A year ago, through the kindness of a friend, I finally got a home. I moved into a one-bedroom apartment with my cats in a quiet neighborhood after a year of homelessness. And in this year, I have been able to heal and find myself again.
We talk about social determinants of health, but I think few people really understand how impactful they truly are, particularly housing.
Social determinants of health refer to factors in our lives that affect our physical and mental health. They are ““the structural determinants and conditions in which people are born, grow, live, work and age.” They include housing, education, access to food, socioeconomic factors, access to healthcare. According to How Housing Matters: “Research estimates that behaviors, social circumstances, and environment—broadly known as social determinants of health—determine approximately 60 percent of our overall health, outweighing the importance of health care and genetics.”
The Kaiser Family Foundation has a good graphic incorporating all SDoH’s here:
I could state personally how each of these factors has negatively impacted my health – how being on disability at less than $11,000 a year, having massive medical, law school, and college debt has affected every part of my life. How when I didn’t have a car it compromised my ability to get and keep jobs in Austin and increased my risk for skin cancer while I waited for buses that never came on time with no shade and sunscreen took too much out of my budget. How the poor walkability in Austin meant extra hardship, especially when it came to grocery shopping. How there was a lack of access to sustainable healthy foods because of limited food stamps. How discrimination of my mental health diagnoses impacted my social integration. And certainly how going without insurance for over three years limited my access to the healthcare I needed.
But today I’ll focus on housing.
My Housing Story
Housing instability hit me hard in January 2013, the same time I started to think about filing for disability. While it had always been difficult to pay rent, with my mental and physical health diagnoses I could not maintain work enough to make a reasonable income. I was working with Travis County for financial assistance to make my rent. I cobbled money together when I could. I think I actually lost an hope of working with IBM again after freaking out at them when their accountants made a mistake in getting me my check and I thought I’d be facing eviction.
I did get eviction letters. They’re terrifying. Every ounce of security is taken from you. And on top of it all was a deep sense of shame and self-hatred for being in this situation.
As my physical and mental health deteriorated and my financial situation deteriorated my housing also deteriorated. I couldn’t afford to move though the apartments I lived in were literally falling apart – cracks in the foundation, management that didn’t want to make reasonable accommodations and violated disability laws. And they were increasing rent as the city of Austin became more and more expensive to live in as a destination for all things startup and tech.
It became a perfect storm and one I needed to escape. And so I left in February 2015 to seek a better housing situation – one with more stability, support, affordability. And I failed. And society failed me. The situations caused more chaos and trauma for everyone.
By October 22, 2015, I was homeless. A few friends let me sleep in a spare room for 2 weeks but then they didn’t want me anymore – it was “too much” for them… They and everyone else thought I could simply apply for low-income housing and get a section 8 voucher and all would be fine. I knew though from years of in Austin that it wasn’t this easy. I knew from reading and calling before I even left Austin that most places had years long waitlists – often I’d hear at least 4 years and the waitlist to get on the waitlist for section 8 housing was closed. Housing is desperate everywhere. And no city in America is really affordable for someone living below the federal poverty limit.
So what then? I knew I wasn’t wanted, I was a burden on society, I had no hope of a home and nowhere to go. I thought the best thing for everyone would be to kill myself and so I attempted. I spent a few days in an ICU and was shipped off to a psych ward for 3 weeks – one of the worst place I’ve ever been in – a place I still have nightmares about. I stayed there not because they felt I needed to be there – the didn’t change my medication or make me more safe. They actually looked to see if there was a housing situation for me but there was none. I didn’t need assistive living of any sort or institutionalization. There was nowhere for me to go. When they released me, they got me a ride to my car. I had a little bit to stay a few nights in a motel. And then I lived in my car. I tried to find another place but everything was too expensive and with my credit, I couldn’t get approved. After a sublet fell through, in despair yet again, I attempted once more. The doctor there said I could stay an extra day so I didn’t have to spend Christmas alone and then they printed out a bus route for me that would take 3 buses, 2 miles walking to get back to my car – it had just snowed and I only had flip flops from the hospital. From there, friends were able to put some money together to get me into a motel. I was terrified living there, I felt completely unsafe. I kept the curtains drawn 24/7 and was afraid to go outside except for therapy and groceries, but I got to have my cats (and their litterbox at the end of my bed) and a bed and a microwave. My health improved slightly with the stability but I felt more like I was living in a cage, scared and alone.
Until July 30, 2016. A generous friend offered to cosign on an apartment with me and help subsidize the rent. I moved in with only the things in my car and my cats. All of my things had been infested with mice while in storage. I slept on the hard floor – but it was my floor. Then a friend of a friend gave me a beat up mattress and some sheets, some glasses, and I could finally start to make this place my home. And it is with a home that I’ve really been able to move forward. I’m the healthiest I’ve been mentally and physically for at least the last 5 years. I started hiking on occasion. My blood sugars came down as I was able to address my eating disorder more. Some of my chronic pain has decreased (some days, not all). I still stay in a lot but I’m no longer stuck at my 4/8 rule. I can open the blinds. I see kids chasing the adorable baby bunnies. My neighbor takes his cat Max for walks. I can get to my appointments, the pharmacy, and grocery store without fear. I can watch the sunset over the mountains. And I’ve been able to start a new project.
