What is healthy housing?
Housing is at the heart of our ability to live healthy, dignified lives. It is where we spend the most significant amount of our time (Robinson & Godbey, 1997). Since 1957, scholarly research has supported the idea that where a person lives and how they feel about their shelter affects their overall health (Pond). Two definitions from the World Health Organization can help us understand better what is meant by the term “healthy housing.”
Health is defined as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief or economic and social condition” (1994).
Healthy housing is defined as “shelter that supports a state of complete physical, mental, and social well-being. Healthy housing provides a feeling of home, including a sense of belonging, security and privacy” (2018).
It doesn’t take a scientist to know that many in our community are far from enjoying a state of total wellbeing. At the time of the 2022 York County Community Health Needs Assessment, 46% of respondents reported experiencing at least one day in the previous month where their mental health was not good—a 6% increase from 2017; 45% reported experiencing at least one day where their physical health was not good.
Of course, people’s access, or lack thereof, to secure housing has a significant impact on health outcomes (Stahre, et al., 2015). However, having housing alone does not ensure residents will be able to achieve complete health, especially if that home fails to meet people’s basic needs for comfort. Attitudes toward one’s space, privacy, crowding, structural issues, and nonstructural issues, such as noise, improper insulation, and pests can all negatively impact residents’ individual and social health (Erman, 1996; Leventhal & Newman, 2010).
It is also important to note that the three areas–physical, mental, and community health–are all linked to one another (Breslow, 1972). Your mental health affects your physical health, affects community health, or any variation. While the state of an individual’s health may not be directly connected to their housing situation, research tells us that housing, and whether it itself is healthy, is a major determinant.
Physical Health
Physical health refers to the condition of one’s body, including the presence of “illness, injury or a health condition.” Your physical health can be impacted by many things, including genetics, diet, physical activity, and mental health, or how we think and feel (National Health Service, 2021).
Housing can have a direct effect on physical health when a dwelling’s infrastructure is not suitable for living. These conditions can include the presence of asbestos, mold, lead paint, inadequate temperature control, deteriorating infrastructure, or other hazardous deficiencies that put a person’s physical health in jeopardy.
Another instance of this is when a household lacks complete plumbing or kitchen appliances. In York County, there are a reported 528 households that lack complete kitchen facilities and 536 households that lack complete plumbing facilities (U.S. Census Bureau, 2020). These conditions have been associated with higher rates of cardiovascular disease, respiratory infections, and psychological distress (Braveman et al., 2011).
The location and cost of housing can also have negative physical health effects (Dunn, et al., 2004). Where housing is in relation to grocery stores and other food stores in addition to a household’s access, or lack thereof, to transportation can make people food insecure (Carter et al., 2013). Even with all other factors equal, high monthly housing costs can prevent households from having enough money to afford food, with people potentially resorting to sex work, theft, and selling drugs which can all jeopardize a person’s physical safety (Whittle, et al., 2015). People who are food insecure are more likely to experience asthma, tooth decay, diabetes, nutrient deficiency, and chronic disease (Gundersen & Ziliak, 2015).
The 2020 American Community Survey found that the average monthly rent in York City is $846 (U.S. Census Bureau, 2020). The same survey reports that 4,501 (45%) of York City renters and 1,315 (21%) of York City homeowners pay 35 percent or more of their annual income in rent alone. In addition to food insecurity, these households likely experience financial stress which can cause health conditions such as heart disease, diabetes, migraines, insomnia, anxiety, and depression (Sinclair & Cheung, 2016).
Mental Health
The CDC defines mental health to include our “emotional, psychological, and social well-being;” our mental health impacts “how we think, feel, and act” as well as determining “how we handle stress, relate to others, and make healthy choices” (2022).
In a review of the literature on the relationship between housing and mental health, Wells et al. (2003) identify four main housing characteristics that affect an individual’s mental wellbeing: 1) housing type 2) floor level 3) housing quality, type, and floor level with respect to children and 4) overall housing quality, including structural quality, maintenance, and dwelling upkeep. Their research finds that poorer quality housing in deteriorated neighborhoods are closely related to psychological symptoms in all age groups. Residents of single-family detached homes typically experience the most positive mental health, as their children have enough room to play and a consistent educational institution, they have more interaction with neighbors, and they usually own their homes (Wells et al., 2003).
Following national trends, York City has become a city of majority renters (U.S. Census Bureau, 2020). As of 2019, there are 10,106 rental units in the city, with that number showing an upwards trend for years to come (U.S. Census Bureau, 2020). Compared to homeowners, renters experience unique stressors due to their housing status such as unaffordable rent, neighbor noise annoyance, crowding, threats of eviction, and forced mobility (Booth, 2020; Jensen et al., 2019; Mueller & Tighe, 2007). These conditions cause higher instances of stress, anxiety, depression, and low self-esteem which makes individuals more prone to physical illness (Cook, 2020; Mueller & Tighe, 2007; Wells et al., 2003).
