As a primary care doctor at a community health center I often realize that the cause of my patients’ illnesses is beyond my control. One day a patient of mine, Ms. Jones (not her real name), came in for her routine visit. She had asthma and though she was taking her inhalers as prescribed her symptoms were getting worse. Her wheezing was getting so bad that she was using her rescue inhaler all the time. I went through the usual list of things that could be causing problems - pets, rugs, allergies, weather change - but none of those were issues for her. We decided to increase her baseline medication and bring her back for a visit in a few weeks to see if she was improving. At the end of our visit I asked how things were going otherwise. She told me that she was trying to move out of her apartment because there was mold everywhere. She had been trying to get her landlord to take care of this for the past few months without success. It hadn't occurred to me to ask about mold exposure, but there it was, the cause for her worsening asthma symptoms.
The Centers for Disease Control and Prevention (CDC) have just released a report, the CDC Health Disparities and Inequalities Report, which details a variety of conditions that lead to poor health and for which there are different health outcomes in different groups in the population. This month you’ve read about a number of these conditions in this blog, including seat belt use, air quality and high blood pressure. Today I’d like to tell you more about another disparity, inadequate and unhealthy housing, which was the source of Ms. Jones’s problems.
Inadequate and unhealthy housing has a significant and largely unrecognized negative effect on health. Inadequate housing is housing with moderate to severe physical problems such as lack of running water, lack of a functional toilet or exposed wiring. Unhealthy housing exposes its occupants to environmental factors such as insects, rodents and toxins. We rely on our homes not just for shelter but also for safety and security. Unfortunately, this is not the case for the people who live in the 5.2% of homes that are inadequate and the 23.8% of homes that are unhealthy. For these folks their homes are a source of anxiety and can cause illnesses and exacerbate chronic conditions.
Not surprisingly, people with lower incomes and lower levels of education are more likely to live in inadequate or unhealthy housing. Encouragingly, the situation improved slightly from 2007 to 2009 but given the recent state of the economy it’s likely that these gains will be reversed when the survey is done this year.
Realistically, there wasn't much I could do to fix Ms. Jones’s worsening asthma unless I could write a prescription for a new apartment. Traditionally dealing with housing issues is a matter for a lawyer or government agency, not for a doctor. Encouragingly, there are a few pilot programs around the country that have explicitly made the connection between poor social conditions and poor health and are using the law to address these issues in a medical setting. Children’s Hospital Boston now offers access to legal services in its primary care clinic to help patients with issues related to food, housing, utilities and education. They realized that the kids in their clinics needed their basic needs met in order to improve their health and so any staff member in the clinic can refer children and their families for legal assistance. The lawyers in the clinic from the Medical-Legal Partnership | Boston can often times resolve problems with advice or a phone call but if needed can provide free legal services as well.
I wish there was a program like that that I could have referred Ms. Jones to. She and millions like her have poor health outcomes because of their housing conditions. Recognizing these barriers to health is the first step to remedying them.