Poor Living Conditions

[Baldomero Prado]

Thissummary of the literature on Quality of Housing as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Crime and Violence, Environmental Conditions, and Housing Instability literature summaries.

In addition, low-income families may be more likely to live in older homes and homes with greater risks that can impact health outcomes.1 For example, these homes may be under-insulated, lack air conditioning, and cost more to heat, leaving homes too hot or too cold, which has been linked to poorer health outcomes.3,4,16 Additionally, limited finances may result in a lack of housing maintenance, which can lead to poor housing conditions inside the home (e.g., damaged appliances, exposed nails, or peeling paint) as well as outside the home (e.g., damage to stairs and windows).6

This microsite is coordinated by the Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services.

Service members reported to GAO that the conditions of barracks affect their quality of life and readiness. However, GAO found weaknesses in the Department of Defense's (DOD) efforts to maintain and improve their conditions. For example,

By developing or clarifying guidance related to these weaknesses, DOD could better prioritize investments in barracks to improve living conditions for service members and help ensure that barracks housing programs across military services are consistently implemented and support quality of life and readiness.

The Joint Explanatory Statement and Senate Report 117-39, accompanying bills for the National Defense Authorization Act for Fiscal Year 2022, included provisions for GAO to review DOD's efforts to maintain and improve military barracks. This report examines, among other things, the extent to which DOD has (1) reliably assessed barracks conditions, (2) made informed decisions on barracks funding, and (3) conducted oversight to improve barracks.

GAO analyzed DOD policies, budgets, and other documentation; interviewed DOD housing officials; toured barracks at a non-generalizable sample of 10 installations; and met with installation officials and barracks residents.

GAO is making 31 recommendations for DOD, including the military departments, to, among other things, provide guidance on barracks condition assessments, obtain complete funding information, and increase oversight of barracks programs. DOD concurred with 23 of the recommendations and partially concurred with 8, in some cases noting ongoing actions that would address them. GAO continues to believe DOD should fully implement all of these recommendations.

Worldwide, a child under the age of 15 dies every five seconds, mostly of preventable causes that poverty exacerbates. And though impoverished living conditions are often perceived as confined to cities, the poverty rates in rural areas continue to exceed those in urban areas in several countries, including Romania, Indonesia and the U.S.

In many regions of the world, the number of low-income households far exceeds the affordable housing units available. In the U.S., for every 100 renter households classified as extremely low-income, just 35 rental units are both available and affordable. Globally, the housing affordability gap, meaning the difference between income available for housing and the market price of a standard housing unit in a region, amounts to nearly $650 billion per year.

Nowhere in the U.S. can a worker earning the federal or prevailing state minimum wage rent a two-bedroom apartment without having to pay more than 30% of their income. In fact, a minimum wage worker must clock nearly 127 hours per week, more than three full-time jobs, to afford a two-bedroom rental, or 103 hours per week, more than 2.5 full-time jobs, to afford a one-bedroom, according to the National Low Income Housing Coalition.

But a safe, decent, affordable place to live can make a real difference in the life of a family. Homeownership has long been the primary way for families to build wealth. Homeownership also offers stability because monthly mortgage payments are predictable whereas rents can increase year over year. A stable home is important for academic achievement. Children who change schools as their families move in search of more affordable housing can struggle to keep up academically.

Habitat for Humanity proves that decent housing can be a path out of poverty for families in need of a hand-up, and every day, you help us partner with families in the U.S. and nearly 70 other countries to create stable homes and vibrant neighborhoods.

Together, we have helped millions of people build or improve the place they call home. With your help, we also advocate to improve access to decent and affordable shelter and offer a variety of housing support services that enable families with limited means to make needed improvements on their homes as their time and resources allow.

\"This is just by far the worst situation I've ever seen,\" he told ABC News. \"The desperation is just beyond belief. All the children I saw were sick. All the children I saw were living in the cold, irrespective of whether intended or not.\"

Medical staff who have returned from deployments spoke with ABC News about the poor hygiene conditions and inadequate water supply that have led to the spread of infections and diseases, children being disproportionately affected and often seemingly small injuries proving fatal.

Kahler is a co-founder of the nonprofit MedGlobal, which has been conducting aid missions in Gaza. At the organization's clinic in the southern city of Rafah, Kahler said staff saw 600 to 700 patients a day, about 200 of whom were children, mostly under 6 months old.

He said there were outbreaks of respiratory syncytial virus (RSV) that often led to a wheezing illness called bronchiolitis in the youngest patients. He also saw children with breathing problems due to smoke, because fire is the only form of heating for many families living in tents.

\"One hundred percent of the children under 6 months of age had a diarrheal illness,\" he said. \"The vast majority of those children had significant diaper dermatitis and you say 'diaper dermatitis' and it sounds relatively benign. But, in this particular situation, with no Pampers access, no clean water access, no hygiene access, In the cold, it can be a very, very difficult situation to deal with.\"

His co-worker, Dr. Zaher Sahloul, president and co-founder of MedGlobal and a critical care specialist in Chicago, said he recalled a few children who came into the clinic, one being a 4-year-old girl name Lama.

According to Sahloul, Lama had been living in a tent with 15 other members of her family and had bloody diarrhea. He said Kahler examined her and gave her oral rehydration fluids, which improved her condition.

Amy Leah Potter, nursing activity manager for the Doctors Without Borders or Mdecins Sans Frontires (MSF) emergency team in Gaza, said some of the biggest issues she saw during her month-long deployment were poor hygiene conditions and inadequate water and sanitation.

\"The hygiene conditions are deplorable, through no fault of the population,\" she told ABC News. \"It's overcrowded, multiple people living in tents; there is no running water, there's no proper drainage.\"

Potter estimated at the Sinai Peninsula in Egypt, where she crossed into Gaza, there were about 2,000 aid trucks lined up to enter Gaza, but with only about 100 entering per day and some periods with no aid entering at all.

Israel, supported by Egypt, has restricted the movement of goods and people in and out of Gaza since Hamas came to power in 2007. The restrictions have tightened since the war began with Israel saying it is trying to limit Hamas' access to weapons, officials said.

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) said Israel does not provide enough authorization to deliver sufficient aid and, even when it does give authorization, the fighting makes it difficult to deliver aid.

\"This is a desert so there's no fresh water,\" Potter said. \"You have to get it from water distribution points, which are just trucks that drive up and then people queue for several hours to try and get water. But if you queue for water, that means you're probably missing the queue for medicine that day or the queue for food. So you kind of have to make decisions.\"

Temperatures in Gaza are also extremely cold. Potter said she was wearing four layers at a time during her first two weeks there. However, most families do not have as many clothes and sleep in poorly constructed tents, exposing themselves to the elements and the risk of smoke inhalation or injuries from the fires used to keep themselves warm.

\"Every day it got worse and worse and worse, more and more tents,\" Potter said. \"When I first came, there were no tents on the beach, because the winds are so strong, you wouldn't want to put a tent there. By the end [of the month-long deployment], the beach was full. There's nowhere to put anybody.\"

He said he saw many patients with chronic diseases who didn't have access to medicine. This included diabetic patients who couldn't get access to insulin and dialysis patients, who usually get dialysis three times a week but were getting dialysis once or twice a week at most.

Staff are often left to treat patients with few supplies and little to no room, Hassan said. One patient Hasan said he remembers very well was a pregnant woman who visited the clinic. Pregnant women and new mothers in Gaza in particular have been facing life-threatening challenges to accessing safe care, putting their health and the health of their babies at risk.

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