Health, Housing, And The Hierarchy Of Need

Maslow's Hierarchy of Needby Danielle Hubley,
Policy Analyst, Partnership for Strong Communities

In the aftermath of the disheartening and tragic death of George Floyd and the protests that followed, racial disparities and injustices have been consuming the media – both in light of the deaths of George and other Black Americans, as well as the inequities that are persistent in responses and outcomes from the Coronavirus pandemic. The global health and racial inequity crises weighing on us today have further highlighted the gaps and failures in our current healthcare system that have been perpetuated disproportionately throughout history for Black and Indigenous People of Color (BIPoC). 

It has reinforced the fact that we have significant disparities in this country, beyond what we believed were possible.  What we are learning more and more each day as we move through these crisis situations is how crucial access to healthcare and housing is to the safety and well-being of people’s lives. One person’s health can affect the whole and, in this way, we are learning that we are all dependent on each other. When everything we do right now and moving forward is centered around keeping as many people safe as possible, we must talk about what it means to be safe in the first place.

Maslow’s hierarchy of need identifies the first two levels of his pyramid as covering human’s physiological and safety needs. Our physiological needs are met when we have access to water, food, shelter, sleep, clothing, etc. Our safety needs are met when we feel we have personal security, resources and good health. Our health is dependent on the place in which we live. It is so important for us to become comfortable talking about these two basic human needs as parallel to one another in terms of success in the quality of human life, and the policies put in place to protect human life.

In this blog, I aim to address some of the intersections in which health and housing overlap, and how they impact one another and the lives of human beings. By understanding this intersection, we can build better systems of care that ensure all people’s basic human needs are being met.

Health

Whether you have chronic or acute health symptoms that impact your day to day life, or you are the picture of health, where you live will impact your well-being. If you are living in your car, you may not be able to regularly shower, or brush your teeth, or wash your clothes. You may not have access to food, or exercise or even water in some cases. If you’re living on the street, you may not feel safe enough to sleep, worried about losing what possessions you are able to carry on your back. If you live in an apartment but are spending so much of your earned income just to live there, you may not be able to afford healthy foods, or fix a broken shower or oven.

The things many people can take for granted every day are some of the things those experiencing homelessness or housing instability have to sacrifice just to survive. Any sacrifice that is made just to have a roof over your head is one too many. One missed doctor’s appointment could lead to the development of a tumor that could lead to cancer, that could have been prevented if caught early enough. Not having a toothbrush can lead to many dental problems that can cause significant damage to your body and brain.[1]  We also know that there are serious short- and long-term health effects from exposure to crime and violence in one’s community. Violence is a main contributor as it relates to public health. Violence can lead to premature death or cause non-fatal injuries,[2] and repeated exposure to crime and violence may be linked to an increase in negative health outcomes.[3]  

Many BIPoC experience exacerbated health concerns and ailments as a result of the historic policies and inequities they have faced[4], compounding on generational experiences and outcomes of violence, illness or disease. Many minorities are “more likely to have respiratory illness, like asthma or other serious health conditions[5]” that especially now, can be dangerous and life threatening. People who survive violent crime endure physical pain and suffering and may also experience mental distress and reduced quality of life.[6]  

Margarita Alegria, a psychiatry professor at Harvard Medical School notes that, generally speaking, but especially so during the coronavirus pandemic, “psychological stress tends to be higher in low-income people”. Higher levels of stress that lasts for long stretches of time are also known to contribute to chronic health conditions[7] , meaning in some instances, the fear and anxiety associated with not having a safe place for you and your children to sleep tonight can be just as damaging to a person’s health as not having a physical location to sleep at tonight.

Substance use can also stem from the results of a stressful life. The opioid crisis has taken the lives of over 948 people in the state of Connecticut alone, according to data available in 2018. Opioids are not the only drug that is harming the health and wellbeing of many of our citizens, however. Many drugs, like heroin, cigarettes, alcohol, and other prescription pain killers are so destructive to our health and safety, and it is imperative to note the intersections of substance use/abuse, having a safe place to live, and feeling secure in our livelihood. Feeling stressed about how you’re going to find a place to live, a meal to feed your family, or where you’re going to find your next paycheck from all are risk factors for the use and possible abuse of a variety of substances, that can, overtime, exacerbate a lifetime of chronic or debilitating health conditions.

