INSIGHTS Housing Research - TN.gov
INSIGHTSfromHousingPolicyResearchThe Impacts of Affordable Housingon Health: A Research SummaryBy Nabihah Maqbool, Janet Viveiros, and Mindy AultApril 2015Housing is well understood to be an important socialresources available to pay for health care and healthydeterminant of physical and mental health andfood, which leads to better health outcomes. High-well-being. In the context of ongoing national andquality housing limits exposure to environmental toxinsstate efforts to reform health care, it is important forthat impact health. Stable and affordable housing alsopolicymakers to understand the various pathwayssupports mental health by limiting stressors related tothrough which housing affects health. Affordablefinancial burden or frequent moves, or by offering anhousing alleviates crowding and makes more householdescape from an abusive home environment. Affordablehomeownership can have mental health benefits byoffering homeowners control over their environment.Affordable housing can also serve as a platform forproviding supportive services to improve the health ofvulnerable populations, including the elderly, peoplewith disabilities, and homeless individuals and families.Safe, decent, and affordable housing in neighborhoodsof opportunity can also offer health benefits to lowincome households.As an update to earlier reviews on the relationship betweenhousing and health, the authors examined recent researchon the various ways in which the production, rehabilitation,or other provision of affordable housing may affect healthoutcomes for children, adults, and older adults.1 This reportis organized around ten hypotheses on the contribution ofaffordable housing to supporting positive health outcomes.Overall, the research supports the critical linkiStockbetween stable, decent, and affordable housingand positive health outcomes.T H E C E N T E R FO R H O U S I N G P O L I CY I S T H E R ES E A RC H D I V I S I O N O F T H E
Families paying excessive amounts of their income forhousing often have insufficient resources remaining for otheressential needs, including food, medical insurance, and healthcare. These tradeoffs can threaten the health of all familymembers, particularly children. An analysis of 2012 householdexpenditures found that low-income households that spentmore than half their income on housing costs, and aretherefore severely housing cost burdened, spent less on foodand health care compared to similar households spending 30percent or less of their income on housing. These differencesin health care and nutrition spending were particularly large inrural areas.2 Another study found that increases in statewideaverage rents are correlated with increased rates of foodinsecurity among families with children.3Insights from Housing Policy ResearchUtility costs are also an important part of total housingcosts. Programs that lower home utility and energy coststo reduce overall housing costs have been shown to impactthe ability of households to purchase sufficient amounts offood. One study found that participation in the Low IncomeHome Energy Assistance Program (LIHEAP), a federal home2weatherization and energy assistance program that canreduce overall housing costs, decreases the likelihood of foodinsecurity and unstable housing situations.4Access to affordable housing, therefore, can enable familiesto spend more on food and health care, which can improvehealth outcomes. Researchers have found that children inlow-income families that receive housing subsidies are morelikely to have access to an adequate amount of nutritiousfood and to meet “well child” criteria—including the absenceof developmental concerns, maintenance of a healthy weight,and classification as being in good or excellent health—thanchildren in similar families on the waiting list for housingassistance.5The connection between unaffordable housing, strainedbudgets, and health outcomes is not limited to children. Forexample, adults living in unaffordable housing are morelikely to describe themselves as being in fair or poor healthcompared to similar individuals living in affordable housing.Cost burdened adults are also more likely to report failure tofill a prescription or adhere to health care treatments as aresult of cost.6 Similarly, adults undergoing a foreclosure havea significantly higher likelihood of failing to fill a prescriptiondue to cost and are less likely to have health insurancecoverage compared to the general population.7iStock1. Affordable Housing Can ImproveHealth Outcomes by Freeing UpFamily Resources for Nutritious Foodand Health Care Expenditures
Green and Healthy Homes Initiative:A Comprehensive Approachto Health and HousingiStockWhen affordable housing options are limited, households oftenend up living in substandard or poorly maintained housing,which can pose a variety of health risks. Improving the safetyand condition of homes to eliminate harmful environmentaltoxins, such as mold, excessive dust, and rodents, leads tobetter health. The Coalition to End Childhood Lead Poisoningleads the Green and Healthy Homes Initiative (GHHI), whichfunctions as a single intake point for low-income householdsseeking assistance grants from a variety of government andphilanthropic sources to address household remediation needs,such as lead removal or weatherization. GHHI completes acomprehensive health, energy, and safety assessment ofhomes, coordinates funding for the home remediation work,and educates households on how to sustain the structuralinvestments it helps them make in their homes. GHHI measuresthe outcomes of its work and found significant reductions invisits to the emergency room for asthma treatment and fewermissed school days as a result of