Early in my public health career, I spent two years working in the community of Commerce City as an employee of Salud Family Health Centers. I spent most of my days going door to door talking to recent immigrants about their health and the neighborhood. Hundreds of community members invited me and my partners from Cultivando and CREA Results into their homes to talk in-depth about their housing conditions and how those impacted the health of their families. During the countless hours talking with these families, two strong, yet conflicting, narratives arose.
Many homes were filled with a deep sense of love and extended familial ties. Hardworking parents expressed pride in their jobs and involvement in their new found community and beamed when their kids bounced across the room. At the same time, it quickly became clear that these families were being failed by an unjust system and society that—due to issues like predatory landlords, lax housing policies that limited protections for renters, and fear due to immigration status—forced most of them to live in homes with unhealthy living conditions. After surveying and inspecting over 450 homes the data was clear: a full two-thirds of homes had at least one environmental hazard like mold or pests that could directly, negatively impact the health of its residents. Poor health outcomes due to these conditions were prevalent.
Although most of the debate around health in our country is still focused on improving the health care system, the things that make us healthy are largely not related to accessing health care services. Although the connection between healthy housing and health is intuitive, it can be challenging for health care leaders and advocates to know where to engage in housing interventions and advocacy. Luckily, new frameworks are being developed that can help us understand where to plug in, including a framework published recently that describes these four pathways connecting housing and health:
- Stability: Securing and keeping housing is essential to good health. Lack of stable housing leads to poor health and higher health care costs.
- Safety and Quality: Substandard housing conditions, like presence of allergens, lack of ventilation, or extreme temperatures, can lead to acute and chronic health challenges for residents.
- Affordability: Lack of affordable housing can lead to displacement and significant pressure on other essential needs, like food and health care.
- Neighborhood: Physical and social characteristics of the neighborhood surrounding a home, like crime, parks, and types of businesses, influence a person’s access to things that promote or inhibit health.
Unfortunately, even 10 years after the data from our study was published, many of Colorado’s laws don’t help people live in homes that are healthy and affordable. Hopefully, that will begin to change in 2019. The 2019 Legislative Session has been a busy year for bills that will help keep residents in their homes and improve the condition of their homes. Center for Health Progress has testified in support of three such bills at the Capitol in the past few weeks. Two of these bills, HB19-1118—which increases the time renters have to resolve issues before being evicted—and SB19-180—which creates an eviction legal defense fund—help create more housing stability for renters in Colorado. The third, HB19-1170, gives renters a better shot at maintaining a safe and healthy home. We’ve also supported further upstream efforts that address affordability and neighborhood improvements, including examples where the health care system has been directly involved in these efforts.
If we’re to create a healthy and equitable Colorado, we need to think about health as more than health care. Housing is an easy and clear way to move our health interventions and advocacy upstream. If the health care system used more of its significant political capital and resources to engage in policy changes that promote stable, safe, high-quality, and affordable housing, I’m certain we’d get closer to a Colorado where all people—especially those the system is working against, like the immigrants I met in Commerce City—have a fair opportunity to be as healthy as they can be.