Housing Affordability and Health Among Homeowners and Renters

doi:10.1016/j.amepre.2010.08.002

American Journal of Preventive Medicine

Volume 39, Issue 6, December 2010, Pages 515-521

https://doi.org/10.1016/j.amepre.2010.08.002 Get rights and content

Background

Although lack of affordable housing is common in the U.S., few studies have examined the association between housing affordability and health.

Purpose

Using quasi-experimental methods, the aim of this study was to examine whether housing affordability is linked to a number of important health outcomes, controlling for perceptions of neighborhood quality, and determining whether this association differs by housing tenure (renting versus owning).

Methods

Data from the 2008 Southeastern Pennsylvania Household Health Survey, a telephone-based survey of 10,004 residents of Philadelphia and its four surrounding counties, were analyzed. The association between housing affordability and health outcomes was assessed using propensity score methods to compare individuals who reported living in unaffordable housing situations to similar individuals living in affordable ones.

Results

Overall, 48.4% reported difficulty paying housing costs. People living in unaffordable housing had increased odds of poor self-rated health (AOR=1.75, 95% CI=1.33, 2.29); hypertension (AOR=1.34, 95% CI=1.07, 1.69); arthritis (AOR=1.92, 95% CI=1.56, 2.35); cost-related healthcare nonadherence (AOR=2.94, 95% CI=2.04, 4.25); and cost-related prescription nonadherence (AOR=2.68, 95% CI=1.95, 3.70). There were no significant associations between housing affordability and heart disease, diabetes, asthma, psychiatric conditions, being uninsured, emergency department visits in the past year, obesity, and being a current smoker. Renting rather than owning a home heightened the association between unaffordable housing and self-rated health (AOR=2.55, 95% CI=1.93, 3.37 for renters and not significant among homeowners) and cost-related healthcare nonadherence (AOR=4.74, 95% CI=3.05, 7.35 for renters and AOR=1.99, 95% CI=1.15, 3.46 for homeowners).

Conclusions

The financial strain of unaffordable housing is associated with trade-offs that may harm health. Programs that target housing affordability for both renters and homeowners may be an important means for improving health.

Introduction

The number of households living in unaffordable housing—commonly defined as spending more than 30% of household income on housing expenses—was estimated to be 39.5 million in the U.S. in 2007.¹ The number of households in unaffordable housing had climbed by nearly 6% from 2001 to 2007.¹ Declining real wages for the lowest earners, combined with high housing costs, has led to an insufficient supply of affordable rental housing units.² In recent years, the housing bubble and lax lending standards have produced high levels of both foreclosure and household debt.¹

High housing costs relative to income, as well as financial strain more broadly, may be an important determinant of health.3, 4, 5, 6, 7 Financial strain has been linked to poor health outcomes including all-cause mortality, higher prevalence of chronic conditions, and depressive symptoms.8, 9, 10, 11 Receiving subsidized housing is associated with improvement in certain health outcomes,¹² for example, in children's nutritional status.4, 13, 14 High housing-related costs may pose health risks through multiple mechanisms, including forcing trade-offs between housing costs and paying for other health-promoting goods and services (e.g., health insurance, medications, and healthy foods5, 6, 7, 15); causing high levels of stress and emotional strain,16, 17, 18 which may be heightened given people's emotional attachment to their home17, 19; through the potential association with housing quality and neighborhood features; and as a marker for low SES associated with material deprivation across other domains.²⁰

The present study uses propensity score methods to examine whether unaffordable housing is linked to poor health and lower healthcare utilization. The present study tests whether the association between housing affordability and health and healthcare utilization outcomes differs for homeowners and renters. People who own their homes have been shown to enjoy better health than renters,21, 22, 23, 24, 25, 26 and homeowners tend to have higher levels of wealth, which is also associated with health.27, 28 However, it is not known whether homeowners who have difficulty affording their housing-related expenses enjoy the health benefits linked to homeownership.

