Housing as a Social Determinant of Health

This essay analyzes and discusses housing as a social determinant of health affecting low-income families in the United States. It explores the impact of housing on health status and ways to improve conditions.

Running head: HOUSING IN THE UNITED STATE 1
Housing as a Social Determinant of Health
Student’s Name
Professor’s Name
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Date

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Introduction
The social determinants of health (SDH) are the particular factors both economic and
social that determines the health status within a particular region or a community in a certain
environment and with a certain group of people or population. The SDH factors either promote
or erode the health status in the living conditions of the specific population. These determinants
of health involve the living standards in which a person is born, grows and the additional forces
and systems that are involved in building regular bases of life conditions. SDH is the important,
unprecedented global that impacts the natural human environment and with significant
implications for human health. This essay will analyze and discuss housing a social determinant
of health affecting the families under the poverty level in the United State (US). The family gives
an individual enough support through various ways like the ideal family environment, effective
parenting skills and socioeconomic status. The essay will demonstrate the impact of housing on
low-income families in the United States. There are ways to address the issue of housing on poor
families in the US as it affects the health status of such populations. The essay will analyze and
discuss how the issue of housing affects the health status the ways to improve the condition
among the affected population.
Description of Americans living under the poverty level
The United State of America is considered the richest country in the world, but there are
millions of its residents who live in a low level of the poverty line. In a research conducted by a
certain organization, it estimated that 13,5% of people of the United States which is around 42.1
million lives under the poverty line. Other scholars underscored that the population in the United
state living under poor living standards were approximately 100 million which is almost a third

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of the population of the United States of America. The US poverty rate in the year 2017 was
12.3% which had improved from 12.7% in 2016 the poverty level in the US had fallen by 2.5%
points since 2014 where it was 14.8% to the 12.3% in 2017 (Federal Interagency Forum on
Child, & Family Studies (US) (Eds.), 2017). This is the poverty rate decline within three
consecutive years. Most of the population in the US living under the poverty line are face by the
issue of housing problems.
Poor housing problems are associated with several other poverty factors. These factors
facing the poor people in the US include; ignorance, dishonesty, dependency and disease apathy.
All these factors contribute to other secondary problems such as poor infrastructures,
unemployment, inadequate capital, bad governance, lack of markets and lack of skills (Moffitt,
2015). The government ignorance due to poor leadership causes negligence of the people living
in poor backgrounds such that there is an unequal distribution of resource. Poor infrastructure is
also supposed to be developed by the government, but due to poor leadership, thus it leads to the
unequal distribution of resources such as healthcare facilities and good housing. In 2009, there
were around 643,000 unsheltered and sheltered homeless population in the US (Goodin, & Le
Grand, 2018).
A third of these people stayed in transitional house programs or on the emergency
shelters; the other others lived on the streets in the abandoned buildings with the unfavourable
condition for human beings. In 2018, there was an increase in the number of citizens of the
United States who chose to reside on their vehicles because they could not afford rental houses
due to the rental increase. The families under the poverty line in the US in concentrated on the
resident who resides on the rundown housing in large urban centres where some industries have
been pushed away. Most poor families, transitional residents and the large population of a

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homeless population migrate and settle there, establishing a slum-like a village. Since these
vulnerable populations settle in those places with no plan or any regulation from the government,
the settlement is clustered everywhere such that there is no space for the construction of better
roads, proper insulation or ventilation by the government. The true picture of poverty is found in
the rural regions of south and southwest areas in the United States. These areas have no
industries or may have ever run down and moved away. Some of the States where poverty is
very high in the United States in the southern region includes; West Virginia (17%), Georgia
(16%), Mississippi (20.8%), Kentucky (18%) and Alabama (17.1%). In the southwest region of
the US, they include; Arizona (16.4%), Oklahoma (16.3%) and New Mexico (19%) (Proctor,
Semega, & Kollar, 2016). This problem was mostly experienced in the cities where the
urbanization and overcrowding increased the cost of living. Some of the cities that were
influenced include; Oregon, San Francisco and in Portland. These areas have a history of poor
family backgrounds and them vulnerable to be affected by the Housing Issues as a social
determinant of health (Garbarino, 2017).
How Housing Affects the Poor Families in the United States
An individual’s health and social development are dependent on available health services
and healthy living standards. The families living under the poverty level in the United States of
America have affected the housing Issue negatively as they experience many challenges in the
areas they live due to poor housing conditions. Lack of proper housing or good sheltering
conditions may lead to major health inequalities and may result to a burden of diseases from the
environment in which someone was born, brought up, works or worked and where one is living
(Hagenaars, 2017).

