Back to Evidence & Resource Library

Investing in housing for health improves both mission and margin

M. Sandel, M. Desmond
JAMA

Medical researchers and clinicians are increasingly recognizing the importance of the social determinants of health, which include stable, decent, affordable housing. Housing problems have been associated with a wide array of health complications, including lead exposure and toxic effects, asthma, and depression. In the United Kingdom, a study of more than 4000 adults found that childhood housing conditions, such as poor ventilation, were associated with an increased risk of mortality. In the United States, data from the Third National Health and Nutrition Examination Survey estimated that 40% of asthma cases in children were related to the children’s home environment. Moreover, the lack of stable housing compromises the ability of clinicians to treat low-income patients with medical complexity, not only because eviction and residential insecurity thwart treatments and continuous care but also because families are often forced to choose between medication costs or rent.

Acute residential insecurity among low-income households contributes to making the US health care system both ineffective and inefficient. The top 5% of hospital users—overwhelmingly poor and housing insecure—are estimated to consume 50% of health care costs. Patients living in poverty in the United States are often the most expensive to treat, in part because of their lack of a stable home. If nothing changes, many individuals with unstable housing will continue to develop difficult-to-treat illnesses and will continue to account for substantial health care costs.

Sandel M, Desmond M. Investing in housing for health improves both mission and margin. JAMA. 2017;318(23):2291-2292. PMID: 29090312. DOI: 10.1001/jama.2017.15771.

View the Resource
Publication year
Resource type
Commentaries & Blogs
Social Determinant of Health
Housing Quality
Housing Stability