Severe Housing Problems - Age 62+ in New Hampshire

New Hampshire

Housing and neighborhood environment are social determinants of health that influence health inequities. Older adults, who often have preexisting health conditions and spend a great deal of time at home, are the most vulnerable to the effects of poor housing. Poor housing quality may cause injury or disease, and other housing-related factors such as neighborhood environment and overcrowding can negatively affect mental and physical health.

Lead paint, allergens, water leaks, poor ventilation and inadequate heating, cooling and plumbing are all home health hazards and can lead to poor respiratory health and disease and increase the risk of cardiovascular conditions. Overcrowding, defined as having more than one person per room in a residence, is associated with tuberculosis and other infectious diseases, as well as mental and emotional distress among both adults and children. 

Housing costs and affordability among older adults are of particular concern. Cost-burdened households may have difficulty affording other basic needs such as health care, food and heat.

Populations at greater risk of experiencing severe housing problems include:

• Low-income families and individuals.
• Racial and ethnic minorities. 

Older adults who rent are more likely to be cost-burdened than those who own their homes, which may also put them at higher risk for severe housing problems.

Evidence supports various interventions to prevent and minimize the impact of housing problems on health. Healthy Homes programs at state and local levels have improved health by remedying hazardous housing conditions such as lead exposure, inadequate ventilation and excess moisture.

Increasing affordable housing options through local and national housing development policies, rental vouchers and subsidized housing programs can help cost-burdened individuals afford housing and achieve better health. More collaboration between the housing and public health sectors is needed to promote healthy home environments and better integrate health care into housing regulation and development, particularly for those with complex health needs. County Health Rankings & Roadmaps has several strategies that have been found to improve housing quality, including healthy home environment assessments and housing rehabilitation loan and grant programs. The National Low Income Housing Coalition offers additional advocacy resources and policy priorities related to housing challenges.

Healthy People 2030 has multiple goals related to housing, including:

• Reducing the proportion of families who spend more than 30% of their income on housing. 
• Increasing the number of states and territories that prohibit smoking in multiunit housing.

Braveman, Paula, Mercedes Dekker, Susan Egerter, Tabashir Sadegh-Nobari, and Craig Pollack. “Housing and Health.” Issue Brief #7: Exploring the Social Determinants of Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, May 2011. https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html.

Donald, Ian P. “Housing and Health Care for Older People.” Age and Ageing 38, no. 4 (July 1, 2009): 364–67. https://doi.org/10.1093/ageing/afp060.

Gibson, Marcia, Mark Petticrew, Clare Bambra, Amanda J. Sowden, Kath E. Wright, and Margaret Whitehead. “Housing and Health Inequalities: A Synthesis of Systematic Reviews of Interventions Aimed at Different Pathways Linking Housing and Health.” Health & Place 17, no. 1 (January 2011): 175–84. https://doi.org/10.1016/j.healthplace.2010.09.011.

Marcia Fernald, ed. “Housing America’s Older Adults 2019.” Cambridge, MA: Joint Center for Housing Studies of Harvard University, 2019. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_Housing_Americas_Older_Adults_2019.pdf.

Marcia Fernald, ed. “The State of the Nation’s Housing 2022.” Cambridge, MA: Joint Center for Housing Studies of Harvard University, 2022. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_State_Nations_Housing_2022.pdf.

Pollack, Craig, Susan Egerter, Tabashir Sadegh-Nobari, Mercedes Dekker, and Paula Braveman. “Where We Live Matters for Our Health: The Links Between Housing and Health.” Issue Brief 2: Housing and Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, September 2008. http://www.commissiononhealth.org/PDF/e6244e9e-f630-4285-9ad7-16016dd7e493/Issue Brief 2 Sept 08 - Housing and Health.pdf.

Sandel, Megan, and Matthew Desmond. “Investing in Housing for Health Improves Both Mission and Margin.” JAMA 318, no. 23 (December 19, 2017): 2291–92. https://doi.org/10.1001/jama.2017.15771.

Swope, Carolyn B., and Diana Hernández. “Housing as a Determinant of Health Equity: A Conceptual Model.” Social Science & Medicine 243 (December 2019): 112571. https://doi.org/10.1016/j.socscimed.2019.112571.

U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Promote Healthy Homes. The Surgeon General’s Call to Action to Promote Healthy Homes. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2009. https://www.ncbi.nlm.nih.gov/books/NBK44199/.