Housing, health, and the neighborhood context.

T he work of the Task Force on Community Preventive Services (the Task Force) joins a growing body of literature confirming the critical importance of neighborhood conditions to health in America. Saying simply that the " incidence rates are not spread evenly across a region " understates the reality. The fact is that, in virtually all regions of the country, health problems are highly concentrated in a small share of all neighborhoods—typically those that rate highest on a number of indicators of distress. You can explain this outcome in two ways. The first is to note evidence that the types of people that have much higher probability of poor health—low-income people of color for the most part—are highly concentrated in these distressed neighborhoods. The second is to rely on the growing evidence that other conditions in those neighborhoods (e.g., high levels of crime, deteriorated but still high-priced housing) have an effect in undermining health that may be independent of the race and income of the residents. The role played by housing is particularly important. Indeed, public policy concerning housing in this country emanated largely from perceptions about the effect of housing on health. Slum housing conditions in our burgeoning industrial cities of a century ago — overcrowding plus the lack of light and air, of decent plumbing and kitchen facilities, of adequate heat and, in some cases, of basic protection from the elements— were seen as major contributors to illness and disease. Programmatic responses ranged from the nation's first building and housing codes to, later on, slum clearance and public housing. Today, housing quality and overcrowding problems are less severe than in the past, but they have not vanished and they have been joined by another significant housing challenge: affordability. A sizeable share of the households in these troubled neighborhoods have to pay more than half of their incomes for rent. Given restricted incomes and the paucity of housing subsidies, these households are living on the edge. Any illness or family disruption that causes them to lose their income stream even temporarily can lead quickly to eviction. Much higher-than-average rates of moves from apartment to apartment in these neighborhoods attest to the seriousness of the issue. It has been shown that stress brought about by living in crime-ridden areas can undermine health and that the impact gets more serious the longer one is exposed. It is not unreasonable to assume …