As health care professionals, we understand that 90 percent of what keeps us all healthy happens outside the doctor’s office.
While 10 percent of health is influenced by clinical care, and another 10 percent by genetics, the remaining 80 percent is a result of physical environment, health behaviors, and socioeconomic factors like housing income, food insecurity, access to quality education and community safety.
Our collective missions extend beyond the traditional health care settings, and as key partners in the health care equation, we all understand that the impact of socioeconomic factors is what can make health thrive or wither. Of all these factors, housing is one of the best-researched; and having safe, affordable housing has been found to improve health outcomes, decrease health care costs, and positively add to the social characteristics of neighborhoods.
We know that stable housing promotes health. An extensive literature review summarized in a Health Affairs housing policy brief demonstrated clearly that being without a stable home is detrimental to one’s health. People who are chronically homeless face substantially higher morbidity in terms of both physical and mental health, as well as increased mortality. The trauma associated with unstable housing also has long-standing adverse impacts on psychological well-being. And just like COVID-19, housing challenges disproportionately impact Black, Indigenous and other people of color in our state. The history of housing access is very much the history of structural racism, as redlining, racist covenants, and other policies created tremendous racial inequities in housing. BIPOC households are more likely than white households to be low-income renters, and disproportionately struggle to pay rent compared to white households. When that struggle turns into homelessness and foreclosure, documented research from 25 studies shows that mental health and health behaviors, including substance abuse, and adverse outcomes such as depression, anxiety, increased alcohol use, psychological distress and suicide are the result.
There are markedly higher costs to health care systems when people do not have stable housing – costs that impact all our wallets. By providing access to stable housing, we would not only leverage better health outcomes, but also reduce health care costs. This is great news, as it means we as a state have the tools to positively impact health and health care costs through affordable housing investments and provisions. Indeed, a study of a population of nearly 10,000 people in Oregon with unstable housing found that after affordable housing provisions were put in place, it decreased Medicaid expenditures by 12 percent. At the same time, emergency department use – a huge driver of health care costs – declined by 18 percent. These results ring true here in Minnesota too. Every year, each of our health care systems have documented higher health care costs for people experiencing homelessness, who often use high-cost emergency systems as their primary care. Such instability and chaos of living without a home exacerbate mental health and substance use too. If we as a state implement reforms and investments to stabilizing housing such as rental and foreclosure assistance, we can bend the health care costs curve and improve those mental health outcomes. This will also reduce unnecessary and preventable costs by reducing avoidable institutionalization, inpatient hospitalizations, and incarceration.
We understand that improving health outcomes requires much more than a prescription or doctor visit. Just as we treat patients as whole people, with complex and connected needs, we know that treating a single ailment does not guarantee health by itself. Still, having the solid foundations of a stable home is critical to healthy patients and healthy families.
As a state we offer Medicaid and Medicare to all people who are eligible, which has worked to support better health outcomes for those who are unable to access other health care options. In contrast, only one out of every four eligible people receive assistance to access housing they can afford. We as a state must re-think how we invest in housing, by scaling investments to match the true demand and need for this fundamental human need. Right now, our under-funded housing systems create just a few hundred new homes each year that are affordable, but we actually need a few thousand new homes each year to meet the housing needs of families with very low incomes. Our housing systems are foundational to health outcomes, and our delivery of health care is compromised when our patients do not have stable, safe, affordable housing. The prescription for what ails our housing system is greater investment that will create more vibrant and healthy communities across Minnesota-and have a positive impact where health really happens.
Bukata Hayes is vice president of Racial & Health Equity, Blue Cross and Blue Shield of Minnesota, Dr. Rahshana Price-Isuk is the director of Clinical Services, NorthPoint Health & Wellness Center and Diane Tran, is system executive director of Community Health Equity & Engagement, M Health Fairview.