Housing and Transit

The housing options and transit systems that shape our communities’ built environment affect where we live and how we get from place to place. The choices we make about housing and transportation, and the opportunities underlying these choices, also affect our health.

Housing

Our homes, and those of our neighbors, play a critical role in shaping our health and the health of the whole community. Housing is related to health through several pathways [1]. First, the safety and quality of our homes are correlated with health. Exposure to lead from pipes and paint can irreversibly harm brain and nervous system development. Improper insulation can expose occupants to extreme temperatures associated with increased mortality, especially among the very young, old, or sick. Asthma, can be exacerbated by indoor allergens such as mold and dust and residential crowding has been linked to both physical illness (e.g., infectious disease) and psychological distress.

The affordability and stability of housing are also important determinants of health. Housing is a substantial expense, reflecting the largest single monthly expenditure for many individuals and families. In 2015, 38.9 million American families were considered “cost burdened” spending more than 30% of their income on housing, and nearly half of those (18.8 million) were “severely cost burdened” spending 50% or more. For low-income families, being cost burdened decreases the likelihood of being able to pay utility bills, to have a usual source of medical care, or having a sufficient supply of food or prescribed medicines. Having low income and being cost burdened also increases the likelihood of housing instability and homelessness. Foreclosure has been found to be associated with poor health outcomes such psychological distress, increased alcohol use, and suicide. Homelessness has many long-standing psychological and physical adverse impacts on health and well-being. Even children who experienced homelessness only while in utero are more likely to be hospitalized or suffer worse health, compared to their peers.

Lastly, the neighborhoods in which our homes are located can have a profound impact on our health. The availability and accessibility of resources such as public transportation, grocery stores, and safe spaces to exercise are all correlated with improved health outcomes. A neighborhood’s social characteristics, including residential segregation, crime and social capital can affect health, as well. For instance, residential segregation can widen health disparities through determining access to schools, jobs, and health care; influencing health behaviors; and increasing crime rates in neighborhoods of color.

Working together, however, communities can adopt policies and programs that ensure access to safe, quality housing for everyone. 

Transit

Transit includes public systems such as city or regional buses, subway systems, and trams as well as cars and bikes, sidewalks, streets, bike paths, and highways. Together, this varied and complex system connects people to each other, and to the places where they live, learn, work, and play.

Local transit options can support active, energy-efficient travel. Too often, however, neighborhoods lack sidewalks, safe crossings, or shared transit services that support these choices. Across the US, we depend heavily on motorized travel, especially cars, to get from place to place: in 2017, the average American drove more than 10,000 miles [2]. Most of our nation’s workers (nearly 88%) get to work in a car. And, we often drive very short distances; almost half of all trips in America are two miles or less, and 74% of these are traveled by car [3].

Dependence on driving leads to 40,000 traffic-related deaths annually and exposes us to air pollution, which has been linked to asthma and other respiratory illnesses, cardiovascular disease, pre-term births, and premature death. It also contributes to physical inactivity and obesity—each additional hour spent in a car per day is associated with a 6% increase in the likelihood of obesity, whereas each added kilometer walked per day is associated with a nearly 5% reduction in obesity risk [3].

Creating and adopting policies that support active travel and encourage shared transportation can not only help to increase physical activity and reduce obesity, but also reduce traffic-related injuries and deaths and improve the quality of our environment.

References

[1] Braveman P, Dekker M, Egerter S, Sadegh-Nobari T. Housing and health. Princeton: Robert Wood Johnson Foundation (RWJF); 2011. Exploring the Social Determinants of Health Issue Brief No. 7.
[2] U.S. Department of Transportation, Federal Highway Administration. Summary of Travel Trends: 2009 National Household Travel Survey. Report No. FHWA-PL-ll-022  June 2011.
[3] Robert Wood Johnson Foundation (RWJF). How does transportation impact health? Princeton: Robert Wood Johnson Foundation (RWJF); 2012. Health Policy Snapshot Public Health and Prevention Issue Brief.

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Our Rankings show how healthy a community is as well as indicators for future health. This provides a starting point for action on improving health for all. Dig deeper into the measures below to learn more about our approaches to measuring health.

Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities.

When it comes to developing and implementing solutions to problems that affect communities, evidence matters. The strategies below give some ideas of ways communities can harness evidence to make a difference locally. You can learn more about these and other strategies in What Works for Health, which summarizes and rates evidence for policies, programs, and systems changes.

Train volunteers, professionals, or paraprofessionals to help residents assess and remediate environmental home health risks and recommend low cost changes (e.g., improved ventilation, integrated pest management, etc.)
Provide rapid access to permanent housing and support (e.g., crisis intervention, needs assessment, case management), usually for chronically homeless individuals with persistent mental illness or substance abuse issues
Support a combination of land uses (e.g., residential, commercial, recreational) in development initiatives, often through zoning regulations or Smart Growth initiatives
Introduce or expand transportation options that are available to the public and run on a scheduled timetable (e.g., buses, trains, ferries, rapid transit, etc.)

The County Health Rankings provide a snapshot of a community’s health and a starting point for investigating and discussing ways to improve health. Select a state below to see what’s happening locally.