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Housing Insecurity, Budget Trade-offs and Young Children’s Health

Stephanie Ettinger de Cuba, MPHChildren’s HealthWatch

National Conference on Ending HomelessnessJuly 14, 2011

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Overview• Brief intro to Children’s HealthWatch

•Definition of terms

•Food insecurity

•Housing insecurity

•Trends

•Impact of being behind on rent

•How many families are behind on rent?

•What does it mean for mothers’ and children’s health?

•How does impact family ability to meet other basic needs?

•Policy implications

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Children’s HealthWatch

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Non-partisan, pediatric research & public policy center

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Impact of economic conditions and public policy → young children’s health & well-being–

Housing

–

Food–

Energy

•

Provide policy makers with evidence to develop policies that protect young children’s health and development

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Where our data comes from:

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Emergency Departments and Primary Care Clinics in Boston, Baltimore, Philadelphia, Little Rock and Minneapolis

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Interviews -

caregivers with children 0 to 4 years old–

“invisible”

group

–

critical window of time

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Neural Connections for Different Functions Develop Sequentially

Months Years Decades

Conception

Age

Source: Thompson & Nelson, 2000

Human Brain Development Vulnerable Period: Birth – Age 3

Fetus Late Infancy/Toddler Puberty

Birth

Sensory Pathways(Hearing, Vision)

Language

Higher Cognitive Functions

Adult neural connections

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What is food insecurity?

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Limited, uncertain access to enough nutritious food for all household members to lead active, healthy life due to economic constraints (USDA)

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Child food insecurity

–reductions in quantity, quality of children’s meals because caregivers can no longer buffer from inadequate household food resources

7Source: USDA, ERS 2006-2009

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Food Insecurity is a health issue Infection-Malnutrition Cycle

Illness/Infection

Hunger/Malnutrition

Weakened Immune System

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What is Housing Insecurity?

Moderate Housing InsecurityCrowded living conditions – more than 2 people per bedroom

Doubling up – living temporarily with another family for economic reasons

Severe Housing InsecurityFrequent moves – moving twice or more in the past year

Defined based on prevalence and child health outcomes

Source: DB Cutts, AJPH, June 2011

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What percent of young children live in housing insecure families?

0

10

20

30

40

50

60

5-city Baltimore Boston Little Rock Minneapolis Philadelphia

Source: Children’s HealthWatch, 1998-2010

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Housing insecurity Harmful to Young Children’s Health & Development

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Crowding/Doubling up –

increased risk of household & child food insecurity

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Frequent moves particularly damaging to young children

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Young children whose families have moved 2 or more times

in the past year are more likely to be:

–

Food insecure–

Child food insecure

–

In fair or poor health–

At risk for developmental delays

–

Lower weight for their ageDB Cutts, AJPH, June 2011

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I am a single mother of two children and am having a hard time making ends meet. I have a decent job but fell behind on my bills and now I am facing eviction. I have tried every single resource available out there. But everywhere I turn I hit a closed door and my hope dies a little again…

www.aidpage.com

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Behind Closed Doors:The

hidden health impacts of being behind on rent

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Much known –

children’s health and homelessness

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Little research health impact for children and families → being behind on rent

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Not included in original definition of housing insecurity

Research funded by the Fireman Foundation

Proportion of families struggling to pay rent increased over recession years

0%

5%

10%

15%

20%

25%

30%

2007 2008 2009 2010

14Source: Children’s HealthWatch

Struggle to pay rent –

risk to children’s health

•

Compared to young children in stable housing–

Young children in families behind on rent more likely•

Child food insecure

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Poor health•

Developmental delays

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How do children in shelter fare compared to children in families

behind on rent?Children in shelter more likely to:

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Be in fair/poor health–

Have history of hospitalization

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Be at risk for developmental delay

BUT

Less likely to:–

Be child food insecure

Household and Maternal Well- being Compromised

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Household – increased risk:

– Food insecurity– Difficulty paying

utility bills (energy insecurity)

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Mothers – increased risk:

– Poor health

– Depression

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Health Care Trade-offs & Foregone Care

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Has the cost of medical care or prescriptions ever stopped you from being able to pay for rent, mortgage, utility bills, food…?

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Was there any time when [you or your child] needed a prescription medicine or medical care, but [were/was] unable to get it because the family couldn’t afford it?

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Household Balancing Act between Basic Needs

19Source: Children’s HealthWatch

What do we know about policy solutions?

Young children in subsidized housing less likely to be housing insecure

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Children’s HealthWatch, Rx for Hunger: Affordable Housing, 2009

Compared to young children on wait list, young children in subsidized housing

• More likely food secure• Less likely seriously underweight•

More likely classified as “well”

(composite of

several health indicators)

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Policy Implications•

Food & housing security = health issues

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Food & housing policy interrelated -

need for:–

Increased supply affordable housing

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Stable, adequate funding subsidized housing–

Stable, adequate funding for stabilization (assistance with arrearages, security deposits)

–

Coordination btw housing/food advocates–

Outreach/assistance programs for those on wait list AND those struggling to pay rent

Stable housing is an economic development issue

Keeping families out of shelter (“front”

and “back door”) and stably housed is often better for children, families and city/state finances

Children are our country’s future leaders, our future workers, and our future community members.

An investment in affordable housing now is an investment in our country’s future. 22

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Thank You!

www.childrenshealthwatch.org

sedc@bu.eduTel. 617-638-5850

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