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4.9 Stephanie Ettinger de Cuba

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  • 1. Housing Insecurity, Budget Trade-offs and Young Children’s Health Stephanie Ettinger de Cuba, MPH Children’s HealthWatch National Conference on Ending Homelessness July 14, 2011 1
  • 2. Overview• Brief intro to Children’s HealthWatch•Definition of terms •Food insecurity •Housing insecurity •Trends•Impact of being behind on rent •How many families are behind on rent? •What does it mean for mothers’ and children’s health? •How does impact family ability to meet other basic needs?•Policy implications 2
  • 3. Children’s HealthWatch• Non-partisan, pediatric research & public policy center• Impact of economic conditions and public policy → young children’s health & well-being – Housing – Food – Energy• Provide policy makers with evidence to develop policies that protect young children’s health and development 3
  • 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 4
  • 5. Human Brain Development  Vulnerable Period: Birth – Age 3 Language Neural Connections for Different Functions Develop Sequentially Sensory Pathways (Hearing, Vision) Higher Cognitive Functions Adult neural  connectionsConception Months Years Decades Birth Age Fetus Late Infancy/Toddler Puberty 5 Source: Thompson & Nelson, 2000
  • 6. What is food insecurity?• Limited, uncertain access to enough nutritious food for all household members to lead active, healthy life due to economic constraints (USDA)• Child food insecurity –reductions in quantity, quality of children’s meals because caregivers can no longer buffer from inadequate household food resources 6
  • 7. 7Source: USDA, ERS 2006-2009
  • 8. Food Insecurity is a health issue Infection-Malnutrition Cycle Hunger/ MalnutritionWeakenedImmuneSystem Illness/ Infection 8
  • 9. What is Housing Insecurity? Moderate Housing Insecurity Crowded living conditions – more than 2 people per bedroom Doubling up – living temporarily with another family for economic reasons Severe Housing Insecurity Frequent moves – moving twice or more in the past yearDefined based on prevalence and child health outcomes 9 Source: DB Cutts, AJPH, June 2011
  • 10. What percent of young children live in housing insecure families?605040302010 0 5-city Baltimore Boston Little Rock Minneapolis Philadelphia 10 Source: Children’s HealthWatch, 1998-2010
  • 11. Housing insecurity Harmful to Young Children’s Health & Development• Crowding/Doubling up – increased risk of household & child food insecurity• Frequent moves particularly damaging to young children• Young children whose families have moved 2 or more times in the past year are more likely to be: – Food insecure – Child food insecure – In fair or poor health – At risk for developmental delays – Lower weight for their age 11 DB Cutts, AJPH, June 2011
  • 12. I am a single mother of two children and am having a hard time making ends meet. I have a decent job but fell behind on my bills and now I am facing eviction. I have tried every single resource available out there. But everywhere I turn I hit a closed door and my hope dies a little again… www.aidpage.com 12
  • 13. Behind Closed Doors:The hiddenhealth impacts of being behind on rent • Much known – children’s health and homelessness • Little research health impact for children and families → being behind on rent • Not included in original definition of housing insecurity 13 Research funded by the Fireman Foundation
  • 14. Proportion of families struggling to pay rent increased over recession years30%25%20%15%10%5%0% 2007 2008 2009 2010 14 Source: Children’s HealthWatch
  • 15. Struggle to pay rent – risk to children’s health• Compared to young children in stable housing – Young children in families behind on rent more likely • Child food insecure • Poor health • Developmental delays 15
  • 16. How do children in shelter fare compared to children in families behind on rent?Children in shelter more likely to: – Be in fair/poor health – Have history of hospitalization – Be at risk for developmental delay BUT Less likely to: – Be child food insecure
  • 17. Household and Maternal Well- being Compromised• Household – • Mothers – increased risk: increased risk: – Food insecurity – Poor health – Difficulty paying utility bills – Depression (energy insecurity) 17
  • 18. Health Care Trade-offs & Foregone Care• Has the cost of medical care or prescriptions ever stopped you from being able to pay for rent, mortgage, utility bills, food…?• Was there any time when [you or your child] needed a prescription medicine or medical care, but [were/was] unable to get it because the family couldn’t afford it? 18
  • 19. Household Balancing Act between Basic Needs Source: Children’s HealthWatch 19
  • 20. What do we know about policy solutions?Young children in subsidized housing less likely to be housing insecureCompared to young children on wait list, youngchildren in subsidized housing • More likely food secure • Less likely seriously underweight • More likely classified as “well” (composite of several health indicators) 20 Children’s HealthWatch, Rx for Hunger: Affordable Housing, 2009
  • 21. Policy Implications• Food & housing security = health issues• Food & housing policy interrelated - need for: – Increased supply affordable housing – Stable, adequate funding subsidized housing – Stable, adequate funding for stabilization (assistance with arrearages, security deposits) – Coordination btw housing/food advocates – Outreach/assistance programs for those on wait list AND those struggling to pay rent 21
  • 22. Stable housing is an economic development issueKeeping families out of shelter (“front” and“back door”) and stably housed is often betterfor children, families and city/state financesChildren are our country’s future leaders, ourfuture workers, and our future communitymembers.An investment in affordable housing now is aninvestment in our country’s future. 22
  • 23. Thank You!www.childrenshealthwatch.org sedc@bu.edu Tel. 617-638-5850 23 88 E. Newton Street | Vose Hall 4th Floor | Boston, MA 02118 | tel: 617.414.6366 | info@childrenshealthwatch.org