Severe housing problems

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

The 2021 County Health Rankings used data from 2013-2017 for this measure.

Reason for Ranking

Good health depends on having homes that are safe and free from physical hazards. When adequate housing protects individuals and families from harmful exposures and provides them with a sense of privacy, security, stability and control, it can make important contributions to health. In contrast, poor quality and inadequate housing contributes to health problems such as infectious and chronic diseases, injuries, and poor childhood development. Housing measures can also be considered proxy indicators of more general socioeconomic circumstances.[1] Households experiencing severe cost burden have to face difficult trade-offs in meeting other basic needs. When the majority of a paycheck goes toward the rent or mortgage, it makes it hard to afford health insurance, health care and medication, healthy foods, utility bills, or reliable transportation to work or school.[2-5] This, in turn, can lead to increased stress levels and emotional strain.[6,7]

Key Measure Methods

Severe Housing Problems is a Percentage

Severe Housing Problems is the percentage of households with one or more of the following housing problems:

  1. Housing unit lacks complete kitchen facilities;
  2. Housing unit lacks complete plumbing facilities;
  3. Household is overcrowded; or
  4. Household is severely cost burdened.


The numerator is the number of households in a county with at least one of the above housing problems. Incomplete kitchen facilities is defined as a unit which lacks a sink with running water, a stove or range, or a refrigerator. Incomplete plumbing facilities is defined as lacking hot and cold piped water, a flush toilet, or a bathtub/shower. Overcrowding is defined as more than 1 person per room. Severe cost burden is defined as monthly housing costs (including utilities) that exceed 50% of monthly income.


The denominator is the total number of households in a county.

Can This Measure Be Used to Track Progress

This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 5-year average. However, in most counties, it is relatively simple to obtain single-year estimates from the resource listed below. In addition, this measure is a composite of the 4 housing problems. It might be of interest to break these out using the data source listed below to more appropriately track progress.

Data Source

Years of Data Used


Comprehensive Housing Affordability Strategy (CHAS) data

The U.S. Department of Housing and Urban Development (HUD) periodically receives "custom tabulations" of data from the U.S. Census Bureau that are largely not available through standard Census products. These data, known as the "CHAS" data (Comprehensive Housing Affordability Strategy), demonstrate the extent of housing problems and housing needs, particularly for low income households. The CHAS data are used by local governments to plan how to spend HUD funds, and may also be used by HUD to distribute grant funds.

Digging Deeper
Age 0
Gender 0
Race 1
Education 0
Income 1
Subcounty Area 1

Overcrowding by race can be calculated from tables B25014A-I, which can be accessed at Lack of complete plumbing or kitchen facilities, housing costs as a percentage of income, and overcrowding can be calculated for census tracts and census block groups using table DP04. Severe cost burden can be found in census tables B25074 and B25095 broken out by owners/renters. 

In addition, the Community Commons Health Equity Assessment Report provides a census tract map of the rate of substandard housing. Note, you will need to log in to the website in order to access these reports.


[1] Shaw, M. (2004). Housing and public health. Annu. Rev. Public Health25, 397-418.

[2] Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of general internal medicine21(1), 71-77.

[3] Ma, C. T., Gee, L., & Kushel, M. B. (2008). Associations between housing instability and food insecurity with health care access in low-income children. Ambulatory Pediatrics8(1), 50-57.

[4] Long, S. K. (2003). Hardship among the uninsured: choosing among food, housing, and health insurance.

[5] Levy, H., & DeLeire, T. (2003). What do people buy when they don't buy health insurance and what does that say about why they are uninsured? (No. w9826). National Bureau of Economic Research.

[6] Hiscock, R., Kearns, A., MacIntyre, S., & Ellaway, A. (2001). Ontological security and psycho-social benefits from the home: Qualitative evidence on issues of tenure. Housing, theory and society18(1-2), 50-66.

[7] Dunn, J. R. (2000). Housing and health inequalities: review and prospects for research. Housing studies15(3), 341-366.

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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
Purchase land to lease to homeowners with low and middle incomes and require them to sell the home back to the CLT or to another resident with low income at an affordable price

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 and a measure below to see what’s happening locally.