Housing, Poverty, and Health Outcomes

Abstract

Poverty and homelessness have significant impacts on the health outcomes of individuals and communities. Lack of safe, healthy, affordable housing in Sussex County requires attention and action to move the needle on the health of our impoverished and housing insecure populations. Health concerns descend on the scale of importance when an individual’s housing and financial circumstances are unstable. Employment opportunities exist, however, housing costs in the area are prohibitive resulting in negative impacts on an individual’s potential for social mobility as well as on local businesses and organizations seeking employees. Social determinants of health are indicated as prominent factors affecting health outcomes, even more so than access to and the delivery of healthcare. Findings from several reports highlight the correlation between financial insecurity, housing insecurity, and health. Innovative and collaborative solutions are necessary to create and hardwire health equity, housing stability, and social mobility within our county and state. Poverty, as defined by Merriam-Webster Dictionary, is “the state of one who lacks a usual or socially acceptable amount of money or material possessions.” Poverty is also one of the leading factors contributing to homelessness, with additional factors including, but not limited to, the lack of affordable housing, mental illness, and substance use disorder. All of which are very present concerns in Sussex County and the state of Delaware as a whole. Due to Beebe Healthcare’s newly launched Community Mobile Health Clinic (MHC), funded through Delaware’s Division of Substance Abuse and Mental Health (DSAMH), we have the ability and commitment to take care to the communities most in need, several of which are in impoverished and unincorporated areas, where our neighbors who are experiencing homelessness are among the individuals presenting to the mobile health clinic in need of care. Most are presenting without a primary care provider or are unable to recall the last time they had an appointment with a provider. Typically, these discussions around healthcare access include visits to a local emergency department or walk-in clinic, which may have occurred due to a need for immediate care and/or the lack of connection to a primary care provider. And the same medical and social complexity healthcare systems are seeing in patients within their brick-and-mortar facilities exists outside those walls in many communities throughout our county. However, this is not unique to Sussex County or Beebe Healthcare. This reality is statewide. In the current state and national healthcare landscape, increased awareness and effort are being directed toward identifying social determinants of health (SDOH) with a secondary focus on mitigating their potentially negative impact on patient health outcomes and preventable healthcare utilization. Poverty, housing instability, access to primary care, and access to health services are just four of the nineteen SDOH that the U.S. Department of Health and Human Services lists in its Healthy People 2030 campaign.1 Secondly the Joint Commission on Accreditation of Healthcare Organizations’ new requirements for providers include having designated leadership to reduce health disparities, assess patients’ health-related social needs, provide information on available resources and services, and demonstrate identification of healthcare disparities through quality and safety data stratification using socio-demographic characteristics.2 And lastly, the Centers for Medicare and Medicaid Services (CMS) released the CMS Framework for Health Equity 2022-2023,3 which details five health equity priorities for reducing health disparities and informs efforts with CMS stakeholders from underserved and disadvantaged areas for the next ten-year period. These recently declared foci of three significant entities in the public health and healthcare system arenas underscore the Robert Wood Johnson Foundation’s County Health Rankings model,4 which depicts the measured influence of clinical care as it correlates to health outcomes is 20%, leaving 80% to other health factors, policies, and programs. This category includes access to care, as it pertains to insurance-or lack thereof-in addition to the accessibility of primary, mental, and dental care as well as the quality of care, which encompasses preventable hospital stays, mammography screenings, and influenza vaccinations. Although the physical environment in this model holds a weight of 10% with severe housing problems as a subcategory, it does not include severe housing cost burden, homeownership, or air & water quality in its calculations. Additionally, the category of social and economic factors weighted at 40% includes community safety, which encompasses injury deaths, homicides, suicides, firearm fatalities, motor vehicle crash deaths, and juvenile arrests And yes, it still does not include the effects of residential segregation, median household income, living wage, and several other highly influential aspects existing in many of our communities that are now well-recognized contributors to health outcomes. Figure 1 shows the County Health Rankings model demonstrating these percentages as they pertain to health outcomes with an equally divided categorization of the length of life and quality of life.