Impact of Housing Struggles A Big Factor in County Health Rankings

Lilo H. Stainton | March 22, 2019 | Health Care
Many Garden State households spend so much on housing that there isn’t enough money for good food and medicine

depression
Nearly one in five New Jersey households spend more than half their income on housing costs, leaving little money available for quality food, medications and other items that impact the health of the families involved.

That’s just one of the sobering findings in the 2019 County Health Rankings for New Jersey, part of a national annual report that compares counties in each state using data on outcomes like birth weight, wellness and mortality. The findings, which include multiple tables that break down the numbers by geography and demographics, also highlight significant racial disparities in many areas, including that black residents of any age die prematurely at nearly twice the rate of white ones.

The rankings, a product of the University of Wisconsin’s Population Health Institute and the Robert Wood Johnson Foundation, also consider health factors — like the rates of smoking, cancer screenings and vaccinations, education and income levels, and the impact of violence. (RWJF also supports NJ Spotlight.) These details can help policymakers focus on opportunities for change.

While income and racial disparities have been highlighted in the rankings reports released in recent years, the latest research focused particular attention on housing issues, particularly questions of quality and cost. Data from 2013 through 2017 showed that at least one in four black and Hispanic families in the Garden State face a particularly high burden, paying more than half their income for housing, compared to roughly 15 percent of white families.

Homes are ‘inextricably tied’ to health

“Our homes are inextricably tied to our health,” said Dr. Richard Besser, the president and CEO of RWJF. “It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing.”

Statewide, the latest rankings determined that Morris County had the healthiest outcomes in recent years, followed by Hunterdon and Somerset counties; these three have tended to place near the top in recent reports. The poorest health outcomes were found in Cumberland County, followed by Camden and Salem counties.

Click to expand/close
“Where New Jerseyans live, learn, work and play influences their health, and we know having safe, secure housing is a critical social determinant of health,” said New Jersey Health Commissioner Dr. Shereef Elnahal. He credited the state’s new minimum-wage increase — which calls for it to rise to $10 this year and $15 by 2024, for most workers — will help ease this burden.

There has been a growing focus in recent years on social determinants of health, or issues like poverty, housing, and community violence, which all play a role in health and wellness. The state has sought to collaborate across departments to address some of these issues and healthcare providers, businesses and local organizations have partnered in new ways to help keep people safe and well within their communities.

Attention has also shifted to the “housing first” model, in which organizations collaborate to ensure an individual has a stable home before addressing other issues, including addiction or chronic illness. Led in part by work by the Camden Healthcare Coalition, which is focused on treating patients with complex needs, these programs have developed in a number of communities and are expected to expand thanks to $12 million in state funding allocated to these initiatives last year.

Passaic, Essex, Hudson

According to the latest rankings, residents are facing the most severe housing problems in Passaic, Essex and Hudson counties; residents in Union and Atlantic counties are also significantly impacted. The measurement takes into account high housing costs when compared to income, overcrowding, or a lack of kitchen or bathroom facilities.

Toni Lewis, a community health strategist who works on local efforts that RWJF funds through its New Jersey Health Initiatives Program, said housing struggles often intersect with poverty and racial segregation. They can also connect with a host of other health-related factors, like access to education, medical care and good jobs, or levels of community violence.

But this overlap also offers opportunity, Lewis said, and a number of communities are working in unusual ways to improve health. Policy experts need to reach across their traditional professional boundaries — “silo busting” she called it — to work together and must also engage those who will be directly impacted by these efforts.

“That’s a really important first step,” Lewis said, referring to the need to engage community members directly. “It’s complex in itself and challenging but that’s where we start: looking at the data and having that conversation.”

As a result, she said leaders in Paterson have sought to expand access to healthy food and create medical clinics in local schools. Partnerships in Cape May have brought together business officials and schools to expand training for various trades — which can lead to higher-paying jobs — and others are working with the local police department to reduce the impact of traumatic incidents, like arrests, on young people. And leaders in Perth Amboy are just beginning a multi-stakeholder conversation on housing concerns, she said.

“The way we’re getting to solutions is really when we get people from different sectors working together. And it’s really happening,” Lewis said. “Healthcare is at the table in these conversations. They know they have a role to play,” she added, “but sometimes they have a limited capacity” to tackle these problems alone.