Housing as Health Intervention

As a nurse, health professional, and health educator, I spend a lot of time talking about housing.  Working with people experiencing homelessness, there is no shortage of traditional health concerns to be worried about: mental illness, addictions, wounds, communicable diseases, infection, etc.  However, looking at both the cause of and solutions to health issues on the context of homelessness, I come back time and time again to housing.  It can be intimidating trying to gain mastery over another area when healthcare is consuming enough, but making the links across sectors is crucial in creating solutions.

Much of the preliminary work on health and housing was on linking housing as a determinant of health and therefore demonstrating a relationship between these.  This has led to a plethora of studies stating, for example, that homelessness is bad for one’s health.  Newer working (refreshingly, for those who are tired of reading of the same correlations) is digging into intervention studies, and in particular housing as a health intervention.  The report “Housing and Health: Examining the Links” from the Wellesley Institute does exactly this, breaking down the various housing interventions that offer some promise in terms of improved health.

Most interesting to me in the report is the ongoing refinement of the differentiation between a Continuum Model of housing versus a Housing First Model.  In a Continuum Model, the individual is expected to advance along a progression of demonstrated capacity to demonstrate ability to move towards independent, market-rent housing.  In Housing First, housing is provided up-front, and supports to the appropriate degree are attached to the housing.  I personally see the most promise in the Housing First model, as this recognizes that for many, advancement along a continuum is not in the perceivable future.  This is not to give up on people, but to recognize for many, recovery simply looks like survival.