Shelter

Shelter, in its most basic understanding, means having a roof over your head to protect you from the elements of the outside world. Many people have this base level of support, but even for those that do, is it necessarily still meeting our needs?

The answer is sometimes yes, but often no. Having a roof over your head does provide some comfort but is not always what most would consider ‘safe’. Would you feel safe living in an apartment that had mold growing on the ceilings and in the bathroom? Would you feel safe knowing that the only way you can afford heat is to turn on the oven? Would you feel safe if the lock on your door didn’t work, or there was a rat infestation in the building? Most likely, your answer is no. Part of having a place to live is feeling secure in that space.

“Two million people in the United States live in severely inadequate homes that lack heat, hot water, or electricity, or have structural defects or other severe problems, which have all been linked to poorer health outcomes.”[8]

We know that lower-income individuals and families often have little control over the environments in which they live, mostly as a result of the lack of affordable housing and wages, that have not kept up with housing costs in Connecticut and across the country. This is especially true for people of color who have been subjected to years of discrimination and segregation in housing.

Those living in poverty more frequently live in homes with mold, asbestos, lead paint, cramped spaces, infestations, and poor air quality. Approximately 2 million Americans are living in homes with severe structural problems, that lack heat, hot water, electricity, which have been identified as factors that contribute to poorer health outcomes. Families and individuals living in these spaces are more likely to face negative health effects like asthma, lead poisoning, heart disease, mental health impairment and even some forms of cancer.

Employment

“If you’re not making a lot of money, you’re not getting the health care you need.” – Wendell Potter, President of Businesses for Medicare for All[9]

With approximately 60% of Americans obtaining their health insurance through an employer[10], having a job becomes synonymous with having access to health care coverage. There is much to unpack in this dynamic, but most important becomes the reality that without a job, you may not have the funds to protect your health when it becomes most important to do so. Many people pass on opportunities to prevent illness at its onset because they lack the immediate funds to do so. Most will ride out the initial warning signs our bodies raise for us and hope these symptoms will either pass, or that they will be able to manage the worst of their symptoms without the intervention of medical professionals.

Many individuals in this country have to work one or more jobs just to make a living and do not have access to employer sponsored healthcare.  In many instances, employer-sponsored healthcare is expensive, and most cannot afford the copays or deductibles.  In these situations, essential healthcare services are often put off towards paying rent or putting food on the table.  In the United States, BIPoC have some type of health coverage but also have lower wages than white people, and often find themselves with generally less savings than their white counterparts and are often working lower wage jobs. We know that “minorities are less likely to have health insurance, and more likely to have respiratory illness”[11].

As we think about the pandemic, it’s important to note that many families of color are working in jobs that are deemed essential, are currently unemployed, or were just barely making ends meet before this  global health crisis. Having to decide between paying for food, health care, utilities or other necessities alongside paying rent increases the likelihood of eviction.  The goal is to look for policy solutions that  ensures safe and affordable housing for all – during a time of health and economic crisis.   

Resources

Following a crisis of any kind, communities come together to assist in helping to restore order and provide help to those in need.  This is especially true, during the coronavirus pandemic as many people are reaching out to their community support networks to access basic human necessities so they can keep themselves and their families safe. We know that all communities are not equal and access to resources may not be accessible or available. 

Resource deserts are a major concern in this regard. Where you live impacts the quality of life you lead. When the community you live in does not have a grocery store with healthy foods available, neighborhoods feel unsafe for people to spend time outdoors, or services or supports are not available within walking distance or a community lacks public transport to areas that do have these resources available, we know people’s health will suffer as a result. “Research indicates that socioeconomic factors [like these] could be responsible for as much as 40% of your overall health”[12].