How residents feel about their homes and the neighborhood’s aesthetic characteristics also impact mental health. Mental wellbeing is higher in neighborhoods that have very good aesthetic characteristics and show signs of progress, such as new developments and art (Bond et al., 2012). People’s mental health is also greater when their homes have a very good external appearance and a functional and visually appealing front door; for renters, mental wellbeing is best when satisfaction with their landlords is high (Bond et al., 2012). Low-income neighborhoods that do not have aesthetically pleasing qualities cause negative mental health outcomes in residents (Bond et al., 2012; Wells et al., 2003).
Healthy housing also includes the need to feel completely safe from domestic abuse (Clough et al., 2014). Abuse includes physical, sexual, emotional, financial, and verbal abuse, all of which harm the physical and mental safety of the victim (Department of Social and Health Services, 2022). For victims of any form of abuse, having access to stable, affordable housing away from their abuser is absolutely necessary for their safety and recovery (Clough et al., 2014). If victims do not have the financial and social resources to escape their abusive situation, they risk continued mental distress, physical harm, or death (National Institute of Justice, 2000).
Where you live and the characteristics of your housing play a role in your overall wellbeing. When people experience home improvements that make their dwelling more suitable to live in (i.e. affordable monthly housing costs, complete kitchen and bathroom facilities, proper insulation, new front doors, etc), there are significant positive mental and physical health outcomes (Curl et al., 2014).
Social health
In general, social health has to do with an individual’s ability to form and maintain fulfilling interpersonal relationships within their community (University of Nebraska, 2022). Similarly, community health refers to “the health status of a defined group of people and the actions and conditions, both private and public, to promote, protect, and preserve their health” (Goodman et al., 2014).
We are part of a collective, and when one of us is unhealthy, the collective is unhealthy. Even if not directly impacted by inadequate housing conditions, it matters if your family, friends, or neighbors are. As civil rights and gender advocate Fannie Lou Hamer famously said in a 1971 speech, “Nobody’s free until everybody’s free.”
Access to quality housing has been very deliberately used as a tool of oppression to keep black and brown Americans impoverished and women subjugated to the home. (Taplin-Kaguru, 2021, Shlay, 2014). This structural violence can look like outright denying people from these groups housing; unequal access to financial resources such as loans, grants, and a livable wage; neglecting neighborhood improvements; and administering a disproportionately high number of citations and evictions in areas with a high population of black and brown residents and women-headed households (Milaney et al., 2019; Shobe & Narine, 2005; Shlay, 2014; Desmond, 2012).
In York’s recent history, there was a real concerted effort in our community to keep black and brown residents in areas of concentrated poverty. The 1969 York race revolts were a direct result of the social and economic conditions experienced black residents, specifically the state of black housing–a third of which was in severe disrepair at the time (Levy, 2018). Historian Peter Levy writes, “urban renewal left black residents fending for a declining stock of urban housing which they could afford and/or which realtors were willing to show them in the first place” (2018, p.232).
As of 2019, there are 6,277 women-headed households with no partner present, which is 39 percent of all households in York City (U.S. Census Bureau). The gender wage gap in York has women, on average, earning $7,785 less annually than men, with the greatest gap being $10,196 between women and men with less than a high school education (U.S. Census Bureau, 2019). Further, black, women-headed households are evicted at a higher rate than any other demographic (Desmond, 2012). As a result, women–especially women of color–are more likely to experience poverty and housing insecurity (Desmond, 2012).
These barriers in addition to the deficit of affordable housing units make it difficult for a great number of local residents to find housing options that both meet their needs and are within budget. In the York-Hanover region as of 2018, there is a -7,321 deficit of affordable and available rental units for residents making less than or equal to 30% of the region’s median family income (MFI) of $65,239 (Federal Reserve Bank of Philadelphia, 2018; U.S. Census Bureau, 2018). For those making less than or equal to 50% of the region’s MFI, there is a -6,096 affordable rental housing deficit (Federal Reserve Bank of Philadelphia, 2018).
Our entire community suffers when our neighbors do not have access to the means to secure healthy housing. York City has the highest poverty rate relative to the surrounding suburbs (Rusk, 2019). The local poverty rate is 27.7 percent, with nine critical mass neighborhoods experiencing the bulk of concentration effects (U.S. Census Bureau, 2020; Rusk, 2019).
A family living in an area of concentrated poverty may experience social isolation, teen pregnancy, school dropouts, welfare dependency, drug abuse, or family breakdown–all of which inevitably impact you and your family (Schill & Wachter, 1995; Rusk, 2019).
It is likely that on a daily basis, you or your children interact with people experiencing housing insecurity. It is in our collective interest to help the most vulnerable in our community secure housing that meets their basic emotional, physical, and social needs.