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According to the study carried out by the Urban Institute of United States in 2016 youths
and teenager living in low-income regions were the most vulnerable to criminal activities such as
drug selling, crime gangs and engaged in sexual activities so that to afford food and maintain
their rental houses. The infrastructure of the environments where the economically challenged
families in the US resides is very challenged, for example, the poor infrastructure, insecurity,
prone to deadly illnesses, inaccessibility to healthcare facilities and limited resources. These
areas with poor housing facilities are always moulded, overcrowded, dampness and very
asthmatic environments where there is a risk of a fatal disease outbreak (Chetty, Hendren &
Katz, 2016).
Damp housing result in microbial growth and mould which are the leading factors that
result in wheezing in both infants and adults. These damp and cold areas create a favourable
environment for bacterial growth and are the friendly environments for dust mites, mould
protozoans and other harmful microorganisms which causes disease to the human being. In these
environments, the rate of development of respiratory illnesses such as bronchitis and common
cold is very high in children (Keet et al, 2015). The poor housing facilities in these areas reflects
how they have undeveloped or poor healthcare facilities. People living in poor housing also are
vulnerable to acute medical illnesses, and they are mostly admitted to the emergency department
and also have a long stay in the hospital due to an outbreak of serious illnesses. The population
living in poor housing facilities are exposed to several unethical domestic issues due to lack of
security and inadequate parental skills, the people are exposed to violence, domestic and
neighbourhood problems and substance abuse (Howenstine, 2017).
It has been said by researchers that the health status of a population is highly influenced
by the quality of housing and surroundings. If a person lives substandard housing conditions,

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there is always poor insulation and ventilation which could predispose him/her into ill health
(Pascoe et al, 2016). The old aged, the children and also the infants spend more of their time
indoors. Therefore poor housing condition is very dangerous to the health due to their weak
immune system and psychological stress. A well insulated and ventilated house is more
effective for the health of old aged and children than providing them with clothes. The research
studies regarding the effect of cold, mould, poorly insulated and damp areas have shown that
they are the leading cause of poor health (Ezeh et al, 2017).
Their Susceptibility of Families under Poverty Level to Health Problems due to
Inadequate Housing
In the US housing problems are experienced in rural areas and in the cities which are
densely populated. The overcrowding and inadequate housing in the cities are more risk to
people’s health problems than to the experiencing health problem in towns. In the overcrowded
places in the US, there is a lack of privacy and draught is most likely to be experienced. Poor
housing condition requires frequent repairs and such expenses prone one to remain in the poverty
level for a long time. There is poor ventilation hygiene in such areas. General poor sanitation is
demonstrated in overcrowded are in the American cities, and this makes the population living in
those areas to more susceptible to diseases associated with poor hygiene. Also cold is a major
problem in regions experiencing inadequate shelter, and this may lead to the outbreak of various
communicable diseases and respiration complications (Chung et al, 2016).
Insufficient cooking facilities due to lack of money to purchase electricity, safe cooking
equipment such as a gas leak, gas refilling and unsafe electrical installation for cooking — lack
of appropriate equipment for food storage such as refrigerators, damp cupboards. The people on
poor backgrounds lack enough money for proper electric meter installation. There is a lot of

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noise experienced in the overcrowded areas within the cities. The noise comes from the local
industries and traffics. Several damping sites and sewerages are directed to flow towards those
areas where people have little or no ”say” and the areas are inaccessible for inspection by the
departments of health in the US. In such remote areas and the slummy part within the urban
centers, there is poor access to the essential facilities like shops, clinic, recreations grounds and
hospital (Duncan, Magnuson & Votruba-Drzal, 2017). The hospitals which are near those places
are mainly private hospitals which are unaffordable, and these regions are far from the public
health care centers which are affordable as they are run by the government (Flora, 2018).
Other Problems Associated with Inadequate Housing
The population that is vulnerable to becoming homeless in United State are runaways,
refugees, young people from remote areas, asylum seekers, care leavers, blacks and minority
ethnic groups. The insufficient shelter can result in the following health issues; food poisoning,
hypothermia, anxiety, inadequate sleep, poor diet and substance abuse. Insufficient housing
exposes the affected families, children and youths to the following psychosocial issues; social
isolations, excessive stress, fewer opportunities in life, have low self-esteem, mental health
problems, unprotected sexual behaviours, poor relationships, unemployment, and lack of
exercises due to inaccessibility of recreation facilities (Bitsko, 2016). People living in
substandard places with poor environmental conditions are susceptible to the diseases associated
with improper hygiene such as cholera, typhoid, and diarrhoea (Cairncross, & Feachem, 2018).
In areas with poor housing conditions, there a lot of stress which worsens the poor health
of the individuals. There is frequent domestic violence, and many youths become the victim of
bullying and engage in theft cases within the urban centers. Poor shelter conditions lead to low
achievement in the education sector because the children have no favourable to do their

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homework or to conduct their supplementary studies. The cause of poor relationship is due to the
poverty within families. During the transition from the time of birth to the adulthood, a person
passes through many challenges, but those brought up in poor housing facilities have more
intense pressures in life compared to those risen in able and rich families (Jocson & McLoyd,
2015).
How the effects of housing could be improved
In order to improve the health and fight the inequalities, well-organized model or
approach is necessary to address the housing SHD on how it affects the concerned population
either indirectly or directly. The health impacts of housing in the United States can be handled
through the establishment of a right based approach to address and analyze the models for
improving the health status of the affected families. The primary health care PHC is an
appropriate right based approach which is a multi-leveled model of health promotion that can be
useful in curbing the health status of the low-income families in the US (Fierman et al, 2016).
This approach can be applicable in cooperation with the government which would support the
project improvement on the infrastructure. Other stakeholders who can be involved in the
development and implementation of this approach are the Non- Government Organizations

