Housing creates health

Health is determined by many factors. People tend to be healthier when they have economic stability, live in quality housing and have access to public space and safe, connected communities. In 2020, the NYC Health Department held a series of community conversations with residents and local stakeholders across 26 neighborhoods. New Yorkers shared personal stories about their priorities for building healthier neighborhoods, healthier childhoods and more. This is one part of a three-part series on how housing, economic stability and public space create health.

Affordable, good quality, stable housing supports health. Living without access to these resources can create poor health that worsens over time. Living in low quality housing as a child also poses particular health risks.

People living in higher-poverty neighborhoods are more likely to experience negative health effects of poor housing. People of color disproportionately experience housing injustices as a result of policies like redlining and blockbusting that are examples of systemic racism.

Housing affordability: lack of affordable housing forces difficult choices between essentials.

Across New York, half of all households are rent-burdened, meaning that more than 30% of their household income goes to rent. Spending so much on rent can leave too little money for food and other essentials. Learn more about the health implications of experiencing rent burden in “How economic stability creates health.”

A person who has a high rent burden is often confronting other housing challenges as well, like overcrowding (defined as more than one person per room). Overcrowding occurs much more often in high-poverty areas, and can have many negative effects, including facilitating spread of disease and making it difficult for children to find a quiet place to study.

Housing quality: Over half of renter-occupied homes in NYC have health-related maintenance problems.

When housing is unaffordable, options become limited, and people often end up in lower-quality housing with maintenance deficiencies that can cause or worsen health conditions.

Homes that are not properly maintained can undermine health, including because they may have:

• Lead paint hazards, which can cause behavioral and brain problems in children. Lead exposure can also cause increased blood pressure, kidney and brain problems, infertility and impotence in adults.

• Pests, like cockroaches and mice, which can make food unclean and contribute to the worsening of asthma and its symptoms.

• Lack of heat, which can cause a dangerously low body temperature and worsen heart disease and other medical problems.

Home maintenance issues are more common in high-poverty neighborhoods and in public housing than in wealthier neighborhoods or privately-owned apartments.

The consequences of these deficiencies can be dangerous. For example, people whose homes lack adequate heating might use space heaters, which are a fire risk. In January 2022, a malfunctioning space heater sparked a fire that killed 17 people in a high-rise building in the Bronx.

Affordability and barriers to cooling can also result in consequences to health. Lack of air conditioning can result in heat stress during warmer weather and periods of extreme heat, making existing health conditions worse and, in extreme cases, resulting in hospitalization and even death.

Housing instability: when people’s living situations become unstable their mental and physical health is at stake.

A lack of affordable housing often leads to housing instability. Most evictions occur because the tenant can’t pay rent, and can result in frequent moves and homelessness, both of which threaten health in the short term and over time. New Yorkers living in high-poverty neighborhoods experience eviction at more than four times the rate of those living in low-poverty neighborhoods.

Eviction is associated with many poor health outcomes. These include babies that are born too small or early, and a higher rate of infant death. Adults who have been evicted have worse physical and mental health, go to the emergency department more often, and are more likely to die by suicide.

A person facing even the possibility of eviction is more likely to report poor health, including high blood pressure, depression, anxiety, and psychological distress.

When COVID-19 hit, New York City paused evictions, recognizing the twin threats of serious financial hardship and health risks created and made worse through experiencing homelessness. This was an effort to keep people housed — but also to keep people out of shelters, where the spread of COVID was hard to contain.

When the eviction pause ended in 2021, homelessness in NYC began to rise at a staggering rate, with Black and Latino residents affected more than other racial groups. This happened amid a backdrop of steadily increasing rates of homelessness over the past two decades, with roots that extend beyond the pandemic.

Implementing programs that incorporate similar strategies coupled with expanding housing options could help reduce homelessness now and in the future.

The NYC Health Department has a supportive housing program offering 11,200 permanent, affordable housing units for people with substance use or mental health diagnoses who are at risk of homelessness. Supportive housing is also available for people who have been homeless for extended periods of time and includes those coming from street outreach and shelters, foster care, the legal system, and more. In addition to a roof, supportive housing offers tenants assistance in getting jobs, reuniting with families, and getting treatment and support. The City also offers public housing, which houses more than 400,000 low-income New Yorkers—1 in every 11 renters—in over 174,000 public housing units.

High-quality, affordable and stable housing is essential to public health.

Effective policy must take into consideration how individual needs are shaped by their experience and can also change at every stage of life. Accessibility and support for older adults should be part of housing discussions too. The NYC Department of Housing Preservation and Development undertook the Where We Live (WWL) project to hear from residents, government, and community leaders about their experiences with housing access, accessibility, and discrimination. WWL initiatives draw on this feedback to prioritize the equitable expansion of housing opportunities in neighborhoods harmed by structural racism.

Also, individuals can call 311 to report health and safety hazards and problems that landlords must legally address.

In summary, when housing is…

• Safe and comfortable

• Affordable and stable

• High-quality

…it supports mental, physical, and emotional health.

To hear more from New Yorkers about how they view housing and health, listen to recordings from the community conversations: