Without Affordable, Accessible, and Adequate Housing, Health Has No Foundation

Centennial Issue
Health Equity Population Health

Policy Points:

  • Today’s housing disparities are rooted in the increasing commodification of housing that has taken precedence over the need for shelter, a basic human right.
  • With rising housing costs across the country, more residents are finding their monthly income going to rent, mortgage payments, property taxes, and utilities, leaving little for food and medication.
  • Housing is a determinant of health, and with increasing housing disparities, action must be taken to ensure no individual is displaced, communities remain intact, and cities continue to thrive.

Disparities in access to safe, adequate, and affordable housing contribute to health inequities worldwide. Today’s housing disparities are rooted in the increasing commodification of housing that has taken precedence over the need for shelter, a basic human right. In the United States, historical and contemporary policies have created and maintained racial, ethnic, gender, and other systemic disparities in opportunities to access economic resources and quality housing. A 2022 report by the National Association of Realtors showed that although homeownership rates in the United States increased by 1.3% in 2020, the highest annual rise recorded, homeownership rates for Black Americans (43.4%) remained lower than White Americans (72.1%).1

Such housing disparities can impact both the physical and mental well-being of populations. For example, mortgage foreclosures have been associated with worse mental health and physical symptoms like trouble sleeping, chest pain, and stomach cramps.2 Furthermore, the impacts of foreclosure go beyond individuals directly affected. Existing research demonstrates that those who resided in neighborhoods that experienced high foreclosure rates were more likely to seek treatment in hospitals and emergency rooms for various conditions including mental health, stroke, and heart attacks.3

The neighborhood environment beyond housing also impacts health. Public health research has provided strong evidence on the connection between a neighborhood’s social, economic, and physical environmental factors such as poverty, access to healthy food, and levels of crime to various mental and physical health outcomes, including anxiety, depression, heart disease, and stroke.4–7 However, much of this research has overlooked the potential role of housing in moderating the effect of neighborhood conditions on health. For example, retrofitting older houses in neighborhoods with greater exposure to air pollution could provide a level of protection against toxins through better air filtration systems.8 Also, the stress of being at risk for eviction may offset the health benefits of neighborhood amenities.

This Perspective demonstrates that housing insecurity—which encompasses the dimensions of housing unaffordability, inaccessibility, and inadequacy—is a major public health issue with strong ramifications affecting households, neighborhoods, and cities.9 Here, I examine each of these dimensions in relation to health and health inequities and discuss policies that have contributed to each dimension, and, in the face of glaring housing disparities in the United States and their effect on health inequities, I propose the important role of public health research to provide additional evidence to inform and advance policies designed to mitigate negative neighborhood impacts, housing disparities, and health inequities.

Open Access


  1. National Association of Realtors. A snapshot of race and home buying in America. https://www.nar.realtor/research-and-statistics/research-reports/a-snapshot-of-race-and-home-buying-in-america. Published 2022. Accessed May 12, 2022.
  2. Cannuscio CC, Alley DE, Pagán JA, et al. Housing strain, mortgage foreclosure, and health. Nurs Outlook. 2012;60(3):134-142.e1. https://doi.org/10.1016/j.outlook.2011.08.004.
  3. Currie J, Tekin E. Is there a link between foreclosure and health? National Bureau of Economic Research. Working paper 17310. https://doi.org/10.3386/w17310. Published August 2011. Accessed December 5, 2022.
  4. Barber S, Hickson DA, Wang X, Sims M, Nelson C, Diez-Roux AV. Neighborhood disadvantage, poor social conditions, and cardiovascular disease incidence among African American adults in the Jackson heart study. Am J Public Health. 2016;106(12):2219-2226. https://doi.org/10.2105/AJPH.2016.303471.
  5. Caughy MO, O’Campo PJ, Muntaner C. When being alone might be better: neighborhood poverty, social capital, and child mental health. Soc Sci Med. 2003;57(2):227-237. https://doi.org/10.1016/S0277-9536(02)00342-8.
  6. Masi CM, Hawkley LC, Piotrowski ZH, Pickett KE. Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population. Soc Sci Med. 2007;65(12):2440-2457. https://doi.org/10.1016/j.socscimed.2007.07.014.
  7. Stulberg EL, Twardzik E, Kim S, et al. Association of neighborhood socioeconomic status with outcomes in patients surviving stroke. Neurology. 2021;96(21):e2599-e2610. https://doi.org/10.1212/WNL.0000000000011988.
  8. Walzer D, Gordon T, Thorpe L, et al. Effects of home particulate air filtration on blood pressure. Hypertension. 2020;76(1):44-50. https://doi.org/10.1161/HYPERTENSIONAHA.119.14456.
  9. US Department of Housing and Urban Development (HUD). Measuring housing insecurity in the American Housing Survey. https://www.huduser.gov/portal/pdredge/pdr-edge-frmasst-sec-111918.html. Published 2018. Accessed May 13, 2022.

Mehdipanah R. Without Affordable, Accessible, and Adequate Housing, Health Has No Foundation. Milbank Q. 2023;101(S1): 419-443.