1. 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

2. 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?

3. 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

4. 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

7. 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)

8. Bethesda, Maryland

9. Washington, DC

10. Why do some people have more health than other people?

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

12. “Health is socially determined”

13. 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)

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

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

16. 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

17. 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.

18. Healthy Social, Emotional, and Cognitive Development

19. Poor Nutrition From No Grocery Stores and
Disproportionate Spending on Housing

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

21. 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 Center for Social Development Research Brief. Washington University in St. Louis.

22. 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.

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

24. UCity Family Zone

26. Thank you!