Policy Considerations for York
York is lucky to have many organizations and advocates solely devoted to solving the local housing crisis and revitalizing neighborhoods. The York College of Pennsylvania’s Urban Collaborative Initiative seeks to “produce research on removing systemic barriers that impede access to safe, stable, vibrant homes and neighborhoods” in York City by working with these organizations and developing plans and policies that work for our community’s specific problems.
The service providers in our community experience what is commonly referred to as “siloing” which is when there is a breakdown of information exchange between organizations with similar missions (Pettit, et al., 2019). This phenomenon isolates actors who would otherwise benefit from data-sharing and resource exchange, potentially leading to duplicate programs or gaps in service (Pettit, et al., 2019). Solutions to the healthy housing crisis must involve breaking down these silos and collaborating to implement policies that improve supply, stability, and affordability–and action must be taken now (Phillips, 2020). As housing policy scholar Shane Phillips says, “The more unaffordable your housing stock gets, the more challenging it is to fix” (2020, p. 34).
First, it’s important that organizations are operating with a universally agreed upon definition of healthy housing so there’s a shared sense of purpose and aligned goals (Phillips, 2020). Additionally, knowing the various resources, strengths, and weaknesses between organizations can help fill service gaps and work together to drive the most fitting policy choices for our community.
It is also necessary that housing actors come from or seek input from groups who have been the greatest victims of segregation, discrimination, gentrification, and community disinvestment–namely “women; people of color; indiginous communities; people with disabilities; individuals from lower socio-economic classes and from LGBTQ communities” (Phillips, 2020, p. 41). Deliberate government actions and policies have denied and continue to deny these marginalized groups in America opportunities for homeownership and generational wealth building (Taplin-Kaguru, 2021). Acknowledging these injustices is the only way to craft policy that provides redress for these historical wrongs.
With these parameters in mind, we recommend the following policies that could be locally implemented along with the problem they address and additional information to learn more.
| Problem | Policy or Program Recommendation | Learn More |
| Lack of green spaces and/or aesthetically pleasing qualities in neighborhoods. | Just Green Enough Neighborhoods are a way to beautify areas while avoiding gentrification. This approach favors small-scale environmental changes such as community gardens or environmental clean up. For bigger projects, local input is centered to protect local culture and address resident concerns. | Greenpoint, Brooklyn, NY
Just Green Enough: Planning Tools for Creating Equitable Green Space |
| Discriminatory evictions against women and people of color.
Cyclical poverty caused by forced displacement. |
Just-Cause Eviction Laws outline specified reasons for which landlords can evict tenants, which can include non-payment of rent, violation of lease terms, and more. Landlords must file this eviction with local courts and get approved before moving forward. This policy is effective in decreasing the number of evictions in an area. | Just Cause Eviction Policy Guide
Seattle Just Cause Eviction Ordinance
|
| Aging infrastructure causing dilapidated housing
Redlining and predatory banking |
Reparations Programs seek to address discriminatory housing practices that have targeted black residents. Governments can offer residents direct payments for homeownership assistance (like in Evanston, IL) or mandate public funding investments to increase access to affordable housing (like in Asheville, NC). | A Guide to the Reparations Movement
The Beginning of Housing Reparations
|
| Affordable housing deficit
Rental cost burdens
Vacant and blighted properties |
Naturally Occurring Affordable Housing (NOAH) are affordable residential rental properties unsubsidized by federal programs that keep rental rates at around 50% of an Area’s Median Income. Governments can use public and private funds to acquire properties to develop and preserve as NOAHs themselves or to offer loans to private developers to do the same. | Available Funds for NOAH Properties
Affordable Housing is Hiding in Plain Sight
|
Conclusion
When safe, healthy housing–one of our most basic needs–is threatened, it is difficult if not impossible to experience a healthy life. As many of us know, the housing crisis is right here in York, with more and more of our neighbors getting priced out of liveable conditions. Moldy walls, sleeping on couches, not buying groceries this month to pay for rent–this is the reality for more people in our community than could ever be justifiable. Just because it’s not happening to you does not mean you shouldn’t care. When one of us suffers, we all suffer.
Public policies about housing must be informed with the reality of people’s situations. The truth is that most of those with any kind of authority to legislate this issue have no experience being housing insecure and certainly do not have the social connections required to learn just how abhorrent York City’s living conditions can be. Maybe it’s willful ignorance, but it’s ignorance either way–and it’s killing people.
Our policy recommendations are not exhaustive and must be designed to work together. If you are in a position where you can advocate for these housing policies at the municipal level, we encourage you to do so. Housing and its nuances ought to be at the forefront of conversations about issues in York City. The Affordable City by urban planner and policy expert Shane Phillips is a great starting point to learn more about potential policy solutions for York.
If you would like to discuss the contents of this paper or how you can be involved in our research, please email Ashley Hines, Scholar-In-Residence, at ahines3@ycp.edu or Jada Richardson, Director of the Urban Collaborative, at jrichar8@ycp.edu. To learn more about the Urban Collaborative and our research projects, visit our website at www.urbancollaborative.ycp.edu.
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