Housing and Health: You are where you live “a zip code is a stronger predictor of a person’s health than a genetic code” Housing Affordability Conference UNC Charlotte Center City April 5, 2017 Mark J. DeHaven, PhD Dean W. Colvard Distinguished Professor and Director Academy for Research on Community Health, Engagement and Services (ACHES) College of Health and Human Services University of North Carolina at Charlotte

What is health. Why do some people have more health than other people What is health? Why do some people have more health than other people? How does housing affect health? How can we improve health?

The Bottom Line About Health Health is a resource that allows us to live long and productive lives; two components: Wellbeing - the the condition or experience of optimal functioning in mind, body, and spirit Resilience – ability to function optimally in the face of changing circumstances by coping with the stressors we encounter in daily living

The Example of Life Expectancy Life expectancy at birth is an indicator of health; it refers to average number of years that an individual is expected to live depending on where they are born and spend their lives

True or False: Men born in suburban Maryland have a higher life expectancy than men born in Washington, D.C.? True How many years higher is the life expectancy of men born in suburban Maryland than men born in Washington, D.C? 0 – 3 years 4 – 6 years 7 – 9 years > 9 years Men born in Maryland live about 10 more years (81.6 versus 71.6)

Bethesda, Maryland

Washington, DC

Why do some people have more health than other people?

Causes of death Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: final data for 2002. National Vital Statistics Reports 2004; 53(5):1-116.

“Health is socially determined”

Rudolf Ludwig Karl Virchow (1821-1902) “The physician is the natural attorney for the poor.” Medicine should be reformed along the following lines: Social and economic conditions affect health and disease . . . Disease is due to poverty, unemployment, poor housing, malnutrition, under education, and poor access to care . . . Measures taken to promote health and to combat disease must be social as well as medical . . . (Virchow, The Medical Reform, 1848)

SES Causes of Death Galea S, et al. Estimated Deaths Attributable to Social Factors in the United States. 2012. American Journal of Public Health .

How Housing Affects Health Housing Affordability Neighborhood Conditions c Conditions Within the Home Health

How Housing Can Affect Health Conditions Within the Home Lead poisoning Impaired brain and nervous system development Lower intelligence and reading disabilities Substandard housing Respiratory conditions from water leaks, poor ventilation, and pest infestation Asthma is the most common chronic disease among children. Neighborhood Conditions Physical characteristics Physical inactivity - unsafe places due to crime, violence, or pollution) Diminished nutrition – limited access to grocery stores Social Isolation – limited contact with others Low income – few employment opportunities Housing Affordability Affordable housing Disproportionate spending on housing - > 30 percent of household income Forego basic needs - basic needs including nutrition and health care 71.2% of those in lowest income quartile spend > 30 percent on housing

Most serious health concern: There is a direct, measurable, and negative pathway between the conditions in which children live, grow, and learn; and their physical, social, cognitive, and emotional development.

Healthy Social, Emotional, and Cognitive Development

Poor Nutrition From No Grocery Stores and Disproportionate Spending on Housing

Stressful Social Conditions Associated with Poverty, Housing, and Neighborhood Conditions Can Produce Lifelong Health Consequences

Housing and Child Wellbeing* Poor Quality Household Chaos Overcrowding Mobility Homelessness Cognitive impairments Behavior problems Behavioral problems Lower reading and math scores Learned helplessness Respiratory and gastrointestinal problems Worse school performance Mental health problems Respiratory problems Worse adult mortality Cognitive delays *Marcal K and Fowler PJ. 2015. Center for Social Development Research Brief. Washington University in St. Louis.

Information versus Noise Disorder, Chaos, and Unstable Living Conditions Limit Children’s Resilience* (Aaron Antonovsky, 1979; Emmy Werner, 2005 ) Comprehensible Manageable Meaningful *Resilient individuals are able to cope well with changes to their world, they interpret events around them as information, that can be used to solve problems; when individuals are not resilient the events around them are only noise, not information, they are unable to cope with events, and they experience poor health as a result.

Improving the health-housing nexus in communities requires a place-based approach based on the social determinants of health!

UCity Family Zone

Thank you! Mark.DeHaven@UNCC.edu