asthma after the remediationprojects were completed. Currently operating at fourteenlocations across the United States, GHHI helps low-incomehouseholds improve their homes to reduce environmentaltoxins and lead healthier lives. For more information, visit http://www.greenandhealthyhomes.org.2. By Providing Families with GreaterResidential Stability, AffordableHousing Can Reduce Stressand Related Adverse Health OutcomesAn emerging body of evidence also suggests that evenless severe manifestations of housing instability, such asdifficulty keeping up with utility bills, mortgage payments, orhome repairs, may be linked to lower levels of psychologicalwell-being and more intensive use of medical services,particularly among men.15Insights from Housing Policy ResearchAt the extreme, there is little question that residentialinstability has adverse health impacts. For example, studiescontinually show that homeless children are more vulnerableto mental health problems, developmental delays, poorcognitive outcomes, and depression than children whoare stably housed, and that stable housing is stronglyassociated with improved mental health outcomes anda reduction in the number of days hospitalized amongformerly homeless adults.8 Less extreme housing instability,including frequent moves, living in doubled-up housing,eviction, and foreclosure, is also related to elevatedstress levels, depression, and hopelessness. Among bothadolescents and seniors, researchers have found evidenceof a connection between the length of tenure in a residentialbuilding and the likelihood that residents report behavioraland mental issues. Longer tenures are associated with lowerlevels of depression among seniors and fewer internalizingand externalizing behavioral issues such as anxiety andaggression among adolescents.9Residential instability and multiple moves among adolescentsand children have a compounding negative effect uponbehavior and mental well-being, particularly among familieswithout strong social bonds or other mediating factors.10Youth transitioning out of the foster care system areparticularly at risk of housing instability and negative healthoutcomes, including difficulty maintaining access to andcontinuity of care.11 Children without stable housing weremore likely to use emergency department services as aresult of a lack of a regular health care provider.12 Childrenunder three years who had moved two or more times in theprevious year were found to have lower weight for their agewhen compared to children who were in stable housing,and they were at greater risk of developmental problems.13Among adolescents, a significant association was foundbetween early use of illicit drugs and moving four or moretimes before the age of sixteen years.143
Insights from Housing Policy ResearchMany studies have shown that homeowners generally havebetter physical and mental health outcomes than renters.16Researchers have put forth a variety of possible explanationsfor this phenomenon, suggesting that homeowners experiencehigher levels of self-esteem and an increased senseof control, which may be related to improved health.Homeowners are more likely to live in higher-qualityhousing and have more freedom to adapt their surroundingsto their needs, reducing stress and leading to greaterlevels of satisfaction.17 The research lacks consensus onwhether homeowners spending more than 30 percent oftheir income on housing receive all the health benefits ofhomeownership, though more recent research supports thisidea that even unaffordable homeownership may have morepositive impacts on health than renting. One study found thatunlike renters, homeowners’ mental health scores remainthe same regardless of whether or not they spend morethan 30 percent of their income on their housing.18 Anotherstudy found owners who had missed a mortgage payment orspent more than 30 percent of their income on housing stillreported better health than renters.194Recent research does not reveal strong evidence of asimilar positive relationship between homeownership andchildren’s health, although there was also no indication of anegative association. A recent study comparing the childrenof low-income homeowners and renters found no differencein health or behavioral problems as rated by the child’sprimary caregiver.24 Earlier research found slightly lowerlevels of behavioral problems among children in familiesthat own their homes as compared to renters. However,researchers have typically been unable to discern whetherhomeownership has a significant impact on children’s healthdue to the many variables related to homeownership thatalso affect child well-being. 25 For example, individuals whochoose to become homeowners may share a commonset of characteristics that, regardless of tenure, influenceparenting and health and at least partially explain differentoutcomes among renters and owners.26 To the extent thathomeownership benefits are related to increased stabilityor housing quality, affordable rental programs that promotelonger-term residential stability and higher housing qualitymay offer benefits similar to homeownership.An unsustainable mortgage, however, can offset many healthbenefits that are associated with homeownership. Recentresearch points to linkages between home foreclosuresand an array of negative physical and psychological healthproblems, including hypertension, heart disease, anxiety,and depression.20 These problems may be exacerbatedby the tendency of many individuals to turn to unhealthycoping behaviors when faced with stressful life events.21 Ina survey of American homeowners and renters in the fourstates with the highest 2008 foreclosure rates, homeownersin foreclosure reported worse health status than renters,regardless