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4.9 Stephanie Ettinger de Cuba
1. Housing Insecurity, Budget Trade-offs and
Young Children’s Health
Stephanie Ettinger de Cuba, MPH
Children’s HealthWatch
National Conference on Ending Homelessness
July 14, 2011
1
2. 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 2
3. Children’s HealthWatch
• Non-partisan, pediatric research & public policy
center
• 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 3
4. Where our data comes from:
• Emergency Departments and Primary Care
Clinics in Boston, Baltimore, Philadelphia,
Little Rock and Minneapolis
• Interviews - caregivers with children 0 to 4
years old
– “invisible” group
– critical window of time
4
5. Human Brain Development
Vulnerable Period: Birth – Age 3
Language Neural Connections for Different Functions Develop Sequentially
Sensory Pathways
(Hearing, Vision)
Higher Cognitive Functions
Adult neural
connections
Conception
Months Years Decades
Birth
Age
Fetus Late Infancy/Toddler Puberty
5
Source: Thompson & Nelson, 2000
6. What is food insecurity?
• Limited, uncertain access to enough nutritious
food for all household members to lead active,
healthy life due to economic constraints (USDA)
• Child food insecurity –reductions in quantity,
quality of children’s meals because caregivers
can no longer buffer from inadequate household
food resources
6
8. Food Insecurity is a health issue
Infection-Malnutrition Cycle
Hunger/
Malnutrition
Weakened
Immune
System
Illness/
Infection
8
9. What is Housing Insecurity?
Moderate Housing Insecurity
Crowded living conditions – more than 2 people per
bedroom
Doubling up – living temporarily with another family
for economic reasons
Severe Housing Insecurity
Frequent moves – moving twice or more in the past
year
Defined based on prevalence and child health outcomes
9
Source: DB Cutts, AJPH, June 2011
10. What percent of young children live
in housing insecure families?
60
50
40
30
20
10
0
5-city Baltimore Boston Little Rock Minneapolis Philadelphia
10
Source: Children’s HealthWatch, 1998-2010
11. Housing insecurity Harmful to Young
Children’s Health & Development
• Crowding/Doubling up – increased risk of household
& child food insecurity
• Frequent moves particularly damaging to young
children
• 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 age
11
DB Cutts, AJPH, June 2011
12. 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 12
13. Behind Closed Doors:The hidden
health impacts of being behind on rent
• Much known – children’s
health and homelessness
• Little research health
impact for children and
families → being behind
on rent
• Not included in original
definition of housing
insecurity
13
Research funded by the Fireman Foundation
14. Proportion of families struggling to pay
rent increased over recession years
30%
25%
20%
15%
10%
5%
0%
2007 2008 2009 2010
14
Source: Children’s HealthWatch
15. 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
• Poor health
• Developmental delays
15
16. How do children in shelter fare
compared to children in families
behind on rent?
Children in shelter more likely to:
– Be in fair/poor health
– Have history of hospitalization
– Be at risk for developmental delay
BUT
Less likely to:
– Be child food insecure
18. Health Care Trade-offs
& Foregone Care
• Has the cost of medical care or prescriptions ever
stopped you from being able to pay for rent,
mortgage, utility bills, food…?
• 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?
18
20. What do we know about policy
solutions?
Young children in subsidized housing
less likely to be housing insecure
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)
20
Children’s HealthWatch, Rx for Hunger: Affordable Housing, 2009
21. Policy Implications
• Food & housing security = health issues
• Food & housing policy interrelated - need for:
– Increased supply affordable housing
– 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
21
22. 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
23. Thank You!
www.childrenshealthwatch.org
sedc@bu.edu
Tel. 617-638-5850
23
88 E. Newton Street | Vose Hall 4th Floor | Boston, MA 02118 | tel: 617.414.6366 | info@childrenshealthwatch.org
