Housing plays part in health outcomes

Delaware County ranks first in Ohio while Adams County, located in the state's southern tip, ranks last in health outcomes based on quality-of-life factors that include where you live, according to the 2019 County Health Rankings released Tuesday.

Researchers with the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute,

who compile annual health rankings for every county in the nation, are focusing this year on where people live, whether they experience severe housing problems and how having a good, affordable home is tied to healthy living.

“We know that a safe and secure and affordable place to call home is a critical foundation for good health,” said Karen Odegaard, an associate researcher at the Population Health Institute.

The cost of housing plays a significant role, especially with low-income families and people of color who are disproportionately burdened, she said.

Delaware County benefits the most, and Adams County the least, when it comes to health factors in four areas: access to and quality of care; social and economic issues; behaviors; and physical environment.

Housing comes into play in the last category, with the report exploring the percentages of households that are overcrowded, paying more than half of income on housing or lacking plumbing or kitchen facilities. In that single category, rural Putnam County in northwestern Ohio fares the best in the state with 7 percent of households having those problems. Athens County in southeastern Ohio, home to Ohio University, fares the worst, with 23 percent.

Rachel Kleit, the associate dean for faculty affairs at Ohio State University’s College of Engineering, has studied housing as a strategy to alleviate poverty. Poor housing conditions have long contributed to health problems, she said, but that’s now exacerbated by rising housing costs.

“There are a hell of lot more renters than owners with severe housing-cost burdens,” Kleit said. And that often means having to move, which creates more instability for parents and their children.

In central Ohio, 17 percent of Franklin County families struggle with severe housing problems because of high costs. In Delaware County, 10 percent of families have such problems; in Pickaway and Madison counties, 11 percent; in Licking and Union counties, 12 percent; and, in Fairfield County, 13 percent.

When families lack affordable housing, it leaves them with less money to pay for things such as healthy food and medications, said Zach Reat, an analyst at the Health Policy Institute of Ohio. Further, he added, poor housing quality, including exposed lead or mold, can have a direct and severe effect on health.

Children, especially, can be affected by these quality issues, said Dr. Kelly Kelleher, vice president for community health at Nationwide Children’s Hospital. Also, poor housing can affect parents who might experience depression or stress related to fear of being displaced and have less time to focus on children.

And, in neighborhoods where crime is high, people of all ages report worse health outcomes, Kelleher added.

“Housing and health,” he said, “are inseparable.”

Another issue related to housing involves families doubling or tripling up in a unit to save on housing costs, leading to crowding, which also leads to health issues, said Bill Faith, executive director of the Coalition on Homelessness and Housing in Ohio. Faith said 21,000 children are homeless in Ohio, 3,000 of them younger than a year old.

“You think about a pregnant mom trying to live out of a shelter, moving place to place while pregnant or with a newborn,” he said. More than 18,000 eviction cases are filed each year in Franklin County, the highest in the state.

Policymakers at all levels, Reat said, are beginning to see the importance of housing to overall health. Until such social and environmental issues are addressed, achieving good health in Ohio will remain a challenge, he said.

Neighborhoods near Nationwide Children’s Hospital, Kelleher said, have benefited from collaboration in the area between healthcare, government, nonprofit and business groups, but such collaborations need to be extended to outside neighborhoods, counties or rural areas.

“Health-care institutions … they’ve never felt empowered in many cities, so many of them don’t have a housing expert, they don’t know how to get involved and they don’t get paid to do housing,” Kelleher added. “So for various reasons, they have stood aside and shrugged their shoulders.”

The report measures income inequality by county, too. Franklin County ranks 19th in terms of inequality between groups at the higher and lower ends. Athens Countyis at the top of the inequality list.

“We see increasing income inequality,” Kleit said. “We have a lot of jobs, but a lot don’t pay very well.”

Also striking and telling in the 2019 rankings is the health disparity among races, Reat said.

Based on length and quality of life, black Ohioans as a group are less healthy than the people living in the unhealthiest county.

Overall, Ohio has higher smoking and obesity rates, inactivity, sexually transmitted infections and deaths due to injury than the nation. It also experiences higher air pollution.