of whether renters spent more than 30 percentof their income on their housing costs.22 Additionally,homeowners in foreclosure were thirteen times more likely toexperience serious psychological distress than homeownerswho were current on their mortgages and could afford theirmonthly payments.234. Well-Constructed and Well-MaintainedAffordable Housing Can ReduceHealth Problems Associatedwith Poor-Quality HousingWhen families have few affordable housing options, they maybe forced to live in substandard housing that puts residents atrisk of lead poisoning, asthma, and accidental injury.27 Unsafeconditions in the home can threaten resident well-being andincrease the risk of accidental burns and injuries.28 Evidencesuggests that simple measures such as the installation ofsmoke detectors and window guards can have a major impacton resident safety and health.29 Code enforcement can alsobe an effective tool for remediating indoor residential healthhazards such as mold.30Despite a major public health effort, low-income familiesare more likely to live in homes that have lead-based painthazards than higher-income families.31 Overall, there havebeen improvements in reducing children’s exposure to lead.Data collected from 1999 through 2004 revealed that thenumber of children with lead levels of 10 micrograms perdeciliter of blood decreased from 63 children per 1,000to 20 children per 1,000 nationwide. Primary householdsources of lead are windowsill dust, soil, and paint, with aniStock3. Affordable Homeownership MayPositively Impact Mental Health;However, Unsustainable Formsof Homeownership MayNegatively Impact Health
iStockestimated 35 percent of 106 million housing units with leadbased paint in the building, and with 22 percent of homescontaining one or more lead-based paint hazards.32Asthma is triggered by a number of environmental factors,particularly air quality affected by residential heating sourcesand indoor allergens. Poor quality or poorly maintainedhousing may be overrun with mold, dust mites, cockroaches,or rodents—all of which are sources of allergens that causeasthma and other respiratory illnesses, as well as fatigue,headache, and difficulty concentrating.33A growing body of research suggests that stable and affordablehousing may help individuals living with chronic diseases suchas HIV/AIDS, diabetes, and hypertension increase their ratesof medical care, maintain their treatment regimens, and achievebetter health outcomes.37 Homeless patients in particularmay have difficulty properly storing medication and syringes,maintaining a recommended diet, and going to follow-upappointments when faced with urgent competing demands,such as finding a place to stay for the night. The challengesposed by homelessness also may increase the likelihood thatindividuals who struggle with drug abuse and addiction willengage in risky behavior, such as sharing needles or exchangingsexual favors for shelter, further jeopardizing their health.38It is easier to access social services in stable housing since anaddress is often required to seek employment and maintaincontinuity of medical care. Women experiencing housinginstability are less likely to utilize social services because ofthe belief that they need to hide their housing situation inorder to keep custody of their children.39Insights from Housing Policy ResearchLead paint removal and allergen relief may require intenseinterventions such as window and carpet replacement andintegrated pest management. While these measures maycarry a higher upfront price tag, research has shown them tobe both effective and more cost-effective than conventionalmaintenance over time.34 Both in simulated models andin implementation, asthma housing interventions such asventilation fans and integrated pest management, lead todramatic declines in the incidence of serious asthma events.Additionally, projects that have implemented healthy housingrenovations like ventilation, heating, insulation, and accessibilitymodifications have decreased rates of acute hospitalizationsamong children and adults.35 The improvements in clinicaloutcomes and corresponding health care costs are greaterthan the costs of the housing improvements.365. Stable, Affordable Housing MayImprove Health Outcomesfor Individuals With Chronic Illnessesby Providing an Efficient Platformfor Health Care Delivery5
6. Access to Neighborhoodsof Opportunity Can Reduce Stress,Increase Access to Amenities,and Lead to Important Health BenefitsFamilies that can only find affordable housing in areaswith very high poverty levels may be prone to greaterpsychological distress and exposure to violent or traumaticevents. The clustering of concentrated social disadvantage,including residential disorder and limited neighborhoodresources, exacerbates stress, which can have an effect onresidents’ physical health.40Residents who feel unsafe in their neighborhoods may also beless likely to walk and engage in other physical activity, althoughfindings in this area are mixed.41 The Moving to Opportunityprogram, which targeted residents of distressed public andassisted housing in high-poverty neighborhoods, providesthe strongest evidence of health improvements related toneighborhood-level housing interventions. Among participantswho received housing vouchers that could be used only in lowpoverty areas (the “experimental” group), adult obesity fell by 11percent. Adult women and adolescent girls in the experimentalgroup also experienced significant reductions in mental healthproblems, including psychological distress, depression, andgeneralized anxiety disorder, and had lower rates of smokingand marijuana use than other participants in the study.426Social cohesion in neighborhoods has been shown to bestrongly