Housing and health care go hand-in-hand

Housing and health care go hand-in-hand
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Over the past two presidential administrations, political fury has swirled around the nation’s health-care system. Health care is almost always at the top of the list of America’s domestic policy concerns. As well, it should be.

But without addressing the nation’s growing housing crisis, an efficient and humane health system will stay out of reach. Health-care delivery systems recognize this. In a few cases, large hospitals, health plans and even insurance companies now are putting resources into housing for patients.

It is time for public policy makers to recognize the absurdity of ignoring the most critical social determinant for good health outcomes: safe housing.


Human services — when it comes to promoting health — fail if delivered in silos. For decades, as the cost of health care has become a larger and larger part of America’s gross domestic product, health outcomes for Americans have continued to fall far behind those for other developed nations. These are countries like Canada, Australia and the European Union that spend much less per capita on their nationals’ health care. Less spending, healthier people.

A fundamental reason for this uniquely American failure is the underfunding and separation, of the basic human care that is essential for medical care to succeed.

A common example: No matter how skilled a primary care doctor or pulmonologist may be, a child with asthma is not likely to improve if living in a mold filled house or apartment. Similarly, providing the best of psychiatric care to a schizophrenic living in a public park is a recipe for failure and waste.

High-minded health policy experts understand this, as do major health systems across the country. Political leaders need to catch up.

The Trump administration’s release of its federal budget proposal for 2020 earlier this month reignited health care anxieties. In addition to its continuing efforts to undermine sections of the Affordable Care Act, also known as ObamaCare, the administration proposed substantial cuts to Medicare, Medicaid and public health. The projected ten-year reduction in Medicaid spending – health care for the poorest Americans amounted to $1.5 trillion.

This level of health-care cuts are not possible without fundamentally changing the current health system. People would die, prematurely and unnecessarily. But, if the United States spent public dollars for human services more prudently, significant savings in the nation’s health system could be found — along with substantial improvements in the health of the American people.

For that to happen, the “social determinants” of health must be recognized as an equally important part of health care as is a well-educated surgeon, a brilliant nurse, or a reliable X-ray machine.

Basic human needs, including food security, a safe environment, literacy and a livable income are among the most frequently cited needs to allow medical care to succeed. These are all important, yet they pale in comparison to the absolute necessity of a secure place to live.

Too many Americans wind up in hospitals unnecessarily, and stay too long, because they have nowhere safe to live. This is awful for a patient, and it also is a huge waste of money — hospital care is enormously expensive, even when the patient does not belong in the hospital.

It is no surprise that people without housing security suffer both physical and mental illnesses far more frequently than those safely housed. Unspoken by political leaders, the United States housing market is now a national emergency —  a real national emergency--one that strikes directly at the health of the American people.

But, look at the administration’s proposal for housing support in its 2020 budget. The president calls for a 16.4 percent cut for the Department of Housing & Urban Development (HUD), which amount to $8.6 billion. A coincidence, likely, but this is the exact amount requested by the President for a Mexican border wall in the same budget proposal.

What this means is, even if some of the cuts make it through the coming Congressional budget negotiations, there will be an even tighter supply of affordable housing, fewer units of housing that provides support for people with disabilities, less money for public housing capital repairs (think heat, water and lead paint removal  and higher rents on already over strapped low-income tenants.

The collateral damage will be the health of Americans. More people will become sick, fewer medical interventions will lead to good health outcomes, and a bloated health-care system will continue to pour resources into expensive and unnecessary emergency room and hospital stays.

Housing is health care. There is no argument otherwise.

There was hope that HUD Secretary Ben CarsonBen CarsonGovernment indoctrination, whether 'critical' or 'patriotic,' is wrong Noem takes pledge to restore 'patriotic education' in schools Watchdog blames Puerto Rico hurricane relief delays on Trump-era bureaucracy MORE, while unschooled in housing or community development, would understand the direct linkage between good health outcomes and sound housing. Secretary Carson, after all, was a practicing physician before he turned to politics.

If there is administration leadership in housing, it is both quiet and ineffective. Unless we can turn our housing market around, we will never have a health-care system that can deliver quality and cost-effective care to the American people.

Those of us who provide health care in the communities of America understands this. Someone in the administration, and many more members of the Congress, need to see this as well.

Robert M. Hayes is the president of Community Healthcare Network, a non-profit providing integrated healthcare to underserved New Yorkers at 14 community health centers and a fleet of mobile units. He is a founder of the National Coalition for the Homeless and the attorney who established the right to shelter in New York for homeless men, women and childre