Health and Housing Equity: a new report released by the American Public Health Association

Earlier this fall the American Public Health Association (APHA) released a remarkable report on the relationship between Housing Equity and Health, “Creating The Healthiest Nation: Health and Housing Equity.” APHA’s Caucus on Homelessness is deeply appreciative of the report’s focus on US housing inequalities and the shortcomings of our current affordable housing programs to address them.

The report was produced by Kelly Hilovsky, a Policy Fellow with the Bloomberg American Health Initiative who is embedded at APHA, along with Kenneth Lim, and Tia Taylor Williams from APHA. It highlights the ongoing effects of institutional and cultural racism on the distribution, quality, and affordability of housing in America.

Copyright: This material is licensed to the public under the Creative Commons Attribution

One of the first principal slogans of the APHA Caucus on Homelessness was that “housing is healthcare”.  For years now, Dr. Georges Benjamin and the rest of the team at APHA have been declaring that “housing is a human right” and that “housing is healthcare.” While the report does not address the human right to housing (a position [pdf] held by the UN since 1991), it echoes much of the messaging and policy that the APHA’s Caucus on Homelessness has been promoting since it was established in 1990. The most recent policy statement adopted by APHA on the issue is available here: “Housing and Homelessness as a Public Health Issue.”

The report stresses:

  • The importance of looking deeply at the racial inequalities in homelessness and housing in our country; and
  • That affordable housing options in the US fall short of addressing the problem.

It ends with a call to strengthen housing access and stability for disenfranchised populations.

Racial Inequality

In the US, certain groups are more likely to become homeless than others. This fact has been demonstrated [pdf] over and over again, in the peer-reviewed literature, new and old media. The federal Annual Homeless Assessment Reports show a persistent over-representation of Black / African Americans, Latinx, and other communities experiencing homelessness. Yet the systems we put into place to address homelessness and make it “rare, brief, and non-recurring” are sometimes blind to the ways they enforce or widen those disparities.

Members of the Caucus on Homelessness wrote a special post for Public Health Newswire back in May. In it, we urged public health and housing agencies to examine the racial disparities in program outcomes before, during, and after the CARES Act funds. These funds are critical to transformation of emergency shelter services and community development block grants during the pandemic. However, as we prioritize the allocation of these funds, we must make sure they don’t blindly reinforce ongoing racial disparities.

Affordable Housing Programs

Although it’s easy to talk about racist institutions in the US in a historical sense, the legacy of racist housing access programs in this country remains. Persistent inequities in ownership and low-income housing enrollment disadvantage and disenfranchise racial and gender minorities, people with disabilities, the elderly population, adolescents, and young adults. Massive racial disparities in income, asset wealth, and HEALTH are partially the result of these housing-related generational wealth gaps.

While the government has many institutions and programs to address the downward economic pressures of our economic system, these programs fall far short of addressing the inequitable distribution of housing. It’s incredible to think that just one in five eligible households receive government-sponsored housing assistance. This leaves over 17 million families without [pdf] the support they need and for which THEY QUALIFY.  As a thoughtful aside, the authors point to how housing assistance programs fall under the government’s “nondefense discretionary section of the budget” and not as an entitlement program, an indication of the low priority given such programs.

Call to Improve Housing Equity

Improving housing access and stability is a preeminent public health intervention. Broadly, the authors of the APHA report recommend five broad dimensions needed to address the housing inequities in the system:

  1. Preventing structural racism,
  2. Increasing affordability,
  3. Advancing quality and safety,
  4. Supporting neighborhoods, and
  5. Ensuring housing stability.

Within each of these, there are calls for policy steps and advocacy that would help to strengthen the system overall. There are other steps that will remove the remnants of our racist policies and institutional practices. With those efforts complete we will have begun to level the playing field and improve health and housing equity.

The partnership between APHA and the Caucus on Homelessness is going strong. We share the lasting intention of elevating issues of housing and homelessness in the discussion amongst public health experts. We continue to applaud the generation of thoughtful, evidence-based reports like this one. Please review this report and incorporate the findings into your work and advocacy going forward.

This post was co-published on the Medical Care journal’s blog:

Disclosure: This post is provided on behalf of the APHA’s Caucus on Homelessness. The Caucus on Homelessness is an affiliated membership organization with the American Public Health Association. It consists of APHA members and non-member public health experts on the issues of housing, homelessness, and public health.

Ben King, PhD MPH

Board Member and Past Chair

APHA Caucus on Homelessness

Equity at the intersection of race and housing

Mortality data associated with COVID-19 shines an uncomfortably bright light on inequitable outcomes stemming from institutional racism in America. A significant body of evidence has long proven that communities of color face inequities leading to worse health outcomes and higher rates of homelessness than their white counterparts. The current pandemic has amplified the devastating effects of these disparities.

In a guest blog for APHA Public Health Newswire on behalf of the APHA Caucus on Homelessness, Rose Englert, Ben King, PhD, MPH, and John Gilvar describe the immediate steps that communities can take to “ensure that spending priorities and strategic responses to the pandemic do not end up worsening the effects we observe in our current housing system outcomes.”

Read and share their full piece:

COVID-19 and Homelessness: Blog from Medical Care

Ben King, past Chair of the Caucus on Homelessness, and Sam Baldazo wrote a blog for APHA’s Medical Care Section that outlines the unique risk factors for COVID-19 for individuals experiencing homelessness, the harm of under-testing this population, and the need for appropriate and safe isolation spaces for distancing.

View and share their article:

Call for Papers: Medical Care Special Issue on Homelessness

The journal Medical Care released a call for papers for a special issue on multi-morbidity among homeless populations.

Some topics may include but are not exclusive to:
-Systematic or meta-analytic reviews of interventions or models
-Evaluation of interaction and/or integration of healthcare, social services, and other sectors in serving homeless populations
-Healthcare and homeless services in unique geographic areas, such as rural regions
-Tele-health and other technology-based solutions for homeless populations
-Innovative effective models of care, such as community psychiatry and street medicine approaches
-Addressing suicide, opioid use disorder, unique medical conditions, and early mortality among homeless populations, particularly from the psychosocial perspective

**The deadline for the initial submissions has been extended until March 15, 2020. Please see the call for papers for submission instructions.

APHA Policy Statement on Homelessness Featured in Medical Care

In June, the journal Medical Care published a special commentary written by APHA Caucus on Homelessness Policy Chair, Jen Elder, and Past Chair, Ben King, Housing and Homelessness as a Public Health Issue: Executive Summary of Policy Adopted by the American Public Health Association. They collaborated again this month to write a piece for Medical Care’s blog, “Homelessness as a Public Health Issue.” In the piece, they recap the evidence and recommendations from the recently adopted policy statement on homelessness for the American Public Health Association and subsequent Executive Summary. We encourage you to take a look at both pieces and share with your networks!