Pediatrician Sees Housing as a Vaccine

The opening session of the Terwilliger Center for Housing’s Housing Opportunity 2014 conference featured a keynote talk by Megan Sandel, MD, MPH, about how housing influences health outcomes. Dr. Sandel is an Associate Professor of Pediatrics at the Boston University School of Medicine, the former Director of Pediatric Healthcare for the Homeless at Boston Medical Center and Co-Principal Investigator with Children’s HealthWatch, a consortium of health policy experts who research the impact of policies and economic conditions on the health of low-income children and families, with a particular focus on housing, hunger and energy.

In particular, Sandel discussed how her research shows that housing can act like a vaccine. It provides multiple and long-lasting benefits for both individuals and society.

“We have a new understanding of the interplay of how housing influences health in terms of stability, quality, and the effect on physical and mental health,” said Dr. Sandel, and listed some key areas where children’s health is affected on the “continuum between homelessness and stable housing.” These areas include:

  • Living in homes with cockroaches increases the risk of a stay in the hospital for children with asthma—as can exposure to molds, dampness, and tobacco smoke.
  • Exposure to lead can stunt brain development and current findings show that lead is harmful at even lower levels than previously thought, meaning nearly half a million children are at risk.
  • Living in poor and unsafe neighborhoods increases rates of mental health problems, such as depression and post-traumatic stress disorder.
  • “Heat or eat” situations, in which residents must choose between heating their home or affording food, tie energy costs to poor health
  • Being behind on rent is strongly associated with negative health outcomes due to the related high risk of food insecurity. Food insecurity puts children at risk for developmental delays and mothers at risk for depression.

Sandel pointed out that housing subsidies become impactful on health because they help free up a family’s resources to buy food and other necessities. Children’s HealthWatch data—which comes from children ages 0-4 years old in emergency departments and primary care clinics in five U.S. cities—show that children in subsidized housing, compared to those on waitlists for housing, are more likely to be food secure.

“With housing security, children are more likely to not be underweight or overweight,” said Sandel.

Sandel concluded her presentation with a business case for intervening on housing to improve health, citing recent decisions by insurer UnitedHealth Group to invest in low income housing in several states and by New York State to use Medicaid dollars to develop or renovate subsidized housing.