Megan Sandel, M.D., M.P.H.
Megan Sandel, M.D., M.P.H.
Associate Professor of Pediatrics
Schools of Medicine and Public Health, Boston University

Housing: A New Vital Sign

I attended a meeting recently where someone called me an “aberration” of a doctor. Most people would be insulted; I felt complimented. The meeting pulled together leaders of various housing agencies and leaders from the Regional Health and Human Services Department to discuss how they could work together to improve health. I was an “aberration” because I’m a doctor who cares about how housing impacts health. Having spent 20 years designing health care and public health programs to improve housing as a way to improve health, I’ve written my own brand of “prescriptions” that don’t involve pills. Instead, they involve things like community health workers visiting families at home and pest contractors ridding alleyways and rowhouses of mice. Not the usual work of a doctor.

I’m often asked why I care about housing, and I often reply: “How can I not care about housing?” Housing is recognized as one of the most important “social determinants of health,” as they’re often called. Yet according to a major study (2002) by J. Michael McGinnis, “approximately 95 percent of the trillion dollars we spend as a nation on health goes to direct medical care services, while just 5 percent is allocated to populationwide approaches to health improvement,”—such as housing and other social determinants, which can account for up to 60 percent of health problems. Other studies support these numbers—for example, a 1997 study published in The New England Journal of Medicine found that if you are both allergic to cockroaches and have cockroaches in your home, you have a threefold increase in the risk of getting hospitalized for your next asthma attack. No amount of medication can change this risk.

Under the of these issues can have a huge impact on health, sometimes increasing the risk of stunted growth, developmental delays, or getting hospitalized by up to 50 percent.

Imagine a health care system and a health care team ready to tackle these social determinants of health. At the beginning of the healthcare visit, your kids get their height, weight, and blood pressure checked, and you fill out a ten-question survey to find out if you have problems buying food every month, securing housing, or keeping your lights turned on. What if, while seeing your health care providers, they review your social determinants of health much like they review your child’s vital signs? If a clinician finds the potential for housing problems like mold, then perhaps a member of a healthcare team, such as a legal advocate, could sway the landlord to fix the problem before your child’s asthma flares—and he or she ends up hospitalized. Models like this, known as medical-legal partnerships, exist and are now in 300 hospital and health centers across the country. In certain communities, these programs are revolutionizing the well being of the whole family.

And so I ask: “Just what is the aberration in my practice of medicine?” I believe strongly that identifying a family’s social determinants as closely as we identify vital signs—and integrating community health workers, legal advocates, and other professions to address social determinants—will become the new norm in health care. And it will be an aberration to ignore these issues.

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Learn More 

“Many Factors Can Turn a House into an Unhealthy Place to Live,” Laura Barnhardt Chec, The Washington Post, 2013

“Baltimore Takes a Holistic Approach to Unhealthy Housing,” Eliza Barclay, The Washington Post, 2010

“Housing Policy is Health Policy: Q&A with HUD’s Raphael Bostic,” New Public Health, 2011

“Is Your House Making You Sick?” Carol Sorgen, WebMD, 2003

“Home is Where the Harm is: Inadequate Housing as a Public Health Crisis,” Samiya A. Bashir, American Journal of Public Health, 2002

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