KATHY BROWN
Understands relationship

Dr. Lauren Smith treats acutely ill children at Boston Medical Center and frequently encounters children who live in unstable, unaffordable or substandard housing.

Smith said such housing conditions put children’s health at risk. Parents struggling to pay rent don’t have much money left over for food, leaving their children more susceptible to malnutrition and infections and illnesses. And children living in housing with poor conditions, such as rodent or cockroach infestations, can suffer from asthma or other respiratory illnesses.

“We have such high prices, and people have to use a substantial portion of their income on housing, that they’re not going to be able to afford the quality of housing that you or I take for granted,” she said.

Extensive research has documented the connection between affordable and stable housing and children’s health and well-being. Just over a week ago, Enterprise Community Partners and the National Housing Conference’s Center for Housing Policy released comprehensive looks at existing research stretching back as far as 20 years ago that links affordable housing and the health and educational achievements of children and families.

The two in-depth analyses found that affordable housing could improve health by freeing up more of a family’s resources to spend on nutritious food and health care. They also showed that well-constructed and managed affordable housing could limit exposure to allergens, neurotoxins and other dangers – thereby reducing health problems – and providing more housing stability could reduce stress and related adverse health outcomes and improve children’s educational achievements.

“There has just been … more and more data that reinforce that housing is really more than just a roof over people’s head. It’s something that really is central to people’s well-being,” said Jeffrey Lubell, executive director of the Center for Housing Policy.

Lubell said the analyses were done to draw more attention to affordable housing. There has been little discussion about affordable housing, even among the presidential candidates, according to Lubell.

“There is right now a debate about how to improve the educational outcomes of children and a debate about how we can ensure that the population is healthy, and you don’t see much about housing in these debates,” he said.

The research is particularly compelling in states like Massachusetts, which has some of the highest housing costs in the nation. The Boston and Cambridge metropolitan areas were among the top 10 least affordable areas to rent a two-bedroom apartment, according to a report by the National Housing Conference that’s based on rents from last year’s third quarter.

And even though the housing market has softened and prices have slipped in Massachusetts, the decline comes after a sharp run-up in prices. The median selling price for a single-family home, for example, surged more than 72 percent from $200,000 in 2000 to $345,000 in 2005, according to The Warren Group, parent company of Banker & Tradesman.

“What’s nice about the reports is that they actually connect the dots [between housing and health and education],” said Russ Lopez, an assistant professor at Boston University’s School of Public Health who has done research about how architecture and neighborhoods affect health.

Lopez said the connections are not always obvious. A family that is frequently moving or worrying about paying the rent and other expenses, for example, can suffer from stress and anxiety that can affect overall health.

One study showed that children whose families receive housing assistance were 50 percent less likely to suffer from iron deficiencies than children in low-income households that do not get housing aid.

“There are these horrendous spillovers of poor housing,” said Lopez.

Documented Impacts

Housing affordability and quality have well-documented impacts on children’s health and well-being, according to Smith, who is medical director of Boston Medical Center’s Medical Legal Partnership.

But despite that, policymakers and the general public are not always fully aware of how housing can affect children’s health, she said.

About two years ago when the Legislature and then Gov. Mitt Romney were contemplating changing the state’s rental voucher program, which provides public subsidies to low-income tenants to help them pay for rent, Smith and her colleagues decided to publish a research paper on the impacts.

In her paper, Smith noted that Romney’s proposal to institute time limits for housing vouchers would increase the likelihood of some families having to trade-off spending money on housing and other basic needs such as food. That would make more children vulnerable to malnutrition and poor growth.

In addition, a proposal to require more voucher holders to work would have led to housing instability, and adversely affect the health and development of children, particularly in families that didn’t have access to adequate and affordable child care, Smith concluded.

Smith testified at legislative hearings about the changes and housing advocates used her research. The proposals ultimately were defeated.

“We really wanted to illustrate the connection of very important policies outside of the health domain to their health impacts in a way that was accessible and understandable to the public and policymakers,” she said. “As clinicians, we see the impacts in our daily clinical work and we wanted to convey that so that people who are thinking about housing policy or energy policy can understand the connections.”

Lopez, who is writing a book on the history of using architecture to promote health, which is expected to be finished this fall, said there are few resources available to build new affordable housing and to repair existing housing.

“I think people in Massachusetts and elsewhere understand that they need to address housing quality and housing affordability. They know there’s a need to address those issues. On the other hand, government support for new assisted housing production has been cut back dramatically,” he said.

Kathy Brown, a coordinator with the Boston Tenant Coalition, said tenant advocates have understood the relationship between quality safe and affordable housing and health for years.

Brown pointed to healthy homes programs that have emerged throughout Boston. City Life/Vida Urbana, a Jamaica Plain-based nonprofit group, started a program almost 20 years ago that places a housing advocate in four community health centers to help patients with housing problems.

“That was the first in Boston,” said Brown.