By: Marcus Smith

Used by physicians in a clinical setting, prescriptions help patients access the pharmaceuticals they need to make them feel better.

However, in the ongoing conversation regarding children’s health and development, an important concept is often overlooked. That is the evidence-based concept that non-clinical interventions can be just as, if not more, effective compared to clinical care as a prescription for healthier outcomes.

Promoting healthy housing is one of those interventions.

As the senior manager of Connecticut Children’s Healthy Homes Program, I was honored to invite Megan Sandel, MD, MPH to deliver Connecticut Children’s Office for Community Child Health’s Pediatric Grand Rounds session. Dr. Sandel is a pediatrician at Boston Medical Center and serves as one of the nation’s leading advocates for healthy housing.

During her presentation, Dr. Sandel stated, “How we make sure everyone has a stable affordable home as a prescription for good health is going to be our challenge for this generation.”

Megan Sandel, MD, MPH

Dr. Sandel discussed the following four dimensions of how housing impacts health and highlighted how partnerships with community organizations can impact the problem.

Housing Quality
An abundance of research exists to support a link between poor housing quality and poor health and development outcomes. Dr. Sandel mentioned examples of children who either develop asthma or allergies, or have their symptoms worsen due to living with mold, moisture, pests, and tobacco smoke. Indeed, over 40 percent of asthma cases among children are caused by their housing conditions. She also talked about those who are injured due to exposed wiring and needed repairs, as well as those who experience developmental delays as a result of lead exposure. Studies show that even low amounts of lead can cause permanent brain damage and lower IQ levels, which has been shown to impact long-term earning power and reliance on support services such as special education.

Housing Stability
Dr. Sandel likened housing stability to an iceberg, noting how society focuses a lot of resources on homelessness, which is the part of the iceberg that is visible, but that other hidden causes of housing instability lurk below the surface, such as housing insecurity in which families make frequent moves or live in overcrowded settings. Multiple moves in a relatively short time frame can have the same effect on maternal mental health as being homeless. Children in these homes are 20 percent more likely to be hospitalized and 25 percent more likely to demonstrate developmental delays. It’s not enough to have a roof over one’s head; housing must also be safe and secure to allow for children and families to thrive.

Housing Affordability
Dr. Sandel noted that housing instability often results from a lack of affordable housing. Too often families are forced to pay a disproportionate amount of their incomes on housing, leaving little money for other essentials such as food and medicine. Additional housing-related costs, such as electricity and heating, only exacerbate this burden. Commonly referred to as the “heat or eat” paradox, many families are forced to compromise their health and well-being in order to keep the lights on. A recent report from the U.S. Energy Information Administration revealed that one in five households reduce or forego necessities such as food or medicine in order to pay energy bills. This sacrifice is intensely felt in Connecticut, which has the highest residential electricity rate in the continental U.S.

Dr. Sandel pointed to housing subsidies as a possible resource that could address this widespread issue. Only one in four households that qualify for housing subsidies actually receives it. Having this support can make the difference in providing proper nutrition for children. One study found that children of families battling food insecurity while living in unsubsidized housing are twice as likely to be underweight than families living in subsidized housing.

Housing Location
Dr. Sandel highlighted neighborhood mapping studies that linked poorer health risks and outcomes to specific neighborhoods with high concentrations of poverty and low opportunities for residents. She noted how such studies support neighborhood interventions as a way of lifting children out of poverty.

Strategies and Partnerships to Create Housing Stability
Dr. Sandel spoke of the need to create partnerships to build housing stability. Boston Medical Center recently invested $6.5 million to support a variety of affordable housing initiatives targeting the city’s most underserved neighborhoods. Such initiatives include providing a no-interest loan and operating subsidy for a new supermarket and launching a housing stability fund to help families avoid eviction.

She encouraged other hospitals to engage in similar partnerships to address housing instability to enhance patient outcomes and reduce healthcare expenses.

At Connecticut Children’s Healthy Homes Program, we are committed to helping low-income households across the state address the lead, allergy triggers and safety concerns that cause poorer health and developmental outcomes.

While we have made great advances in this field, we recognize that there is far more to be done.

We look forward to learning more about the impact Boston Medical Center’s investment into healthy housing has on improving the health of children and families, and reducing health care costs. We are thankful for advocates like Dr. Sandel who are paving the way toward healthier communities by recognizing the need and writing prescriptions for healthy housing.

Read additional blogs on healthy housing here.

Marcus Smith is the senior manager of Connecticut Children’s Healthy Homes Program, which is a program of Connecticut Children’s Office for Community Child Health.

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