Section snippets

Data Source

The current study draws on data from the Philadelphia Public Health Management Corporation's 2008 Southeastern Pennsylvania Household Health Survey,²⁹ which is a biennial survey of residents of Philadelphia County and the four surrounding counties (Bucks, Chester, Delaware, and Montgomery) with households selected via random-digit dialing to land telephone lines and additional interviews conducted via cell phone. Respondents were eligible if they were aged >18 years and resided in one of the

Results

Overall, 14.0% of the sample reported that paying housing costs was very difficult and 34.4% reported that it was somewhat difficult. Table 1 shows the sociodemographic characteristics of the sample for (1) the unaffordable housing group; (2) the unweighted affordable housing group; and (3) the propensity score–weighted affordable housing group. Before weighting, the unaffordable housing and affordable housing groups looked different on eight of the 11 independent variables included in the

Discussion

People who live in unaffordable housing were more likely to report cost-related prescription drug and healthcare nonadherence, fair or poor self-reported health, and certain chronic conditions in comparison to similar people living in affordable housing. However, many chronic conditions, insurance, and health-related behaviors were not different between the two groups. The results were generally consistent among both homeowners and renters, but with stronger associations found among renters

Conclusion

Like other forms of financial strain, lack of affordable housing is related to poor health outcomes. Tax benefits for homeowners and rental subsidies are perhaps the most prominent policy programs affecting housing affordability, although other programs exist (e.g., Low-Income Home Energy Assistance Program, LIHEAP).¹³ Among homeowners experiencing the threat of home foreclosure, current mortgage foreclosure mitigation efforts may reduce the financial costs of unaffordable housing. Programs and

References (44)

The State of the Nation's Housing 2009
(2009)
The State of the Nation's Housing 2008
(2008)
J. Harkness et al.
Housing affordability and child well-being: evidence from the national survey of America's families
Hous Policy Debate
(2005)
A. Meyers et al.
Subsidized housing and children's nutritional status: data from a multisite surveillance study
Arch Pediatr Adolesc Med
(2005)
M.B. Kushel et al.
Housing instability and food insecurity as barriers to health care among low-income Americans
J Gen Intern Med
(2006)
C.T. Ma et al.
Associations between housing instability and food insecurity with health care access in low-income children
Ambul Pediatr
(2008)
S.K. Long
Hardship among the uninsured: choosing among food, housing, and health insurance
(2003)
D.G. Blazer et al.
Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults
Am J Public Health
(2005)
A. Steptoe et al.
Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening
Psychosom Med
(2005)
S.L. Szanton et al.
Effect of financial strain on mortality in community-dwelling older women
J Gerontol B Psychol Sci Soc Sci
(2008)

P. Drentea et al.

Over the limit: the association among health, race and debt

Soc Sci Med

(2000)

M.A. Laurie et al.

Providing affordable family housing and reducing residential segregation by income: a systematic review

Am J Prev Med

(2003)

D.A. Frank et al.

Heat or eat: The Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age

Pediatrics

(2006)

A. Meyers et al.

Public housing subsidies may improve poor children's nutrition

Am J Public Health

(1993)

H. Levy et al.

What do people buy when they don't buy health insurance and what does that say about why they are uninsured?NBER Working Paper No. 9826

(2003)

R. Hiscock et al.

Ontological security and psycho-social benefits from the home

Housing, Theory Soc

(2001)

A. Kearns et al.

‘Beyond Four Walls'The psycho-social benefits of home: evidence from west central Scotland

Housing Stud

(2000)

J.R. Dunn

Housing and health inequalities: review and prospects for research

Housing Stud

(2000)

M. Fullilove

Root shock

(2004)

D.E. Alley et al.

Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age

Am J Public Health

(2009)

M. Schoenbaum et al.

Race, socioeconomic status, and health: accounting for race differences in health

J Gerontol B Psychol Sci Soc Sci

(1997)

A. Ellaway et al.

Does housing tenure predict health in the UK because it exposes people to different levels of housing-related hazards in the home or its surrounding

Health Place

(1998)

