Housing has a significant and sustained impact on people’s health, perhaps just as much impact as policies or programs that focus on promoting “healthy living” (e.g. healthy eating, physical activity)1. Variations in health status among population groups (health inequities) remind us that health and well-being have complex causes.2 Effectively incorporating health and well-being into housing helps communities to develop resilience and support residents that most need help.3
From a community perspective, meeting housing needs is not only a human rights issue, but also a cost issue. People who are socio-economically disadvantaged tend to have unmet housing needs, and the individual price they pay is higher mortality rates, poor health, and being at risk for serious chronic illnesses.4 The social cost of not meeting housing needs is also high, and includes paying for resulting cumulative costs of health care, services, and institutional care.5
Governments have a responsibility to provide citizens with the building blocks of health.6 Local government leadership, policies, and actions are key to meeting residents’ housing needs, and thereby positively influencing health outcomes by:
- encouraging design, construction, and maintenance of healthy homes across the housing continuum
- working with other agencies to create housing that meets residents’ varied affordability criteria and special needs
- developing a healthy community context for housing
Image of housing continuum, page 3 table 2
What is this issue about?
Internal housing environments are not always healthy
In some cases, housing worsens health, usually for residents with the fewest financial resources to deal with the problems. Serious and debilitating health conditions can result from exposure to housing hazards, and existing chronic conditions tend to worsen.
Examples of problematic housing conditions include poor quality and lack of upkeep, radon, mould, lead, bugs and rodents, heating and cooling problems, pollution from transportation emissions (in very busy traffic areas), and crowding in housing due to lack of affordability.
Complex housing needs
Housing insecurity can be linked to income insecurity, which in turn can lead to illness and premature death.7
- Households that spend more than 30% of their income on housing are described by Canadian Mortgage and Housing Corporation as those in “core housing need.” Demand for households who struggle to afford market rents is projected to increase by 43% in the next 10 years in B.C.
- Many B.C. communities have an inadequate and stagnant (not increasing) supply of affordable rental housing to meet community residents’ needs. A combination of factors are contributing to a housing affordability crisis: international market factors, sharp increases in land and construction costs, a lack of rental housing supply, and a high proportion of low income jobs.8
- Any given community’s housing needs are complex. In addition to the need for affordable housing, additional housing needs include an increasing supply of housing that is accessible and adaptable.
- The proportion of the population with physical disabilities in B.C. is currently 16%9 and will increase dramatically as our population ages.
- Specific types of housing and connected services are needed for people with mental health conditions and substance use problems.
Supportive housing: social housing that provides tenants with on-site or closely linked medical, mental health, and substance abuse services.
Supported housing: a person lives independently, and service providers visit as needed.
Research shows that supportive and supported housing can lead to fewer hospitalizations and less time spent in jail among homeless people with severe mental health issues. The resulting cost savings in these areas significantly offset the cost of the programs.
Community characteristics – mix of housing
In communities that integrate housing types throughout, there is a good opportunity for residents to access services and opportunities. If housing is not well integrated in the community, people with lower incomes often end up living in areas of the community with reduced access to transportation, community services, and amenities. Ironically, these are often the same lower income and more vulnerable populations who would have the most benefits to gain from accessing these “public goods” in terms of their health and social outcomes.10
Why is healthy housing important for health and well-being of communities
Housing conditions and contaminants
- Substandard housing is a big health risk for lower-income households (e.g. lead, mould, mites, and allergens are found in housing that is in poor condition). 40% of children’s asthma is attributed to indoor exposures11 and children who live in low-quality housing conditions have a greater likelihood of poor health outcomes in both childhood and as adults.12
- Issues related to maintenance and poor design can cause critical injuries and death (e.g. fire hazards, poor ventilation, unsafe conditions that do not meet building code requirements).13
- In northern areas, radon (a colourless, odourless radioactive gas) is naturally occurring in many northern soils and has the ability to build up in homes. Radon is the second leading cause of lung cancer, killing about 2,000 people in Canada every year.14
Accessible / adaptable homes
Accessible interior features are requirements for people with a disability and limited mobility, but the housing context for access to the community are also key *e.g. near transit, social services, groceries, accessible recreation, medical services). Due to a lack of housing supply and affordability, people with disabilities on limited incomes (50% of people with disabilities are not employed15) often have to live in places that do not meet their needs, putting them at risk of injury and declining health. It is not unusual for people with disabilities to move to new areas and communities to seize accessible housing opportunities that arise. Unfortunately, relocation can result in losing important social and employment connections, which are also essential to well-being and health.
Affordable housing and homelessness
A combination of low (or even middle) income and high rent makes it difficult to afford basic sustaining health needs: securing a roof over your head, eating food that nourishes you, not to mention accessing health services, and participating in health-promoting community activities. A lack of suitable and affordable housing has a ripple effect on health; for example, families may “double up” and crowd into housing causing psychological distress, helplessness, and higher blood pressure.16
Presentation by Michael Shapcott
"My Home My Health - the View from the Mountaintop"
Housing provides a platform for stability, heath, and accessing care. For example, homeless patients in particular may have difficulty properly storing medication, maintaining a recommended diet and going to follow-up appointments when faced with urgent competing demands, such as finding a place to stay for the night.17 In addition, homeless people are 8 to 10 times more likely to die prematurely than the general population.18
Why does healthy housing matter for local governments?
- The BC Local Government Act outlines municipalities’ responsibility to plan housing (location, type, density) that meets the community’s needs over at least five years. The legislation also requires local governments to plan for particular housing that meets special needs for affordability, special needs, and rental housing.
- A healthy balance of housing (including a diversity of forms, densities, and tenures) is a key component of a healthy and resilient local economy, and an attractant to new progressive firms and investors, and skilled workers to come to the community.19
- There is a market demand for healthy housing, according to a recent B.C. and Ontario study. In particular, homes with healthy design, and homes located in walkable communities are in demand 20 (for more information see Active Transportation and Community Design).