About This Literature Summary
This summary of the literature on Quality of Housing as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Crime and Violence, Environmental Conditions, and Housing Instability literature summaries.
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Literature Summary
There are several aspects to housing that impact health, including affordability, stability, quality and safety, and surrounding neighborhood.1 This summary will discuss the quality of housing, specifically the physical quality of housing and neighborhood conditions. In this summary, “home” is used as an all-inclusive term to include all different types of dwellings, such as single-family homes and apartments. Housing quality refers to the physical conditions of a person’s home as well as the quality of the social and physical environment in which the home is located.2,3 Poor-quality housing is associated with various negative health outcomes.3–6
Home design and structure significantly influence housing quality and may affect both mental and physical health.7–9 Poor housing quality and inadequate conditions — such as the presence of lead, mold, or asbestos, poor air quality, and overcrowding — can contribute to negative health outcomes, including chronic disease and injury.2–6 For example, lead exposure from paint, pipes, and faucets can lead to irreversible adverse health effects.10–13 Even low levels of lead exposure can have serious effects on children’s health and behavior, including nervous system and cognitive development.14,15 Lack of air conditioning and heating can affect residents’ health.3,4,16 Cold indoor conditions have been associated with high blood pressure and respiratory conditions, as well as depression.4,17 Additionally, water leaks are associated with mold growth, which has been shown to affect respiratory health and increase the likelihood of asthma, coughing, and wheezing.18,19 Lack of smoke alarms, carbon monoxide detectors, and other fire suppression requirements can lead to injury and death.1 Lastly, residents of overcrowded homes may be at risk for poor mental health, food insecurity, and infectious diseases.3,10,20,21
Physical and structural housing conditions discussed above disproportionally impact children, older adults, individuals with physical disabilities, and low-income individuals.10,22,23 Children’s behaviors, such as hand-to-mouth activity, may increase their exposure to home pollutants that may influence growth and development.10,22,24 Older adults may experience serious injury from falls in the home, especially in homes with stairs, narrow doorways, or other obstacles.2,4,25 Steps, balconies, and windows are features of home design that may present a threat to safety, especially for individuals with physical disabilities.2,3,26
In addition, low-income families may be more likely to live in older homes and homes with greater risks that can impact health outcomes.1 For example, these homes may be under-insulated, lack air conditioning, and cost more to heat, leaving homes too hot or too cold, which has been linked to poorer health outcomes.3,4,16 Additionally, limited finances may result in a lack of housing maintenance, which can lead to poor housing conditions inside the home (e.g., damaged appliances, exposed nails, or peeling paint) as well as outside the home (e.g., damage to stairs and windows).6
The quality of a house’s neighborhood is shaped in part by how well individual homes are maintained, and widespread residential deterioration in a neighborhood can negatively affect mental health.6 In addition to housing quality, physical, social, and economic conditions within neighborhoods can also impact short- and long-term health outcomes.27 These conditions may include crime and violence, environmental conditions, and access to public services such as public transportation, law enforcement, and schools. As a result, poor-quality housing in disadvantaged neighborhoods further exacerbates health disparities.27
Addressing the quality of housing as a public health issue may help prevent and reduce negative health outcomes. Housing codes and laws, such as banning the use of lead paint, have led to increased quality of housing.3,10 Additionally, local building codes and state statutes require landlords to provide basic standards such as sufficient hot water, reliable heat, and smoke and carbon monoxide detectors.28 Programs such as the federal government’s Housing Choice Voucher program assist vulnerable populations in securing quality housing. Landlords are required to pass the program’s housing quality standards to provide decent, safe, and sanitary housing.29 Further research is needed to develop other effective interventions to improve housing quality. This additional evidence will facilitate public health efforts to address quality of housing as a social determinant of health.
Citations
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Bonnefoy, X. (2007). Inadequate housing and health: An overview. International Journal of Environment and Pollution, 30(3/4), 411. https://doi.org/10.1504/IJEP.2007.014819
Krieger, J., & Higgins, D. L. (2002). Housing and health: Time again for public health action. American Journal of Public Health, 92(5), 758–768.
Hwang, S., Fuller-Thomson, E., Hurlchanski, J., Bryant, T., Habib, Y., & Regoeczi, W. (1999). Housing and population health: A review of the literature. Sociology & Criminology Faculty Publications, 1–135.
