February 25, 2016

Housing is a Critical Vaccine

By Megan T. Sandel, MD, MPH

The newly released report, Health in Housing: Exploring the Intersection between Housing and Health Care, published by Enterprise and the Center for Outcomes Research and Education (CORE), is an important and pioneering study. Its findings contribute keen insights and evidence as we work toward elevating ongoing discussions on the intersection between health and housing into a clear national priority.

As a physician, Health in Housing speaks to what I see in my work every day: far too many low-income people who lack access to primary care and as a result seek treatment for chronic conditions at emergency rooms. For many of my patients, concerns about keeping up with doctor appointments and medications are far outweighed by trying to pay their rent on time or finding safe and stable housing.

An affordable home that connects people to opportunity through health care as well as good schools, jobs and transit is the foundation for a healthy, productive life. For many years, I have shared my fundamental belief that housing is a critical vaccine that can pave the way to long-term health and well-being. Securing affordable housing for vulnerable families with children, older adults and formerly homeless individuals is indeed the platform for increasing access to primary and preventative care. It is also a critical and necessary long-term investment.

The Health in Housing study involved residents and health care services based in Portland, Oregon, yet it holds national implications for health care systems, payers and policy makers looking for upstream solutions to address major health care needs and fulfill health care reform goals. Housing with integrated health services is an important solution toward bending the health care cost curve.

Adding to a growing evidence base, the study offers clear recommendations:

  • States, localities and managed care organizations should invest resources such as Medicaid in housing solutions that research shows can improve health outcomes and reduce health expenditures for vulnerable individuals.
  • Health services must be integral to affordable housing developments: States, policymakers and payers should explore devoting Medicaid resources to health-related services and resources such as resident services coordinators. As this study shows, stable housing plus health-related services can yield significant cost savings and improve resident health outcomes.

The study also provides a solid foundation on which to begin building policy reform:

  • In support of more upstream investments into the social determinants of health, the Internal Revenue Service should require that community health needs assessments by nonprofit health organizations regularly include affordable housing in their assessments and community improvement plans.
  • The Department of Housing and Urban Development should invest more in Section 4 grant dollars to build the capacity of community development organizations, and the Department of Health and Human Services should invest through the Health Resources and Services Administration to provide more technical assistance and support for housing organizations to collaborate on housing and health.

Health in Housing contributes vital evidence to move forward on major health  care reform priorities: delivering quality health care, achieving better health outcomes and reducing health care costs by creating affordable housing linked to health services. I welcome you to share this study with your peers and colleagues and think about how you can encourage further linkages between health and stable housing.

About the Author: Megan Sandel, MD, MPH, is an Associate Professor of Pediatrics at Boston University School of Medicine and serves on the Board of Trustees for Enterprise Community Partners, Inc. Find her on Twitter at @megansandel.  

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