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INTRODUCTION

Beyond providing basic shelter, the home often comprises the center of people’s daily life, a place where people share meals, spend large amounts of time, and engage with family. It may be a place of safety and security or one riddled with precarity and stress. The link between public health and housing is multifaceted. A clean, safe, and decent home is important for individual, family, and community health. Historically, the housing-health connection has focused primarily on homelessness and physical exposures; however, emerging research suggests that the housing-health relationship transcends beyond these two categories. Health is also associated with rental assistance status, housing insecurity, a lack of affordable housing, and neighborhood quality.

Over the past decades, housing has been increasingly recognized as a critical social determinant of health and there have been growing attempts to promote the concept of “housing as a vaccine.”1–4 In this chapter, we discuss the connection between housing and health in four sections:

  1. Homelessness;

  2. Physical exposures in housing units;

  3. Housing affordability and security; and

  4. Neighborhood context.

For each section, we describe the scope of the issue, review evidence linking the factor and health, and discuss potential public health and policy solutions to addressing the different exposures. This chapter focuses on established housing-health research. However, it is important to note that some known and emerging issues, such as housing destruction due to natural or man-made causes, housing for certain populations (including disabled populations), and specific health issues related to housing structure type (e.g., high-rise apartments and mobile homes) are not covered in this chapter.

HOMELESSNESS AND HEALTH

Scope: Homelessness

Homelessness can be defined as a state in which a person, family, or household lacks a home, and includes individuals “without permanent housing who may live on the streets; [i]ndividuals who stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; [a]nd, individuals in any other unstable or nonpermanent situation.”5 Many definitions of homelessness also include “doubling up,” a term used to define circumstances when an individual is forced to stay with friends or family due to an inability to pay for one’s own housing unit. When persons who are released from prisons, hospitals, or other institutional do not have a stable housing situation to which they can return, this can also be considered a form of homelessness.6

Research on the dynamics of how individuals experiencing homelessness interface with the homeless assistance system reveal a typology of homeless households based on the duration of their homelessness experience. Homeless individuals and families may be categorized as chronically homeless, indicating that they have been homeless for a year or longer; episodically homeless, indicating that they cycle in and out of homelessness; or, transitionally homeless, defined by those who experience homelessness for only a brief period of time (typically less than a ...

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