Beginning Life Without a Home

As the Covid-19 pandemic lingers, many are concerned its effects on employment and housing will lead to more evictions and homelessness. Although we often picture people who are homeless as single adults with chronic health challenges, three in 10 people experiencing homelessness are members of a family with young children.

Research shows that unstable housing affects young children’s health in many ways, but we know relatively little about how it influences them over time. How long health problems last is a particularly important question for health care providers and policymakers who must understand and address both current and long-term consequences. With support from the Health Resources and Services Administration, MassHealth (Massachusetts’ Medicaid program) and the Massachusetts Department of Housing and Community Development, my colleagues and I explored this question among Massachusetts Medicaid members who used emergency shelter for homeless families between 2008 and 2015.

Using MassHealth claims and admission data from emergency shelters for homeless families, we identified 5,762 infants born in the 12 months before or after their family entered a homeless shelter. We chose this broad window because studies have shown that housing instability, such as frequent moves or doubling up with other families, often precedes shelter use and can affect health. Infants experiencing homelessness were matched with a similar group of MassHealth members born during the same month. We compared medical diagnoses, health care use, and spending for up to six years.

Unstable housing impacts children’s health directly by exposing them to stressful environments and increasing their susceptibility to common childhood diseases.

All participants had continuous health care coverage and relatively good access to care. For example, homeless infants had only slightly fewer well-child visits than the comparison group in the first year of life. Infants who experienced unstable housing resulting in homelessness had significantly higher rates of common conditions like upper respiratory infections, fever, and allergic reactions. They were also more likely to have less common health problems such as low birthweight, asthma, injuries, and developmental disorders. They visited emergency rooms more often and were more likely to be admitted to a hospital. In most cases these differences lasted for two to three years after birth. But asthma, emergency room use, and health care spending continued at higher rates through age six.

Unstable housing impacts children’s health directly by exposing them to stressful environments and increasing their susceptibility to common childhood diseases. It also subjects them indirectly to adverse experiences that can have lasting health effects. Some consequences of unstable housing appear to diminish over time. Others may continue to undermine physical and mental health for many years. Adults who experienced homelessness in childhood reported more adverse childhood experiences, which are associated with increased risk of a variety of adult health problems, including suicide and substance use disorders.

Health care providers can improve screening and use targeted interventions to identify and treat many of the problems we identified. But prevention would be even better. Hope for lasting population-level solutions almost certainly lies beyond healthcare. Infants exposed to unstable housing in our study had many more health concerns, despite having continuous health coverage and reasonably good access to healthcare. Policies that recognize the critical importance of early child development in the life course and offer better economic and housing support for young families can reduce housing instability. And, like so many other health problems, race-based discrimination in housing plays an important role in placing minority families at greater risk of unstable housing and homelessness.

Reducing the impact of homelessness on children demands a broad understanding of health policy that acknowledges and begins to address the fundamental economic and racial disparities that underpin family homelessness in the United States.

Photo via Getty Images