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Housing Instability and Homelessness in Pediatrics: A Narrative Review of Health Impacts and Multi-level
Emma M Hartswick Finch1, Aura M Obando2, Janna R Gewirtz O'Brien3
1Department of Medicine (EM Hartswick Finch), Boston Children's Hospital, Boston Mass; Department of Pediatrics (EM Hartswick Finch), Boston Medical Center, Boston Mass.
Insights
Stable housing is crucial for child health. Pediatricians can advocate for policies and interventions to support children and families facing housing instability and homelessness, improving pediatric health outcomes.
Area of Science:
- Pediatric Health
- Public Health
- Social Determinants of Health
Background:
- Safe and stable housing is fundamental for child and adolescent well-being.
- Housing instability and homelessness pose significant health risks to children.
- The relationship between housing and health is complex, with multiple influencing factors.
Purpose of the Study:
- To examine the impact of housing stability, instability, and homelessness on child and adolescent health.
- To explore advocacy interventions for pediatricians to support vulnerable youth and families.
- To synthesize evidence on housing's role in pediatric health for research, practice, and policy.
Main Methods:
- This narrative review synthesized existing research on housing and child health.
- Identified key mechanisms through which housing affects pediatric health outcomes.
- Explored practical advocacy strategies for pediatricians at various levels.
Main Results:
- Stable housing promotes educational and economic opportunities, leading to better health.
- Unsafe housing increases exposure to health and injury risks.
- Housing instability and homelessness cause chronic stress and disrupt community support systems.
Conclusions:
- Housing is a critical driver of pediatric health.
- Pediatricians have a vital role in addressing housing challenges through advocacy.
- Clinical and systems-level advocacy is essential for improving the health of unstably housed children and families.
Objective:
Safe and stable housing is foundational for child and adolescent health; likewise, housing instability and homelessness are associated with significant pediatric health risk. This narrative review sought to 1) describe the impact of stable housing, housing instability, and homelessness on child and adolescent health, and 2) explore advocacy interventions for pediatricians to support unstably housed children, youth, and families. While the relationship between health and housing is complex, here, we describe three primary mechanisms through which housing impacts pediatric health. Safe, stable, and affordable housing supports educational and economic opportunity for children and their families, and is associated with positive health outcomes. Poor quality and unsafe housing negatively affects health through increased exposure to risk factors for illness and injury. Finally, housing instability and homelessness create chronic stress that is detrimental to health, increase exposure to risk factors for poor health, and disrupt supportive connections to community resources. Though screening is a prerequisite for identifying housing needs among patients, it must be coupled with clinical and systems-level advocacy to improve youth and family health. We describe advocacy interventions that pediatricians can incorporate into their practice that target needs at the clinical, institutional, community, and policy levels This review highlights the importance of housing as a driver of pediatric health, and the opportunities that pediatricians have to address housing challenges through advocacy. By synthesizing the current evidence on the health impacts of housing, this work hopes to inform further research, clinical practice changes, and policy.
What This Narrative Review Adds:
This review explores the health implications of housing on children, youth, and families and describes impactful advocacy opportunities for pediatricians to support patients with barriers to stable housing.
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