Elisabeth Haub Law School of Law
Pace University
Land Use Law Center
Supervisor: John R. Nolon, Distinguished Professor
Blog No. 20 of the Land Use, Human Health, and Equity Project
Editor: Brooke Mercaldi
Contributing Author: Colt Watkiss [*]

Housing, a Crucial Determinant of Health


Housing insecurity is a pandemic plaguing America. Although no uniform definition for housing insecurity exists, the U.S. Department of Housing and Urban Development (HUD) defines affordable housing as spending less than 30% of one’s income on housing while spending above 30% is considered cost burdened, and spending above 50% is considered severely cost burdened. An estimated 29.8% of households in the U.S. are cost burdened, equaling over 36 million households, and the affordability crisis is worsening. One report found median home sales prices increased 28% between December 2016 and December 2020, 10% just between December 2019 and December 2020. Meanwhile, the number of existing homes on the market fell from 1.46 million in February 2020 to 1.03 million in February 2021. Vacancy rates for moderate- and low-income rentals are also low while roughly 46% of renters were cost burdened and 24% were severely cost burdened as of 2019. The supply shortage is the consequence of decades of slow housing development. 2010-2019 saw the fewest houses built of any decade in the United States since the 1960s. Freddie Mac estimates that housing supply is 3.8 million units short of meeting long-term demand, and the National Association of Realtors conservatively estimates the deficit is as high as 5.5 million units. “This production shortfall naturally leads to a bias towards higher house prices.

Several forms of housing insecurity exist, and each can be detrimental to health. One study looked at three different forms of housing insecurity – being behind on rent, making multiple moves, and having a history of homelessness – finding each form of housing insecurity “individually associated with increased adjusted odds of adverse health and material hardship compared with [secure] housing.” Another study, which tested five different characteristics of housing – quality, stability, affordability, ownership, and receiving a housing subsidy – “found that the quality of housing – whether a [child’s] home has structural or maintenance deficiencies such as infestations of rodents or cockroaches, exposed wiring and peeling paint, or a lack of light, heat, or hot water – was the most important aspect of housing for children and families.” Experts typically discuss healthy housing in relation to four categories: quality, affordability, stability, and neighborhood location. The first three, combined with the definition of affordable housing, illuminate a more comprehensive definition of housing insecurity.



Many low-income individuals face the reality that housing they can afford often comes with substandard living conditions. Housing quality can significantly impact health outcomes. Poor quality housing is a contributing factor to infectious diseases, chronic illnesses, injuries, poor nutrition, and mental disorders. One especially prevalent quality issue is exposure to lead. An estimated 24 million housing units contain significant amounts of lead-based paint, 4 million of which house children. Exposure to lead, especially for young children, can cause damage to organs and blood, and it can impair cognitive and socioemotional development. Lead exposure is also significantly negatively associated with IQ and with lower test scores, and, at higher levels, can “cause coma, convulsions and even death.” Another survey found poor housing quality was strongly and independently associated with asthma and emergency department visits for asthma. Additionally, overcrowding within housing units is associated with multiple health issues.



Frequent moving and residential instability “is associated with emotional, behavioral and academic problems among children, and with increased risk of teen pregnancy, early drug use, and depression during adolescence.” (Click on “Read the issue brief (PDF)” in the previous hyperlink for the full brief). Research has found that “any residential move during childhood is associated with nearly half a year loss in school,” lower educational attainment, and lower earnings later in life. Each additional move is associated with declines in social skills. One study found a significant negative impact on high school graduation probability related to moving. Longer tenure in one’s residence is also “associated with lower levels of depression among seniors and fewer internalizing and externalizing behavioral issues such as anxiety and aggression among adolescents.” In the year following an eviction, one study found “mothers are 20[%] more likely to report depression than their peers” who were not evicted, and some mothers still reported significantly higher rates of depression several years after.



Matthew Desmond, author of Evicted, coined the term “the rent eats first.” Essentially, when households face high housing costs, they often must make cuts to other spending, including child enrichment activities, medical care and filling prescriptions, and even food. One survey found homeowners in default or foreclosure, compared to homeowners with no housing strain, suffered worse physical and mental health effects, including being 13 times more likely to suffer serious psychological distress. The experience of foreclosure has been associated with depression, anxiety, alcohol use, and suicide. Stress from being behind on rent also correlates with poor health. Higher homelessness rates correlate with high rents and lack of affordable housing. Homeless individuals face shorter life expectancies, higher rates of traumatic brain injuries, disproportionate risk of morbidity, and risk of physical and sexual violence. Homelessness also severely impacts children, including pre- or post-natal homelessness.

The remaining blogs in the Housing Insecurity series will look at ways state and local governments can help mitigate this pandemic, including allowing and incentivizing accessory dwelling units (ADUs), pursuing adaptive reuse initiatives to add additional housing, and enacting more multifamily zoning above the missing middle threshold, as well as actions being taken to remediate distressed properties.


For additional resources, the Gaining Ground Information Database is free and features best practice models used by governments to control the use of land in the public interest. Please direct your search toward the Healthy Communities topic.

[*] Colt Watkiss is a second-year student at the Elisabeth Haub School of Law and Student Associate at the Land Use Law Center.

Brooke Mercaldi is a second-year student at the Elisabeth Haub School of Law and Research Assistant to Professor Nolon.

The previous blogs in the series are listed here:

  1. Reframing Sustainability: Introducing the Land Use, Human Health, and Equity Project
  2. Planning for Public Health: A New Beginning for Land Use Law
  3. The Role of Density in Combatting Climate Change and COVID-19
  4. Novel Coronavirus Claims Implicate Age-Old Property Rights Questions
  5. State & Local COVID-related Emergency Powers: Individual Rights
  6. COVID-Related Land Use Regulations and Judicial Deference
  7. Mediation of Eviction Disputes May Hold the Key to the Survival of Small Businesses
  8. Using Zoning to Help Eliminate Food Deserts: A Few Steps Forward
  9. Urban Heat Islands and Equity
  10. Urban Heat Island and Equity: What Can Local Governments Do?
  11. The Recovery Lease: Preventing Evictions of Commercial Tenants During the Pandemic
  12. The Role of Hazard Mitigation Planning in Promoting Public Health and Resilience
  13. Hazard Mitigation Planning: A Case Study
  14. Complete Streets: Protecting Public Health
  15. Zoning and Lease Mediation as a Way to Retain Critical Small Businesses
  16. Segregation by Law and the Racial Inequity Pandemic
  17. Combating Food Swamps to Improve Equity and Public Health
  18. The Pandemic Plan for Healthy Buildings
  19. Remediating Distressed Properties to Improve Public Health

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