Spotlight Exclusives

The Housing Vaccine: Why Housing Matters to Young Children

Dr. Megan Sandel and Dr. Deborah A. Frank, Children’s HealthWatch Dr. Megan Sandel and Dr. Deborah A. Frank, Children’s HealthWatch, posted on

In collaboration with the John D. and Catherine T. MacArthur Foundation’s How Housing Matters Initiative, Spotlight on Poverty and Opportunity will be running a series of commentaries for the next two months exploring the relationship between housing and three topics: health, economic opportunity, and education. Please be sure to read Michael Stegman’s “An Introductory Note to learn more.

This commentary is the second installment in the series, which is entitled “How Housing Matters to Families and Communities.”

People sometimes ask us why, as practicing pediatricians, we care so much about housing. Our answer is “How can we not?” For many of our patients, a safe, decent, affordable home is like a vaccine—it literally keeps children healthy. That’s why it’s essential for policymakers to take account of children’s health when making housing policy.

Extensive medical and educational research shows clearly how much housing matters to children. We, with our pediatric and public health colleagues, conduct such research as part of Children’s HealthWatch, a pediatric research center studying the impact of nutrition, housing, and energy policy on very young children from birth to three years old. Our research has shown how profound the influence of housing policy is on young children’s health, growth, and development, with its impact extending into the womb.

Because of the uniquely rapid rates of growth of both the body and brain in the earliest years, young children are immensely vulnerable to deprivation. Unfortunately, this deprivation is often invisible to all but their families and their healthcare providers.

How can housing problems lead to destructive deprivation?

First, it’s critical to recognize that family homelessness represents the extreme end of a continuum of economically driven housing conditions that endanger young children. We term this range of conditions “housing insecurity”—a concept analogous to the measurement of food insecurity.

“Housing insecurity,” quantifies less visible forms of housing stress than homelessness. This consists of doubling up with other families for economic reasons, overcrowding, or moving two or more times in a year—conditions that put children at risk of negative impacts on their health.

Children in families who move this frequently are not only more likely to be food insecure but are 50 percent more likely to be in fair or poor health – as opposed to good or excellent health – and children in these families are 70 percent more likely to be at risk of developmental delays than similar children whose families do not move that often.

Housing insecurity can also impact child health even before children are born. Our most recent analyses show that women who experience homelessness during pregnancy are 50 percent more likely to have a low birth weight baby and over 30 percent more likely to have a pre-term delivery than similar women who were not homeless during pregnancy.

The good news is that housing policy can make a difference. Our research has shown that housing subsidies will protect families from both housing insecurity and food insecurity. Similar to receiving one shot against multiple diseases,  young children who live in subsidized housing are much more likely to be  “well”—developmentally normal, not underweight or overweight, in good or excellent health, and  with no history of hospitalizations.

That housing subsidies can alleviate the negative impacts of housing insecurity may not be surprising. Yet few recognize just how protective subsidized housing can be for young children in the face of other kinds of deprivation. In the same way that some vaccines decrease the severity of an illness though they may not fully prevent it, housing subsidies double the chances that young children in families suffering from food insecurity will avoid stunted growth when compared to other young food insecure children whose families do not receive housing subsidies.

Add up the negative effects of poor housing and the potential upside of housing subsidies, and it’s clear housing is one of the best investments we can make. We spend substantial public funds each year to care for low birth weight babies or to alleviate the impact of ill health and developmental delays in early childhood. Yet every dollar spent in housing can play a part in helping to prevent many of these negative outcomes before they happen.

Professor David Williams put it best in the documentary Unnatural Causes: “Housing policy is health policy.” Housing matters, particularly to young children. Strategic investments in the critical developmental window from pregnancy to three years of age can, quite literally, change the trajectory of a child’s life.

When administering childhood vaccinations, we make sure a child receives the right dose. The same goes for housing. Just as vaccines in early childhood have a lifelong payoff for a child and society, making sure families can avoid housing insecurity is preventive medicine that will help put a child on the right path from the beginning.

Dr. Megan Sandel is a research scientist at Children’s HealthWatch.

Dr. Deborah A. Frank is the founder and principal investigator of Children’s HealthWatch.

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