correlated with mental well-being.46 Adults who livein neighborhoods that they perceive to have strong cohesionare buffered from daily stresses and report better physicalhealth.47 Studies show that social cohesion of a communityis dependent on the quality of a neighborhood, which canpromote social interactions through public spaces andfacilities.48 Communities with perceived social disorder havebeen correlated with higher rates of anxiety and depressionamong residents.49Community development strategiesthat improve neighborhoodamenities and opportunities cancontribute to increased physicalactivity and healthier eating.iStockInsights from Housing Policy ResearchThe federally funded HOPE VI program provides anotheropportunity to assess neighborhood-level housing interventionsand their impact on health. HOPE VI supports the redevelopmentof large, troubled public housing developments as lower-density,mixed-income communities. Some original residents return tothe redeveloped properties, while others relocate to other publichousing developments or use vouchers to move to privatelyowned units. Based on a rigorous panel study of residentsaffected by revitalization activities at two Chicago HOPE VIsites (those who moved to other public or privately ownedhousing as well as those who stayed in what became a mixedincome development), researchers found that eight years afterbaseline data were collected both respondents who returnedto the redeveloped housing and those who used vouchersto move to new neighborhoods lived in safer neighborhoodsand higher-quality homes. While most health problems hadnot improved and, in many cases, continued to deterioratefrom already-poor ratings, panel study participants did reportsignificant reductions in anxiety levels.43 HOPE VI residentsalso reported an improved sense of safety and decreased fearof crime in their new neighborhoods, both of which can causestress and social isolation.44 As other researchers have alsofound, neighborhood conditions and housing location may havea stronger impact on anxiety and depression than the quality ofthe individual housing unit.45Community development strategies thatimprove neighborhood amenities andopportunities, including creating walkingtrails and bike paths to facilitate exercise50and attracting retail establishments, includinggrocery stores and farmers’ markets, cancontribute to increased physical activity andhealthier eating.51 Areas near current orplanned public transit stations represent aparticularly favorable opportunity to integratethese features as demand for transit-orienteddevelopment rises. New or redevelopingcommunities in these areas can be designedto provide access to an array of retail outlets,schoo
reduce overall housing costs, decreases the likelihood of food insecurity and unstable housing situations. 4. Access to affordable housing, therefore, can enable families . to spend more on food and health care, which can improve health outcomes. Researchers have found that children in low-income families that receive housing subsidies are more
Crisis response system recognize roles in housing advocacy and rapid connection to permanent housing. Strong referral linkages between crisis response system and permanent housing. Unified, streamlined, and user-friendly process for applying for rapid re-housing, permanent supportive housing and/or other housing interventions.
Policy Research. from THE CENTER FOR HOUSING POLICY IS THE RESEARCH DIVISION OF THE. The Impacts of Affordable Housing . on Education: A Research Summary. By Maya Brennan, Patrick Reed, and Lisa A. Sturtevant. November 2014. A growing body of research suggests that stable, affordable housing
housing authorities in England (2012). The Chartered Institute of Housing (CIH) and BMENational run a Housing Rights website specifically aimed at answering housing eligibility queries in regard to new migrants. Information on housing eligibility in Scotland can be found on the Housing Rights website at . Housing Rights in Scotland
SECTION 2 COMPREHENSIVE CITIZEN PARTICIPATION PROGRAM. Knox County, Nebraska County-Wide Housing Study with Strategies for Affordable Housing - 2018 2.2 KNOX COUNTY SURVEY RESULTS Top Housing Needs Housing for Middle-Income Families. Single Family Housing Rental Housing (General). Housing Choices for First-Time Homebuyers.
Mercy Housing Sue Reynolds— . Affordable housing developers compete to creatively stretch and utilize a limited pool of public and private financing sources to develop housing. And even though the demand for affordable housing continues to far outstrip our ability to supply housing, the affordable housing industry has changed .
a Best Value approach to housing. This guidance is directed primarily to local authority policy staff and those involved in . Housing and Health(1998) Chartered Institute of Housing, Good Practice Unit, and other guidance and advice issued by the Audit Commission and the Chartered Institute of Housing. Housing Disrepair Legal Obligations .
It is not a comprehensive review of behavioral science but aims to point readers to relevant Behavioral Insights materials, principles, and methods. . how Behavioral Insights is being used in practice and provides guidance applying Behavioral Insights principles. Finally, we provide an overview of the . Behavioral Insights project research .
KOREAN LANGUAGE PROGRAM (9 credits, Fall & Winter 2 semester course) FIRST LEVEL KOREAN Courses offered. This course is a continuation of First Level Korean.The goal is to give students necessary tools to speak, read and write Korean fluently. Continuing learning further sentence structures, we will also focus on contextual aspects. Special attention is given on using and recognizing minimal .