Office of the Surgeon General. (2009). The surgeon general’s call to action to promote healthy homes. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK44192/
Kruger, D. J., Reischl, T. M., & Gee, G. C. (2007). Neighborhood social conditions mediate the association between physical deterioration and mental health. American Journal of Community Psychology, 40(3–4), 261–271. https://doi.org/10.1007/s10464-007-9139-7
Mitchell, C. S., Zhang, J. (Jim), Sigsgaard, T., Jantunen, M., Lioy, P. J., Samson, R., & Karol, M. H. (2007). Current state of the science: Health effects and indoor environmental quality. Environmental Health Perspectives, 115(6), 958–964. https://doi.org/10.1289/ehp.8987
Bonnefoy, X., Braubach, M., Moissonnier, B., Monolbaev, K., & Robbel, N. (2003). Housing and health in Europe: Preliminary results of a Pan-European study. American Journal of Public Health, 93(9), 1559–1563. https://doi.org/10.2105/AJPH.93.9.1559
Weich, S., Blanchard, M., Prince, M., Burton, E., Erens, B., & Sproston, K. (2002). Mental health and the built environment: Cross-sectional survey of individual and contextual risk factors for depression. The British Journal of Psychiatry: The Journal of Mental Science, 180, 428–433. https://doi.org/10.1192/bjp.180.5.428
Weitzman, M., Baten, A., Rosenthal, D. G., Hoshino, R., Tohn, E., & Jacobs, D. E. (2013). Housing and child health. Current Problems in Pediatric and Adolescent Health Care, 43(8), 187–224. https://doi.org/10.1016/j.cppeds.2013.06.001
Jacobs, D. E., Wilson, J., Dixon, S. L., Smith, J., & Evens, A. (2009). The relationship of housing and population health: A 30-year retrospective analysis. Environmental Health Perspectives, 117(4), 597–604. https://doi.org/10.1289/ehp.0800086
Gostin, L. O. (2016). Politics and public health: The Flint drinking water crisis. The Hastings Center Report, 46(4), 5–6. https://doi.org/10.1002/hast.598
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Schnoor, J. L. (2016). Recognizing drinking water pipes as community health hazards. Journal of Chemical Education, 93(4), 581–582. https://doi.org/10.1021/acs.jchemed.6b00218
Centers for Disease Control and Prevention. CDC response to Advisory Committee on Childhood Lead Poisoning Prevention recommendations in “Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention.” (2012). 16.
Evans, J., Hyndman, S., Stewart-Brown, S., Smith, D., & Petersen, S. (2000). An epidemiological study of the relative importance of damp housing in relation to adult health. Journal of Epidemiology and Community Health, 54(9), 677–686. https://doi.org/10.1136/jech.54.9.677
Lloyd, E. L. (1991). The role of cold in ischaemic heart disease: A review. Public Health, 105(3), 205–215. https://doi.org/10.1016/s0033-3506(05)80110-6
Adamkiewicz, G., Zota, A. R., Fabian, M. P., Chahine, T., Julien, R., Spengler, J. D., & Levy, J. I. (2011). Moving environmental justice indoors: Understanding structural influences on residential exposure patterns in low-income communities. American Journal of Public Health, 101(Suppl 1), S238–S245. https://doi.org/10.2105/AJPH.2011.300119
Mendell, M. J., Mirer, A. G., Cheung, K., Tong, M., & Douwes, J. (2011). Respiratory and allergic health effects of dampness, mold, and dampness-related agents: A review of the epidemiologic evidence. Environmental Health Perspectives, 119(6), 748–756. https://doi.org/10.1289/ehp.1002410
Cutts, D. B., Meyers, A. F., Black, M. M., Casey, P. H., Chilton, M., Cook, J. T., Geppert, J., Ettinger de Cuba, S., Heeren, T., Coleman, S., Rose-Jacobs, R., & Frank, D. A. (2011). US housing insecurity and the health of very young children. American Journal of Public Health, 101(8), 1508–1514. https://doi.org/10.2105/AJPH.2011.300139
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Rollings, K. A., Wells, N. M., Evans, G. W., Bednarz, A., & Yang, Y. (2017). Housing and neighborhood physical quality: Children’s mental health and motivation. Journal of Environmental Psychology, 50, 17–23. https://doi.org/10.1016/j.jenvp.2017.01.004
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Housing Choice Voucher Program Section 8. (n.d.). U.S. Department of Housing and Urban Development (HUD). Retrieved February 8, 2022, from https://www.hud.gov/topics/housing_choice_voucher_program_section_8
