Why Homeownership Is a Public Health Issue

This post is the first in a series of blog posts for National Homeownership Month 2019.

Homeownership has a long list of recognized benefits. It builds wealth, provides long-term stability and over time is more affordable than rental housing, especially for low- and moderate-income (LMI) Americans and households of color. While these benefits alone justify the pursuit of homeownership, there is another important advantage: owning a home improves health.

Housing has long been recognized as a major social determinant of health. Other determinants include socioeconomic status, race/ethnicity and geography among others. These determinants, including housing, are arguably the most significant identifiers of health between different social groups disparities in the United States.

Existing research has broadly identified four main pathways that housing affects health: stability, quality and safety, affordability and neighborhood characteristics.

The quality and safety of a home, or its physical characteristics, are perhaps the most obvious links to health outcomes. Poor ventilation, air pollution, lack of indoor climate control and exposure to lead are just some of the clear ways that substandard housing characteristics can negatively impact health outcomes.

Neighborhood characteristics such as proximity to high-traffic areas and “green spaces” have also been shown to hurt or help health outcomes, respectively, as does ease of access to places like schools or grocery stores and the area’s social environment.

However, an often overlooked consequence of housing on health outcomes is its impact on stability and affordability. Where the physical qualities of a home may affect health outcomes directly through injury, disease, or exposure to harmful materials, the financial impact of housing affects health more indirectly, albeit significantly.

Specifically, spending too much on housing has serious negative health impacts. Cost-burdened households (households spending over 30% or more of their income on housing) often prioritize paying housing bills over health care, and are likelier to live in housing conditions that may be more affordable but unsafe.

Similarly, frequent moving has been associated with inconsistent health care service utilization and poorer health/development in children. Furthermore, prolonged periods of stress, including financial stress, have been found to greatly harm a variety of health outcomes, including increased rates of depression, hypertension and heart disease.

In other words, the financial aspect of housing plays a big part in how housing affects health. Given that the United States is facing a growing housing affordability crisis, with median home values being 3.6 times greater than income, it would be fair to say that the issue of housing is an issue of public health.

One solution to this problem is expanding access to affordable homeownership. Homeownership provides stability and in most U.S. markets a mortgage can be more affordable than renting. Furthermore, the negative health impact of housing unaffordability appears to be greater for renters than homeowners. Assuming a home is purchased with an affordable, fixed rate mortgage, owning a home also provides stability and a chance to build wealth, which may go on to benefit a family’s health for generations.

Most states already offer downpayment assistance and homeownership counseling, and many also direct lending to new homeowners. Furthermore, states can expand usage of affordable homeownership strategies like manufactured housing and implement credit-building programs such as rent reporting to increase homeownership readiness for LMI households. Building on these programs and others like them would go a long way to reduce not only economic inequality, but also health disparities.

However, increasing homeownership is not a perfect solution to the problem of health and housing inequality. Homeownership itself is not without health risks, with the added burden of foreclosures and different financial stressors compared to renting. Owning a home also doesn’t inherently mean that you avoid unsafe housing conditions, and may in fact be a greater safety burden as you are responsible for keeping the home maintained rather than a property manager or landlord. The health benefits of homeownership may also not be evenly distributed across racial and ethnic groups. Programs looking to increase homeownership should take steps to minimize these negative effects and do so equitably to prevent unintended consequences.

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