8.4.3: Housing Quality
Substandard housing is also a public health issue. The U.S. Department of Housing and Urban Development (HUD) considers substandard housing to be any permanent residence lacking hot and cold water, sink, toilet, or shower, and kitchen facilities like a stove, refrigerator, and sink with running water. Living in a place without any of these utilities can affect personal hygiene, the ability to cook fresh and healthy meals, and ultimately increases the risk of both infectious and chronic diseases. A recent report estimates that substandard housing affects over 1.5 million people living in cities and over 368,000 people living in rural areas. American Indian and Alaskan Natives have the highest rates of lacking appropriate plumbing and kitchen utilities, followed closely by rural communities and people with disabilities (Swendener et al., 2023).
Even if housing has adequate plumbing and kitchen facilities, there may be other issues that impact health such as rodent or insect infestation, mold, lack of heating or cooling, or exposure to household toxins like lead or formaldehyde. Even low levels of lead exposure can have significant effects on neurodevelopment in children. Dilapidated structures pose higher risks for injuries for children, older adults, and people with disabilities ( Quality of Housing - Healthy People 2030 , n.d.). A lack of disposable income can make it difficult to pay for home repairs, and landlords can sometimes shift responsibilities to tenants - particularly in competitive rent markets. One report found that even prior to the COVID-19 pandemic, nearly 15% of rental homes either needed substantial repairs, had rodent infestations, or lacked some resource (like heating or water), and these homes were more likely to be rented to the poorest - and most rent-burdened families (U.S. Government Accountability Office, 2020).
Other issues around housing include struggling to pay rent or a mortgage, spending more than 30-50% of income on housing, overcrowding, and having to move frequently ( Housing Instability - Healthy People 2030 , n.d.). Housing is considered “affordable” when it costs 30% or less of the household income (Braveman et al., 2011). Children who have to move more than 3 times in one year have much poorer health and are also less likely to have health insurance. Overcrowding increases the risks of infectious disease transmission and can also impact mental health. The COVID-19 pandemic only highlighted the impact of overcrowding and poor ventilation in living spaces. All of these factors can impact both physical and psychological health of individuals and the social cohesion of a community. Over their lifespans, people living in areas of poverty or experiencing homelessness have significantly worse health outcomes ( Housing Instability - Healthy People 2030 , n.d.).