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Megan Sandel MD MPH
Principal Investigator, Children’s HealthWatch
Associate Professor , Boston University Schools of Medi...
• Overview of how housing influences health
• Stability
• Quality
• Affordability
• Discuss why Housing is like a Vaccine
...
Children’s HealthWatch
• Non-partisan, pediatric research and policy center
• Improve health & development young children→...
Where our data comes from:
• Emergency
Departments and
Primary Care Clinics in
Boston, Baltimore,
Philadelphia, Little Roc...
Unstable Housing, Hunger, Health Linked
Evidence on Housing Quality
and Children’s Health
• Development and Worsening Asthma has
been tied specific housing condit...
Behind Closed Doors
• Being behind on rent strongly
associated with negative health
outcomes
– High risk of child food ins...
Rx for Hunger: Affordable Housing
• Housing subsidies free
up resources for food &
other necessities
• Children in subsidi...
Site-Specific Housing Briefs
• A look at housing
insecurity in each of
the five cities
• Outlines the nature of
the local ...
More than Half of Families
in Philadelphia are Housing Insecure
12
• Similar findings
in briefs from:
• Minneapolis
• Arka...
• What are the properties of vaccines?
• Provide benefits against multiple threats
• Builds immunity to be long lasting
• ...
• Five cities (Boston, Baltimore, Chicago, Los
Angeles and New York )
• Designed to examine how relocation influenced
empl...
• Results examined severe obesity (BMI >35 ),
morbid obesity (BMI >40) and Hgb A1C > 6.5
levels
• Each was lower by 3-4 pe...
• Examined prevalence of mental disorders in the
adolescents 10-15 years later
• Boys in the low poverty voucher group had...
Investing in the Housing Vaccine:
What is the business case?
• New understanding of interplay of how
housing influences health
• Stability- Beyond homelessness
• Quality- Physical and...
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel
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Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel

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Megan Sandel, Children's Health Watch

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Housing Opportunity 2014 - Why Connecting Housing and Health Matters, Megan Sandel

  1. 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. 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. 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. 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
  5. 5. Unstable Housing, Hunger, Health Linked
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. More than Half of Families in Philadelphia are Housing Insecure 12 • Similar findings in briefs from: • Minneapolis • Arkansas • Massachusetts • Baltimore
  11. 11. • 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?
  12. 12. • 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
  13. 13. • 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:
  14. 14. • 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:
  15. 15. Investing in the Housing Vaccine: What is the business case?
  16. 16. • 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

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