Medical Education and Housing as Health Care

By Andrew Hyatt

Expectations of first-year medical students are mercifully low when we are presenting patients. So when I told my preceptor, “Jose is a 9-year-old male with a history of moderate intermittent asthma and ADHD presenting for an asthma exacerbation,” I was not expected to know much about the pathophysiology or pharmacotherapy of either ADHD or asthma. However, one thing I can bring to the table is a more in-depth social history. Taking the time to ask a few questions, I found out that Jose’s mother had moved between apartments three times in the last year, and that she still did not feel her new apartment or neighborhood were safe or healthy for Jose.

After presenting Jose to my preceptor, I was left with an uncomfortable question: Now what? Even as a first-year, I could hazard a guess as to the care of Jose’s asthma, and I could look up which of his medications I should have the pharmacy refill. But how was I to address the lack of a home? Our pharmacy does not carry that on its shelves, and my medical education so far had given me limited tools to address it.

Encounters with patients like Jose led me to spend the summer after my first year trying to learn as much as I could about the link between health, community development, and affordable housing. I was awarded a summer pediatric health advocacy fellowship through my school, and was able to supplement my knowledge of physiology and biochemistry with a new understanding of how community development affects health. Although second year looms and my time was too short, I have learned several things:

Housing is critical to health. Being deprived of stable affordable housing is detrimental to pregnant women and their children; decreases emotional, cognitive, and behavioral development in children; and kills homeless patients at a rate eight to nine times that of the general population.

Housing is health care. Providing affordable, stable, safe housing improves health by reducing developmental risk factors for poor children; decreases domestic violence, childhood hunger, and drug abuse; and lessens the need for emergency medical services among chronically ill, formerly homeless individuals.

Affordable housing is in crisis. While support for housing as a health intervention is slowly gaining traction, families are increasingly stretched trying to pay rent. Half of U.S. renters spend more than 30 percent of their income on rent, and waitlists for public housing and low-income rental vouchers (“Section 8”) are often years long, leaving individuals and families to suffer needlessly.

If there were a multi-year wait for a pill with all the beneficial effects of adequate housing, doctors would be up in arms trying to get their patients access to it. But given that doctors cannot just write a script for a healthy, affordable home, what role can academic medicine play in equipping physicians to address this crucial need in their patients?

First, residents can be trained to screen for housing insecurity in their patients, and can be trained to refer to local organizations. Second, medical students can be taught not just about health disparities, but also about interventions to address the social determinants of health. My first-year class, for example, was given training on how to advocate to utility companies and landlords to help prevent eviction and keep the lights on.

Medical schools and residencies that want to train the next generation of physician leaders and advocates can incorporate more education on interventions to promote access to affordable housing. Trainees can then take leadership in moving hospitals and health systems to address housing instability (as is already happening) and speak out to advocate to the public and policymakers for housing as a public health intervention. For the sake of the millions of patients like Jose, we can train our students to be more attentive to housing insecurity in the clinic and louder voices for our patients in the public square.

Hyatt AndrewAndrew Hyatt is a second-year medical student at the Boston University School of Medicine. He can be reached at ashyatt@bu.edu.

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