There has always been disproportionate access to resources within communities where BIPoC often reside, which is connected – especially so in Connecticut, to racist and unjust redlining practices.

All of these factors are only being exacerbated by the current health crisis. Access to food, mental and behavioral health supports, medicine, protective equipment, technology and safety services like those provided by domestic violence shelters/centers, child protective services, and crisis hotlines are all struggling to meet the demands being elevated by the pandemic.

“When we don’t have a clear strategy that keeps equity at the center when distributing testing resources, we’re likely to see…disproportionate access” – Wizdom Powell, director of the Health Disparities Institute at UConn Health[13]

Families especially benefit from access to childcare and educational resources for their children. According to research conducted by the Economic Policy Institute, Connecticut is the 5th most expensive state for childcare in the United States. According to the U.S. Department of Health and Human Services, “child care is considered affordable if it takes up no more than 7% of a family’s income.” With only one child, a family’s median income is cut by 18.3%, and only 11.5% of families in the state fall into this category.[14] If a family cannot afford child care services in their communities, finding/maintaining employment and subsequently being able to afford rent can become increasingly prominent challenges.

Conclusion

The Reaching Home Campaign, among many others in the work of ending homelessness have long operated under the values of ensuring all humans have access to the basic necessities that allow us to live happy and healthy lives. The Homes for All campaign pledge includes the beliefs that “no person, regardless of race, gender, class, sexual orientation, age, ability, citizenship, or previous criminal or housing record should be denied a home nor forced to live apart of the networks and institutions our communities rely on to survive and thrive”.

Our health is dependent on the place in which we live. The factors that contribute to our health include our access to shelter, personal security, employment, resources, and health or as many are now calling it, the “Social Determinants of Health”. The policies we put in place set the stage for a person’s ability to survive and thrive within our communities. The theory of a hierarchy of human need shows plainly that having a safe, secure place to live, a stable income, and supportive services within the community to provide help when it is most needed DOES impact our health. Shifting our policies to be reflective of our holistic set of needs will ensure more equity, more affordability, and more security in our ability to be happy, healthy, and housed human beings.

For more information on the Reaching Home Campaign, our mission and our work, visit www.pschousing.org/reachinghome.

[1]  https://www.geisinger.org/health-and-wellness/wellness-articles/2017/03/29/16/26/heres-how-not-brushing-your-teeth-could-make-you-sick

[2] Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360(9339):1083-8.

[3] Margolin G, Vickerman KA, Oliver PH, Gordis EB. Violence exposure in multiple interpersonal domains: Cumulative and differential effects. J Adolesc Health. 2010;47(2):198-205. doi: 10.1016/j.jadohealth.2010.01.020.

[4] https://inequality.org/facts/inequality-and-health/

[5] https://www.msn.com/en-us/news/us/our-communities-are-suffering-frustration-grows-for-ct-minorities-amid-coronavirus-pandemic/ar-BB142yXr

[6] McCollister KE, French MT, Fang H. The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug Alcohol Depend. 2010;108(1-2):98-109. doi: 10.1016/j.drugalcdep.2009.12.002.

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137920/

[8] https://www.healthaffairs.org/do/10.1377/hblog20200319.757883/full/

[9] http://c-hit.org/2020/04/16/pandemic-exposes-stark-health-disparities-generations-in-the-making/

[10] https://www.futurity.org/health-care-insurance-employment-covid-19-2322532/

[11] https://www.msn.com/en-us/news/us/our-communities-are-suffering-frustration-grows-for-ct-minorities-amid-coronavirus-pandemic/ar-BB142yXr

[12] http://healthleadsusa.org/wp-content/uploads/2019/07/Report-Bridging-Gaps-to-Build-Healthy-Communities.pdf

[13] https://ctmirror.org/2020/05/12/frustration-growing-in-minority-communities-over-governments-response-to-pandemic/

[14] https://www.epi.org/child-care-costs-in-the-united-states/#/CT

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