I have been traveling a lot this fall to meetings with leaders in housing development, policy, and research, and I am always struck that the housing world is starting to connect the dots on housing and health, but they are not talking about the patients I see.

When talking to parents of young patients at Boston Medical Center, they often express defeat, frustration, or even guilt as they talk about their inability to pay rent on time, despite their best attempts at making ends meet. An impassioned father told me once that it’s near impossible for him to afford his family’s substandard apartment in a violent neighborhood without sacrificing other needs. Even though he works a full-time job, he and his wife are forced to skip meals and risk utility shut-offs just to keep a roof over the heads of their three children. On the day I met them, their three year old daughter was admitted to the hospital for the fifth time in her short life. Even though their two older children were healthy, their youngest daughter was diagnosed with multiple health problems, including epilepsy and developmental delays. She required more care than usual for children her age, causing her mother to quit work and care for her full-time. A downward spiral soon started.  The family began struggling to keep up with the high costs of rent, food, utilities, and medical care.

Unfortunately, this family is not alone in their difficulties paying rent. Boston is rapidly gentrifying.  As luxury condominiums attract wealthier residents, the rents for everyone rise while wages for low-income workers remain stagnated. Nationally, a survey conducted by the John D. and Catherine T. MacArthur Foundation found that in the past three years, over half of adults in the US made at least one sacrifice, including accumulating credit card debit, working overtime, cutting back on  health care, and/or stopping retirement savings in order to pay rent on time. The housing crisis may be over for financial analysts, but for renters, especially those who are forced to pay upwards of 30% of their paychecks each month toward rent, the struggle to afford rent along with other basic necessities is an ongoing crisis.

In a previous blog post, we highlighted the negative impacts of homelessness on child health and called for a Housing Vaccine that moves families out of homelessness and into safe, stable housing, protecting them over the long term. Vaccines provide so-called ‘herd immunity’ – in other words, the more people in a population who are vaccinated, the more protected the whole population is from being infected by contagions.  In housing, the more of our neighbors are protected in stable housing, the more protected we all are. While families with young children experiencing homelessness are on one extreme of this crisis, thousands of families are the hidden crisis, just one pay check and missed rent payment away from homelessness.   Their children are suffering now. We know that children whose families are behind on rent are more likely to be in fair or poor health, child food insecure, at risk of developmental delays, and below average in length or height (an indication of under-nutrition).  It is time to face the fact that we cannot solve the crisis with band-aids like time-limited vouchers.  We need real, sustained treatment like long-term rental assistance, a Housing Vaccine. In the medical community we call this a ‘trivalent vaccine’ because it serves three purposes:  The Housing Vaccine helps families to gain access to affordable, stable, and quality housing options.

The reality is three out of every four of my patients are on waiting lists for the Housing Vaccine. Mayor Walsh recently kicked off his Housing a Changing City: Boston 2030 initiative and while we laud the effort to attack the very real housing problem in Boston, this plan focuses on housing for middle income families and does not go far enough in building affordable housing for families who need the Housing Vaccine.

Vaccinating our communities over the long-term is not an easy task.  It requires innovative solutions from both the public and private sectors. National, state, and local officials must work together to invest in housing subsidies, build more affordable housing, and ensure that quality standards for low-income housing are met or exceeded.