results. This article reports on results of an online survey of 656 adolescents aged 14–16 years completed at 17 schools in New Zealand. Sampling was based on selecting schools for invitation, with the probability of selection weighted proportional to school size, within strata defined by climate zone. Results from a small e-mail interview study of survey respondents who consented to follow-up are also reported.

Results

The study found that almost half of the survey respondents (47%) felt their home was sometimes cold during the winter; a further 40% felt their home was often or always cold. More than two thirds of respondents (70%) had shivered inside at least once during winter. Respondents were more likely to report key indicators of fuel poverty depending on their self-reported ethnicity, with Māori at increased risk. Living in private rental housing or state-owned housing also increased risk of fuel poverty compared to those in owner-occupied dwellings. Participants of email interviews expressed concern about the widespread problem of cold housing for youth and a desire for Government intervention.

Conclusion

The integrated results confirm that cold housing and risk of fuel poverty are important problems for young people in New Zealand. Results contribute to the evidence-base for policy targeting of schemes such as the Government-sponsored retrofitting of insulation to households with dependent children.

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Mixed methods action research investigated cold housing among New Zealand youth.

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Participatory approach included youth throughout the research process.

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Online school-based survey found cold housing is a significant problem among youth.

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Risk of fuel poverty is higher among those in rental tenure and of Māori ethnicity.

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Young people support policy intervention to improve housing conditions for youth.

Moderation of the Relation of County-Level Cost of Living to Nutrition by the Supplemental Nutrition Assistance Program

OBJECTIVES

To examine the association of county-level cost of living with nutrition among low-income Americans.

METHODS

We used the National Household Food Acquisition and Purchase Survey (2012-2013; n = 14 313; including 5414 persons in households participating in the Supplemental Nutrition Assistance Program [SNAP]) to examine associations between county-level cost-of-living metrics and both food acquisitions and the Healthy Eating Index, with control for individual-, household-, and county-level covariates and accounting for unmeasured confounders influencing both area of living and food acquisition.

RESULTS

Living in a higher-cost county-particularly one with high rent costs-was associated with significantly lower volume of acquired vegetables, fruits, and whole grains; greater volume of acquired refined grains, fats and oils, and added sugars; and an 11% lower Healthy Eating Index score. Participation in SNAP was associated with nutritional improvements among persons living in higher-cost counties.

CONCLUSIONS

Living in a higher-cost county (particularly with high rent costs) is associated with poorer nutrition among low-income Americans, and SNAP may mitigate the negative nutritional impact of high cost of living.

Understanding 'energy insecurity' and why it matters to health

Energy insecurity is a multi-dimensional construct that describes the interplay between physical conditions of housing, household energy expenditures and energy-related coping strategies. The present study uses an adapted grounded theory approach based on in-depth interviews with 72 low-income families to advance the concept of energy insecurity. Study results illustrate the layered components of energy insecurity by providing rich and nuanced narratives of the lived experiences of affected households. Defined as an inability to adequately meet basic household energy needs, this paper outlines the key dimensions of energy insecurity-economic, physical and behavioral- and related adverse environmental, health and social consequences. By thoroughly examining this understudied phenomenon, this article serves to raise awareness of an increasingly relevant issue that merits more attention in research and policy.

"Extra Oomph:" Addressing Housing Disparities through Medical Legal Partnership Interventions

Low-income households face common and chronic housing problems that have known health risks and legal remedies. The Medical Legal Partnership (MLP) program presents a unique opportunity to address housing problems and improve patient health through legal assistance offered in clinical settings. Drawn from in-depth interviews with 72 patients, this study investigated the outcomes of MLP interventions and compares results to similarly disadvantaged participants with no access to MLP services. Results indicate that participants in the MLP group were more likely to achieve adequate, affordable and stable housing than those in the comparison group. Study findings suggest that providing access to legal services in the healthcare setting can effectively address widespread health disparities rooted in problematic housing. Implications for policy and scalability are discussed with the conclusion that MLPs can shift professionals' consciousness as they work to improve housing and health trajectories for indigent groups using legal approaches.