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"A House, a Tent, a Box": Mapping the Gaps Between Expert and Public Understanding of Healthy Housing 15 Untranslated Expert Story of Healthy Housing What is healthy housing? • Broadly defined: "Health" is understood to include physical health, mental health, community health, and well- being more generally. • Multidimensional: "Healthy housing" refers to housing that supports health, broadly understood, by being safe, stable, affordable, and free of toxins. • Community context: A home can only be healthy if it is in a neighborhood that is healthy. What are the problems with housing? • Lack of affordability: There is a shortage of affordable healthy housing options. • Market distortions: The housing market does not value investments in health- related improvements (e.g., improving ventilation or removing lead paint). • Income disparities: Those with lower incomes have fewer housing choices and limited mobility, and are therefore more likely to live in unhealthy housing. • Disparities by immigration status: Immigrants without documentation often have limited housing options and no mechanisms for lodging complaints about unhealthy housing conditions. • Residential segregation: Neighborhoods are often segregated by race and by income, leading to concentrated areas of unhealthy housing. How does housing affect health? • A core determinant with varied mechanisms: Housing is a core determinant of health. It affects not just physical health, but also mental health, stress, satisfaction and happiness, self- esteem, and community cohesion. It does so through multiple pathways. • Toxins: Toxins in homes remain a serious problem, often because their dangerous effects are unrecognized and unseen. • Urban infrastructure: Transportation options and other aspects of local infrastructure affect health in serious but under-recognized ways. • Financial decisions: When housing is not affordable, people make tradeoffs that negatively impact health. • Cascading effects: Low-quality housing can cause a spiral of health problems, missed employment, and loss of income—thus leading to even worse housing conditions. • Prevention: More resources should be devoted to prevention activities, such as frequent and mandatory housing inspections that cover health-related issues (both for individually owned homes and rentals). • Built environment: Environments must be "built for health." They should be walkable and provide access to jobs, healthcare, quality foods, and social interactions. • Affordability: Policies should be enacted that increase the availability of affordable housing through subsidies, zoning, public housing, and land trusts. This should include housing for people who are currently homeless. • Integration across fields: The health and housing "elds should be better integrated (e.g., by sharing information and pooling funds to target the root causes of health problems). How should housing be improved?

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