Investments with returns: a systematic literature review of health-focused housing interventions
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Investments with returns: a systematic literature review of health‑focused housing interventions Genevieve Davison1 · Dan Ferris1 · Adam Pearson1 · Ruth Shach1 Received: 9 January 2019 / Accepted: 29 October 2019 © Springer Nature B.V. 2019
Abstract Housing access and the built environment are both recognized as significant social determinants of health. Numerous studies and articles detail housing-based interventions that result in improved health outcomes. However, less is known about potential financial impacts and which programs and initiatives not only improve health but also generate return on investment (ROI). Through a systematic literature review, the authors identified evidence regarding the economic benefits of housing interventions aimed at improving health, using ROI as a measure of program success. Specifically, housing interventions that are aimed at childhood asthma, HIV, chronic illness among the homeless, and urban blight have demonstrated a positive ROI ranging from 30 to 480%, with most cost savings attributed to meaningful reductions in hospitalizations and emergency department visits. Keywords Housing · Health · Social determinants of health · Return on investment
1 Introduction 1.1 The connection between housing and health Housing has been established as a significant social determinant of health as access to housing and the safety of the built environment can affect both health and quality of life (Office of Disease Prevention and Health Promotion 2018). Likewise, sufficient evidence now shows that specific housing interventions can improve certain health outcomes (Jacobs et al. 2010). Looking back further, connections between housing quality and health * Dan Ferris [email protected] Genevieve Davison [email protected] Adam Pearson [email protected] Ruth Shach [email protected] 1
Brown School at Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
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have been well established, as multiple studies have examined how features of the built environment impact health. For example, homes in the United States, especially those built before 1978, can be a considerable source of lead exposure. This exposure can irreversibly affect brain and nervous system development and result in intellectual and learning disabilities (Committee on Environmental Health 2005). Additionally, multiple hazards often coexist in homes and cause co-occurring health problems. In-home exposure to factors such as tobacco smoke, cooking pollutants, asbestos, and volatile organic compounds are correlated with respiratory illnesses and some cancers (Bonnefoy et al. 2004). Serious injuries or death can be caused in part by the lack of or inadequacy in housing features such as smoke detectors, rail guards, balconies and heating systems (Braubach and World Health Organization 2011). Furthermore, mental health is also impacted by housing quality; for instance, crowded housing can result in poorer cognitive and psychom
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