HOUSING IN THE UNITED STATE 9
(NGOs), department and ministry of health of US, heads of all the healthcare centres, private
sector in the healthcare, the department of infrastructure and house planning and also education
to the public. The primary prevention of housing problems can be achieved through strategized
actions which aim particularly to promote and maintain health and living standards of the
citizens of the United States. This healthcare approach can be attained by the provision of a
healthy environment through availing of affordable health services and offering enough
education to the vulnerable groups concerning the health risk that is attributed in the areas. The
healthcare services providers have to carry out home to home or door to door survey while
treating and educating people on the preventions methods and strategies regarding their disease.
These people have to educate about the importance of maintaining high hygiene within those
areas to prevent the outbreak of the associated illnesses. The secondary prevention actions are
offering treatment for diseases and the prevention of further associated complications. Tertiary
healthcare actions involve basic rehabilitation services and teaching the disadvantaged group on
how to cope with the environmental conditions such as cold, the dampness and the sewerage
passing through those parts of the cities (Newman & Holupka, 2015).
Some of the stakeholders and their roles in the PHC approach
Department of infrastructure and housing
The role of this department is to plan and design the models of houses and also regulate
the number of people to settle or occupy a certain space to overcome the cases of overcrowding
and environmental pollution. There also responsible for the planning of the streets and corridors
within a densely populated area to avoid suffocation and creation of slums. The department will
be helpful in the implementation of the approach as it deals with ventilation, public spaces
creation, insulation, sewage system installation and involving and educating the public on the

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significance of participating in health development programs (Smith, 2015). The health of every
family, any individual and the whole community will be improved by insulated and designed
houses, public participation in community health service activities (Gubits et al, 2015).
US Centers for Disease prevention and control
This body emphasized on the program to promote health through the uplifting of the
living environments and housing conditions. The organization stated that the admissions to the
emergency department and the long stay in the hospitals due to the outbreak of acute illnesses
could be reduced and shortened by improving the living standards and improved the housing of
the families living under the poverty line. This organization can handle conditions such as mental
health and maternal health which are associated with poor housing.
Government
The government of the US is responsible for the coordination of all activities and
programs that are helpful to its citizens. The government has the power to make immediate
decisions in all areas such as infrastructure, and healthcare services. The government has a role
in generating direct the health and social policies in response to the poor housing conditions and
other factors that affect the life of the citizens and also protect the economic status of the families
living in the substandard environments (Aizer, Eli, Ferrie, & Lleras-Muney, 2016). The US
government also will start a cluster of randomized trials for involving the building of better
houses, electric installation, insulation and health research of insulting houses of the poor
population with low socioeconomic status. A properly coordinated strategies are required to
generate by the policymakers towards the health care provision and from the leaders of various
sectors associated with people’s health to use their knowledge in enhancing better living

HOUSING IN THE UNITED STATE 11
standards especially to the vulnerable population to promote the best health outcome to all
citizens in US (Buckley, Kallergis, & Wainer, 2016). Every individual admires to live good and
favourable indoor environments, healthy lifestyles, healthy respiratory conditions, better working
conditions and in safe neighborhoods. The PHC approach will improve the living standards of
people living in poor conditions through the provision of better housing which is properly
ventilated and insulated. This will enable them to have a good life with better standards. The
rights-based approach will promote the health of the population in the United States living under
the poverty line and reduce the susceptibility of disease respiratory and hygienic conditions
(Schickedanz, Dreyer, & Halfon, 2015). The PHC approach will minimize and prevent ill health
standards in the community. People living in well-insulated buildings and better living standards
are less likes to acquire acute illnesses such as pulmonary and obstructive respiratory diseases.
The approach reduces the effect associated with dampness and cold such as wheezing, asthma,
postnatal depression and cough (Giles-Corti et al, 2016).
Conclusion
The interventions and the right based approach to improve the housing conditions of the
people living under the poverty level in the United States could reflect on better health outcomes.
The provision of ventilation and insulation for the people living under the poverty line is
somehow cost-effective, but, the PHC approach which involves the coordination of the
government, NGOs, heads of healthcare centers and other stakeholders can make the strategies to
promote the people well being easier. As it is shown in the essay, the quality of life is greatly
influenced by the surrounding society and the environments where people work and live in.
Through the improvement of the housing conditions, it helps in reducing the burden of ill health
and the outbreak of fatal disease. Better housing conditions can promote the decrease of

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healthcare expenses as the disadvantaged population face challenges due to the inaccessibility of
physicians and general medical care. It is therefore recommended for the public and the
community living in the susceptible conditions to actively participate in the health promotion
programs their future better health and well being.

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