Severe Housing Problems in North Carolina

North Carolina

Housing influences health and well-being. Those lacking at least one basic household necessity (bathtub/shower, sink with faucet, stove or refrigerator) have higher rates of being uninsured. Poor quality of housing can cause disease and injury and affect childhood development, while other housing-related factors such as neighborhood environment and overcrowding can lead to mental and physical health problems. 

Housing issues that can impact health include, but are not limited to:

• Affordability: Cost-burdened families may have difficulty affording other basic needs such as health care, food and heat. Individuals who had difficulty affording housing were more likely to report fair or poor health, certain chronic conditions and non-adherence to prescriptions due to cost. Housing costs have increased at a much faster rate than renters’ income, causing housing to become less affordable over time. Median rent increased by 15% between 2001 and 2019, but median renter household income only rose 3.4% over the same period. This finding underscores the continued importance of federal and local housing subsidies. Almost 10 million renters were severely cost-burdened in 2020, paying more than 50% of their income toward rent. 
• Hazards: Hazards in the home – such as lead paint, allergens, water leaks, poor ventilation and inadequate heating, cooling or plumbing – are associated with poor respiratory health and disease, increased risk of cardiovascular conditions and developmental delays in children. 
• Overcrowding: Overcrowding is defined as having more than one person per room in a residence. It is associated with an increased risk of poor mental health and physical illnesses, such as tuberculosis and other infectious diseases. 

While anyone may live in a home with conditions that threaten health, those with a greater risk of experiencing housing-related health conditions include: 

• Low-income families and individuals.
• Racial/ethnic minorities.
• Renters.
• Children and older adults.

Evidence supports various interventions to prevent and minimize the impact of housing problems on health. Healthy Homes programs at state and local levels have been found to improve health by remedying unhealthy housing conditions, such as lead hazards, inadequate ventilation and excess moisture.

Increasing affordable housing options through local and national housing development policies, rental vouchers and subsidized housing programs can help cost-burdened individuals afford housing. More collaboration between the housing and health sectors is needed to promote healthy home environments and to better integrate health care into public housing systems, particularly for those with chronic health needs. The National Low Income Housing Coalition offers additional resources and policy recommendations related to housing challenges.

Healthy People 2030 has multiple goals related to housing, including:

• Reducing the proportion of families who spend more than 30% of their income on housing. 
• Increasing the number of states and territories that prohibit smoking in multiunit housing.

Braveman, Paula, Mercedes Dekker, Susan Egerter, Tabashir Sadegh-Nobari, and Craig Pollack. “Housing and Health.” Issue Brief #7: Exploring the Social Determinants of Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, May 2011. https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html.

Donald, Ian P. “Housing and Health Care for Older People.” Age and Ageing 38, no. 4 (July 1, 2009): 364–67. https://doi.org/10.1093/ageing/afp060.

Gibson, Marcia, Mark Petticrew, Clare Bambra, Amanda J. Sowden, Kath E. Wright, and Margaret Whitehead. “Housing and Health Inequalities: A Synthesis of Systematic Reviews of Interventions Aimed at Different Pathways Linking Housing and Health.” Health & Place 17, no. 1 (January 2011): 175–84. https://doi.org/10.1016/j.healthplace.2010.09.011.

Pollack, Craig, Susan Egerter, Tabashir Sadegh-Nobari, Mercedes Dekker, and Paula Braveman. “Where We Live Matters for Our Health: The Links Between Housing and Health.” Issue Brief 2: Housing and Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, September 2008. http://www.commissiononhealth.org/PDF/e6244e9e-f630-4285-9ad7-16016dd7e493/Issue Brief 2 Sept 08 - Housing and Health.pdf.

Pollack, Craig Evan, Beth Ann Griffin, and Julia Lynch. “Housing Affordability and Health Among Homeowners and Renters.” American Journal of Preventive Medicine 39, no. 6 (December 2010): 515–21. 
 https://linkinghub.elsevier.com/retrieve/pii/S0749379710004551.

Sandel, Megan, and Matthew Desmond. “Investing in Housing for Health Improves Both Mission and Margin.” JAMA 318, no. 23 (December 19, 2017): 2291–92. https://doi.org/10.1001/jama.2017.15771.

Swope, Carolyn B., and Diana Hernández. “Housing as a Determinant of Health Equity: A Conceptual Model.” Social Science & Medicine 243 (December 2019): 112571. https://doi.org/10.1016/j.socscimed.2019.112571.

“The State of the Nation’s Housing 2022.” Cambridge, MA: Joint Center for Housing Studies of Harvard University, 2022. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_State_Nations_Housing_2022.pdf.