Megan Sandel, Children's Health Watch

1. Megan Sandel MD MPH
Principal Investigator, Children’s HealthWatch
Associate Professor , Boston University Schools of Medicine
Medical Director, National Center for Medical-Legal Partnership
Grow Clinic, Boston Medical Center
Housing and Health:
Why a Stable, Decent Affordable
Home is Like a Vaccine
www.medical-legalpartnership.org

2. • Overview of how housing influences health
• Stability
• Quality
• Affordability
• Discuss why Housing is like a Vaccine
• Provide multiple benefits
• Long lasting benefits, differential benefits
• Benefits to individual and society
• Discuss how Housing and Healthcare can be
bridged to provide the Housing Vaccine
How does Housing Influence Health

3. Children’s HealthWatch
• Non-partisan, pediatric research and policy center
• Improve health & development young children→
alleviate economic hardships→ public policies
• Hunger (Food Insecurity)
• Unstable Housing (Housing Insecurity)
• Keeping Heat or Lights on (Energy Insecurity)
• Provide policy makers with evidence to develop
policies that protect young children’s health and
development

4. Where our data comes from:
• Emergency
Departments and
Primary Care Clinics in
Boston, Baltimore,
Philadelphia, Little Rock
and Minneapolis.
• Interviews - caregivers
with children 0 to 4
years old
– “invisible” group
– critical window of time

6. Unstable Housing, Hunger, Health Linked

7. Evidence on Housing Quality
and Children’s Health
• Development and Worsening Asthma has
been tied specific housing conditions
• Pests (cockroaches and mice)
• Molds/Chronic Dampness
• Tobacco smoke
• Lead exposure tied to long term effects
• CDC recently lowered the “action level” to 5 ug/dl
• “Heat or eat” ties energy costs and poor health

9. Behind Closed Doors
• Being behind on rent strongly
associated with negative health
outcomes
– High risk of child food insecurity
– Children & mothers more likely
in fair or poor health
– Children more likely at risk for
developmental delay
– Mothers more likely
experiencing depressive
symptoms

10. Rx for Hunger: Affordable Housing
• Housing subsidies free
up resources for food &
other necessities
• Children in subsidized
housing (compared to
those on waitlist)
– More likely food secure
– Less likely underweight
– More likely a “well” child

11. Site-Specific Housing Briefs
• A look at housing
insecurity in each of
the five cities
• Outlines the nature of
the local housing
problem
• Calls attention to
state and local policy
solutions

12. More than Half of Families
in Philadelphia are Housing Insecure
12
• Similar findings
in briefs from:
• Minneapolis
• Arkansas
• Massachusetts
• Baltimore

13. • What are the properties of vaccines?
• Provide benefits against multiple threats
• Builds immunity to be long lasting
• Acknowledged to have differential
benefits, can be targeted or tailored to
groups
• Why do we think vaccines are good
investments?
• Benefits to individual and society
Why would Housing be like a vaccine?

15. • Five cities (Boston, Baltimore, Chicago, Los
Angeles and New York )
• Designed to examine how relocation influenced
employment, income, education and well-being
• Almost 5,000 families with children were
randomized to three groups from 1994-1998
– Low poverty voucher with counseling
– Traditional voucher
– Remain in public housing
• Continued 2 waves of studies on these three
groups
Moving to Opportunity (MTO) Study:
Randomized Controlled Trial

17. • Results examined severe obesity (BMI >35 ),
morbid obesity (BMI >40) and Hgb A1C > 6.5
levels
• Each was lower by 3-4 percentage points over all
between low poverty vs control group
– BMI >35 was 31.1% vs 35.5%
– BMI >40 was 14.4% vs 17.7%
– Hgb A1c was 16.3% vs 20.0%
• For a study not designed to have this health
effect, this is similar effect that is seen in diabetes
medications (15-20 percent overall reduction)
Moving to Opportunity (MTO) Study:

19. • Examined prevalence of mental disorders in the
adolescents 10-15 years later
• Boys in the low poverty voucher group had higher
rates of mental disorders than control group
– Major Depression 7.1% vs 3.5%
– PTSD 6.2% vs 1.9%
– Conduct disorder 6.4% vs 2.1%
• Girls in traditional voucher group had lower rates
of mental disorders vs control groups
– Major depression 6.5% vs 10.9%
– Conduct disorder 0.3% vs 2.9%
Moving to Opportunity (MTO) Study:

24. Investing in the Housing Vaccine:
What is the business case?

32. • New understanding of interplay of how
housing influences health
• Stability- Beyond homelessness
• Quality- Physical and mental health
• Affordability- Hardships are interconnected
• Housing can act like a vaccine
• Provide Multiple, Long Lasting benefits
• Differential Benefits to Individual and Society
• How can we pay for it requires evidence based
partnerships
Housing Influences Health