With the stability and security of housing, I am able to engage in life. I fear every day that it could be taken away from me again – if my friend can no longer help, what then? Denver is only getting more expensive, “affordable housing” solutions from the city do not mean they are affordable to low income individuals. I am still on waitlists for places I applied for almost 2 years ago. The right to housing is not recognized and few actually see the benefit of providing housing. My story alone likely won’t persuade them that what I needed for the past few years wasn’t more doctors and certainly wasn’t hospitals, it was housing.
Since data can often be more convincing, I’ll put it in numbers. From November 5, 2015 to December 31, 2015, Medicare paid doctors and hospitals over $21,785.49. That is nearly $11,000 per month. And taxpayers paid for it. You paid $11,000 per month when you could have spent 1/10 of that on helping me find housing.
Perhaps that just makes you angry with me and the system that I would somehow get care that you pay for. I would argue to that point, I did not ask for the care – society deemed it necessary that I should live. And if society so badly wants me to live, there is a cost. That cost just didn’t have to be as high as society made it. With housing 90% of that money would have been saved and perhaps I’d have reached this point of stability long ago – able to contribute more to society.
But it’s bigger than me or my story. According to How Housing Matters:
Nearly 9 million Americans live in extreme poverty, with poor quality housing, poor schools, poor job access and other factors significantly and negatively impacting their physical and mental health.
In their recent article, Writing a Prescription for Housing, they wrote:
There is a link between stable, decent, and affordable housing and positive health outcomes. Housing plays into social determinants of health in several different ways:
- Families lacking affordable housing options are at higher risk of lead poisoning and exposure to mold and other allergens, which can trigger asthma. Green housing retrofits improve general and respiratory healthby removing harmful indoor air allergens.
- As Matthew Desmond wrote in Evicted: Poverty and Profit in the American City, the rent eats first. When a large portion of a family’s income goes toward rent, there is little leftover for food and health care expenses. Cost-burdened adults are less likelyto fill prescriptions and follow health care treatments.
- … Clustering in high-poverty neighborhoods exacerbates stress and leads to lower social cohesion, both of which negatively affect health.
- Frequent moves can disrupt health care services, especially for people with chronic diseases. Children lacking stable housing are more likely to use costly emergency servicesinstead of visiting a regular health care provider. Housing loss can contribute to job loss, which has further health implications. The number of years spent in one’s residence—an indicator of stability—is connected to residents’ behavioral and mental health.
So what can be done? There are many initiatives around the country trying to address the issues of homelessness and low income housing. One initiative that’s held great promise is Housing First. As How Housing Matters describes it:
Housing First is an evidence-based program that provides permanent housing to people experiencing homelessness. It is coupled with access to supportive services that residents can use to address mental health, employment opportunities, or issues with substance abuse. Provision of supportive housing through these programs reduces health care expenditures for homeless individuals and families. Although supportive housing programs cost money, they can reduce health care spending. These savings have led to the integration of these interventions into pay for success projects.
If you ask me, it’s makes common sense to provide housing. It’s far cheaper than paying for someone to stay in a hospital for emergency care, paying for treatments when chronic illness worsens, or simply the lost productivity of a society that is ill because of instability. But shouldn’t it be the compassionate side of our humanity that we want and offer housing to every individual? And not just tiny houses or motel rooms, but actual stable, secure, healthy housing where people can heal and grow?
Housing Is A Human Right
Housing is and should be realized as a human right. It is so inextricably linked with health that one could say that the right to health is not fulfilled without it. The international community and international rights laws agree that housing is a right. It is enshrined in Article 28 of the Convention on the Rights of Persons with Disabilities, Article 31 of the Revised European Social Charter, and the African Charter on Human and Peoples’ Rights. The UN Committee on Economic, Social and Cultural Rights, further states that the right to housing includes: legal security of tenure; availability of services, materials, facilities and infrastructure; affordability; habitability; accessibility; location and cultural adequacy.
And the Yogyakarta Principles state that
everyone has the right to adequate housing, including protection from eviction, without discrimination and that States shall a) take all necessary legislative, administrative and other measures to ensure security of tenure and access to affordable, habitable, accessible, culturally appropriate and safe housing, not including shelters and other emergency accommodation, without discrimination on the basis of sexual orientation, gender identity or material or family status….
Housing is a human right – an it’s more than just a roof over one’s head, it’s a home.
In December 2015, I plead for a home. I explained how that would help me beyond any medical measure. Almost nine months later, through the incredible generosity of a kind soul and donations from others, I finally got one. And I’m doing so much better a year later.
I’m lucky. I’m lucky to have had others who could help me. I’m beyond fortunate to have been given this chance to find stability. And I will never be able to express my gratitude for this gift. But what about the other millions of Americans who don’t?
There’s a lot that you can do to get involved to help with affordable housing – you can start by becoming involved with your city or county where many affordable housing laws and initiatives start – including disability issues, funding for housing, where and how housing is built. In Denver, you can link up with the Colorado Coalition for the Homeless – most cities have similar organizations that you can work with as well. If you’re tech oriented, you can look for projects to help with through Code for America or other local projects that often focus on city issues. You can volunteer at food pantries and donate to charities helping the homeless. I wrote a few ideas helping the homeless here and for giving here. You may also find some information and inspiration following the #OurHomesOurVoices hashtag that was used last week for the National Housing Week of Action. And you can simply have compassion and understanding for others who are facing homelessness or housing instability – no matter what their circumstances.
We all deserve a home and the opportunity to heal and grow and live a full life.
 Michael Marmot et al., “Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health,” The Lancet 372, no. 9650 (Nov. 8, 2008):1661–1669.