September 30, 2015
By Rachel Meltzer and Alex Schwartz
Blood poisoning from peeling lead paint and leaking gas pipes; asthma and other diseases aggravated by inadequate heating and insulation; injuries and fatalities from falls or fires in unsafe and derelict buildings; researchers and reformers have long raised alarms about the serious health hazards associated with substandard or badly maintained housing.
Now our newly published research suggests that another factor – the high cost of housing – may be just as bad for many New Yorkers’ health as these physical perils. In some cases, unsustainable rent burdens may in fact be even more detrimental.
In a recent article, “Housing Affordability and Health: Evidence from New York City” (published in Housing Policy Debate), we analyze data from the Census Bureau’s 2011 New York City Housing Vacancy Survey. This is a rich dataset that contains characteristics about the physical conditions of housing units and the socioeconomics of the inhabitants of those units, for a sample of all residential units in New York City. We find that for low-income New Yorkers in particular, high rent burdens can potentially undermine good health at least as much as unsafe housing conditions can. The reason: steep housing costs often force tenants to sacrifice seeing a doctor or dentist or getting a drug prescription filled. With the majority of New York City tenants dedicating 30 percent or more of their monthly incomes towards housing, and with some 20 percent spending at least half their incomes on rent, such tradeoffs are common – and can have meaningful health consequences as well.
We also find that as the burden of rent on household income mounts, so does the likelihood that tenants will postpone or forego medical care. For example, a 10 percent rise in the burden of monthly rent makes it 25 percent more likely that the respondent postponed at least one health care service. Further, that same 10 percent addition to the burden of monthly rent correlates with an increase of 3.5 in the number of postposed health care services (out of five total). This could help explain why, despite the offsetting social safety net benefits of Medicare and Medicaid, almost one-fourth of the city’s roughly 2.1 million tenants told the Census that their health was either “poor” or only “fair.”
Untreated communicable diseases can spread rapidly in our crowded city; decisions to put off medical care also all too often eventually leads to expensive emergency room visits and hospitalizations. For such reasons, we believe that if households continue to defer health care services in favor of housing, these tradeoffs, in aggregate, could mean significant health care costs for the public sector in the future. These future costs could offer another justification for providing housing subsidies now. Public subsidies should not only help landlords make needed physical repairs but also cut tenant out-of-pocket housing costs. Policies need to aim at reducing both kinds of impediments to housing-related health challenges, especially for those under circumstances of severe housing cost burdens.
Rachel Meltzer and Alex Schwartz are professors of urban policy at The New School’s Milano School of International Affairs, Management, and Urban Policy. Their article, “Housing Affordability and Health: Evidence from New York City,” was published online in Housing Policy Debate on April 27, 2015.