Why high rents are a health care problem

A new survey looking at housing and health outcomes supports a growing body of scholarship showing how rent-burdened Americans face potentially damaging delays in medical care.

Commissioned by Enterprise Community Partners Inc., a national affordable housing nonprofit, the survey found that more than half of renters surveyed delayed health care because they couldn’t afford it, and 100 percent of medical professionals surveyed said they had dealt with patients in the past who expressed concerns and anxiety about affordable housing. When these doctors and nurses advised patients to reduce stress, 92 of them percent said financial issues were their biggest stress trigger.

“We can’t just focus on stability, and we can’t just focus on affordability, and we can’t just focus on quality and safety on the home itself,” says Brian Rahmer, Enterprise VP of health and housing. “The kind of solutions we need to bring to the table are solutions that tackle multiple pathways to health and wellness at the regional or local level.”

Released this morning, the survey exemplifies how housing groups, including nonprofit and government entities, have begun to not just view health and housing outcomes as intertwined, but to experiment with new solutions and programs that provide residents with new services and healthier places to live. Increasing rent burdens force low-income renters to divert money that could pay for healthcare to cover monthly housing costs, leading to less preventative care and more expensive emergency care. Medicaid programs in Oregon, New York, and Massachusetts have partnered with local and regional health care systems to investment in housing services and even housing stock, while other large health care systems have invested in community benefit funds to build new affordable housing developments.

How linking housing and health care saves money

The renters in the new Enterprise survey painted a picture of limited budgets, with health and housing fighting for priority. Of the severely rent-burdened respondents, defined as those who spend half or more of their monthly income on housing, 45 percent said they weren’t able to follow a medical treatment plan because they couldn’t afford it, while 31 percent delayed a routine check-up due to a shortage of available funds.

For every 100 low-income renters, only 35 rental units were affordable and available nationwide, according to the National Low-Income Housing Coalition, a shortfall of 7.2 million units. In every one of the nation’s 50 major metro areas, low-income renters vastly outnumber the amount of affordable units.

The survey consisted of responses from 1,000 U.S. renters, half of whom have household incomes of under $50,000, and 500 medical professionals including doctors and nurses.

This research joins a growing body of scholarship linking housing and health outcomes. Housing has always been a well-researched determinant of physical health, and increasingly, housing groups such as Enterprise have sought to better understand the link, and partner with health care organizations to collaborate on ways to cut costs and improve resident care. Urban planners have also started looking at ways to design neighborhoods to increase safety, pedestrian pathways, and medical access to improve resident wellbeing.

A 2016 study in Portland conducted by Enterprise and the Center for Outcomes Research and Education (CORE) examining Medicaid data found that after residents with unstable living situations moved into stable and affordable housing, their Medicaid costs declined by $48 per resident per month, resulting in a 12 percent overall decline in costs. Outpatient care increased, while expenditures on emergency care dropped. The overall savings were even greater for seniors and those with disabilities, which saw health care costs drop 16 percent.

Last year, a study published by the American Association of Pediatrics suggested screening children and caregivers for housing instability (behind on rent, multiple moves, homelessness) as a prime risk factors for adverse health effects. The Case for More, Not Less, a 2018 report by the Urban Institute, found that housing assistance saves public money; renters in dire straits turn to other programs to cover budget gaps left after increasingly high monthly payments, robbing them of the ability to pay for better long-term health and wellness outcomes.

Designing healthier housing

Enterprise is using this data to develop housing and services that improve health outcomes. The organization recently partnered with health care provider Kaiser Permanente to create the Housing for Health equity fund in the greater Bay Area, which may total $85 million, and plans to update its standard for affordable housing to reflect a greater focus on health care outcomes and access.

Simply improving the quality of the country’s housing stock can also go a long way in impacting health outcomes. Renter respondents to the new survey spoke of the toll substandard housing itself takes on their health. The severely rent-burdened reported low rates of satisfaction with access to outdoor space (47 percent), exposure to indoor toxins (48 percent) and general air quality (38 percent). In many cases, the low-income or affordable housing available to these renters isn’t close or connected to accessible health care; 44 percent of medical professionals believe “a lack of accessible health care hinders the health of lower income communities,” and just 48 percent of the lower income respondents reported being satisfied with health care accessibility.