How Does the Affordable Housing Crisis Impact Health Outcomes?

The affordable housing crisis might impact patient health, with new data from the UCLA David Geffen School of Medicine showing that moving because rent gets too high is linked to more psychological distress, higher likelihood for emergency department visits, and lower likelihood of having preventive care visits.

The study, published in JAMA Network Open, highlights a very particular element of housing instability as a social determinant of health. Previous studies and other anecdotal evidence have demonstrated how experiencing homelessness or living in unsafe housing can impact patient health.

But in this latest study, researchers outlined how unaffordable housing can impact patient health. This is particularly salient as the nation stares down an affordable housing crisis.

“Cost-driven displacement is a potential consequence of unaffordable housing that encompasses both forced residential moves (eg, evictions) and reactive residential moves, defined as unforced but unwanted moves in response to escalating rents or income instability,” the researchers wrote.

To get a better handle on how these reactive residential moves impact patient health and wellness, the researchers compared clinical outcomes measures among over 52,000 people who rented in California between 2011 and 2017. Of those people, around 9 percent had to move because they could no longer afford their living space; the remainder either did not move or moved for reasons other than cost.

And, notably, those latter groups had better health outcomes than the one with cost-driven moves.

Compared with people who got to stay put completely, people who had cost-driven moves saw a 4.2-percentage point higher likelihood of experiencing moderate psychological distress and a 3.2-percentage point higher likelihood of experiencing severe psychological distress.

Outcomes suffered when it came to physical health, as well. Those with cost-driven moves were 2.5 percentage points more likely to have an emergency department visit, 5.1 percentage points less likely to have a preventive care visit, and 3.7 percentage points less likely to rate their own health as good or very good.

These trends persisted somewhat when comparing those with cost-driven moves and moves for other reasons, such as for a new job.

Folks who had to move because of rent increases were 3.2 percentage points more likely to experience moderate psychological stress, 2.5 percentage points more likely to experience severe psychological stress, and 4.6 percentage points less likely to say they are in good, very good, or excellent health, compared to those who moved for other reasons.

The findings about stress were particularly notable, the researchers said, because they persisted when comparing cost-driven moves to both groups who did not move and those who moved for other reasons. Any move is stressful because it costs time and money, but the higher stress levels among those who moved due to rent increases show a more impactful issue.

“These differences suggest that the turmoil of cost-driven moves could produce a distinctly enduring form of postmove stress that has negative implications for health,” the researchers explained.

Moreover, heightened stress among those experiencing cost-driven moves has an outsized impact on general well-being. The researchers suggested that deteriorating general well-being could be the physical manifestation of stress, plus a foregoing of healthy behaviors like physical activity plus the uptake of unhealthy coping mechanisms.

The finding that ED and preventive care access changed as the result of any kind of move is likely the result of changes in location and neighborhood resources. People may need time to become established with a new doctor, leading to less preventive care access and more ED visits.

Notably, a cost-driven move was also slightly linked with poorer built environment, with those who experienced a cost-driven move having 16.8 fewer minutes of walking for leisure—which is linked to neighborhood walkability—compared to those who didn’t move. They had 13 fewer minutes of walking for leisure compared to those who also moved but for different reasons.

Neighborhood walkability and the built environment are key social determinants of health. Neighborhood walkability enables individuals without access to a car or public transportation to go to the grocery store or socialize. Walking is also an effective and accessible form of physical activity.

The researchers emphasized that there is a racial component to all of this. Hispanic and Black people were more likely to have a cost-driven move during the study period than their White counterparts, exposing them to the health impacts and potentially deepening racial health disparities.

These findings have serious public policy implications, the researchers said.

“Potential approaches to mitigate excessive housing costs include emergency rental assistance, longer-term rent subsidies, rent stabilization policies, affordable housing development incentives, social housing models, and revisions to zoning constraints on housing supply (especially if implemented in high-opportunity exclusionary neighborhoods and in conjunction with increased tenant protections),” they recommended.

Renter assistance, policies to expand unemployment insurance, the earned income tax credit, and the child tax credit will also be helpful, the team suggested. That’s in addition to policy mechanisms to expand patient access to care.