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This study used cross-sectional data from the Global Mind Project to investigate the association of PA on overall mental well-being and various subcategories of mental health across different adult age groups.
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An estimated ATC of 17.41 was found for overall MHQ, corresponding to a standardized mean difference (SMD) of 0.25. Among the mental health subcategories, PA engagement was estimated to have the largest ATC for Mind-Body Connection (ATC = 18.90; SMD = 0.30), followed by Adaptability and Resilience (ATC = 17.09; SMD = 0.26), Core Cognition (ATC = 16.00; SMD = 0.24), Drive and Motivation (ATC = 15.43; SMD = 0.24), Mood and Outlook (ATC = 14.81; SMD = 0.21), and Social Self (ATC = 12.53; SMD = 0.17).
Our findings support the existing literature demonstrating an association of PA engagement on overall mental well-being, and builds on this work by revealing consistent effects that exist across various mental health subcategories and the adult lifespan.
Neighborhood-level housing affordability and maternal depression
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Housing affordability is a growing public health crisis, with lower-income families disproportionately affected. At the individual-level, measures of housing affordability have been linked to maternal mental health, but less is known about how neighborhood-level characteristics influence wellbeing in the perinatal period. Using data from the Future of Families and Child Wellbeing Study, which follows a national cohort of children born between 1998 and 2000 in United States cities and their parents, we examined associations between neighborhood-level housing affordability and maternal depression in the postpartum year. Non-Hispanic Black and Hispanic mothers were overrepresented among those living in rent-burdened neighborhoods. Living in a rent-burdened neighborhood was associated with a 3-percentage-point increase in the risk of maternal depression in the postpartum year, even after adjusting for individual and other neighborhood-level covariates. Individual-level housing hardships associated with maternal depression included difficulty paying rent, staying in temporary housing, and having trouble paying utilities. Policies that address neighborhood-level affordability may have spillover benefits for lowering the risk of depression and reducing disparities in maternal mental health.
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Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast.
This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.
Cold homes in Australia: Questioning our assumptions about prevalence
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Australia is considered by many to be a warm climate country and hence winter cold and its health effects are often overlooked. The majority of the Australian population live in temperate climate regions, which are heating-dominated and experience cold wintertime conditions. The prevalence of cold in Australian homes has to date been rarely measured or estimated, and the few studies that do are based on proxy data that estimate a low prevalence (around 5 %). This paper tests these proxy measures, using high resolution temperature data on indoor temperature from 100 homes across temperate Australia. The data were assessed using the World Health Organization's Housing and Health guideline for minimum indoor temperature (18 °C), which provides an internationally recognised benchmark for defining cold in homes. Across the sampled homes, 81 % were below 18 °C on average across the whole of winter (June–August 2022). Average winter indoor temperatures were 16.5 ± 2.7 °C across all homes, with no significant difference between locations. These early findings suggest that the problem of unhealthily cold homes in Australia is likely to be significantly more prevalent than previously estimated. Far from affecting 5 % of Australian households, the affected population may be 10 times this value. These initial findings have important implications for how we model health impacts and develop policy. This early release data from a recently commenced large environmental monitoring project is of timely importance. It challenges our understanding of the prevalence of cold housing in Australia context, flagging the pressing need to increase policy attention in advance of winter.
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Research articleHousing Affordability and Health Among Homeowners and Renters

Background

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Data Source

Results

Discussion

Conclusion

The State of the Nation's Housing 2009

The State of the Nation's Housing 2008

Housing affordability and child well-being: evidence from the national survey of America's families

Hous Policy Debate

Subsidized housing and children's nutritional status: data from a multisite surveillance study

Arch Pediatr Adolesc Med

Housing instability and food insecurity as barriers to health care among low-income Americans

J Gen Intern Med

Associations between housing instability and food insecurity with health care access in low-income children

Ambul Pediatr

Hardship among the uninsured: choosing among food, housing, and health insurance

Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults

Am J Public Health

Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening

Psychosom Med

Effect of financial strain on mortality in community-dwelling older women

J Gerontol B Psychol Sci Soc Sci

Over the limit: the association among health, race and debt

Soc Sci Med

Providing affordable family housing and reducing residential segregation by income: a systematic review

Am J Prev Med

Heat or eat: The Low Income Home Energy Assistance Program and nutritional and health risks among children less than 3 years of age

Pediatrics

Public housing subsidies may improve poor children's nutrition

Am J Public Health

What do people buy when they don't buy health insurance and what does that say about why they are uninsured?NBER Working Paper No. 9826

Ontological security and psycho-social benefits from the home

Housing, Theory Soc

‘Beyond Four Walls'The psycho-social benefits of home: evidence from west central Scotland

Housing Stud

Housing and health inequalities: review and prospects for research

Housing Stud

Root shock

Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age

Am J Public Health

Race, socioeconomic status, and health: accounting for race differences in health

J Gerontol B Psychol Sci Soc Sci

Does housing tenure predict health in the UK because it exposes people to different levels of housing-related hazards in the home or its surrounding

Health Place

Research article
Housing Affordability and Health Among Homeowners and Renters