As a pediatrician and researcher on how housing affects child health, I see the unintended consequences of public policy playing out on the bodies on my patients every day. I was particularly struck by the series of New York Times articles featuring Dasani, an 11 year old homeless child, which illustrated how homelessness affects all aspects of child health and development. What was so striking about Dasani’s story was how much this family was costing the system with an enormously expensive substandard shelter space, active involvement of child protection agencies, avoidable emergency room visits, and multiple rehab hospitalizations. Despite these costly interventions, Dasani and her family had terrible results – poor health, high rates school absences, and increased stress. The crushing reality is that I know one thousand Dasanis.  We are wasting children’s potential. It’s time to get serious about how to solve homelessness on a systemic level.

Last week, my colleague Stephanie Ettinger de Cuba and I presented at the Beyond Housing Conference in New York. Since then I’ve been thinking more and more about how we can move beyond homelessness to stable housing for all families. We have previously published a blog post related to this topic titled, The Housing Vaccine: Why Housing Matters to Young Children. In the current crisis of homelessness among young families, this vaccine is needed more than ever.

It’s time to be realistic. We can pay now and invest in proven solutions like housing subsidies that have been shown to improve child health and well-being, or we can continue to pay for disjointed services that achieve worse outcomes and cost us more over the lifetime of a child. Our research at Children’s HealthWatch shows just how powerful a housing subsidy can be in the life of a young child and his/her family. In a study we published almost ten years ago, young children in families that received a housing subsidy were healthier and less likely to be suffering from signs of undernutrition than children whose families did not have a housing subsidy.  A subsidy helps to stabilize families, helping them to avoid moving frequently, being doubled up for economic reasons, or living in overcrowded housing – each of which carries their own health risks for children.  Moreover, few recognize just how protective subsidized housing can be for young children in the face of other kinds of hardships.

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. But again, like many vaccines, a booster is needed.

In Dasani’s case, the state of New York used a short-term voucher of just two years, which provided only minimal benefit and after the voucher ran out, the family ended up homeless again. It’s like giving the first shot in a series, but not finishing the set of vaccines. Very few homeless families can stay permanently housed with such a short subsidy.  We should learn from this, and come to understand permanent income-adjusted housing subsidies as an effective housing vaccine worth investing in.

As a society, we need to think about ending homelessness and investing in housing vouchers in the same way we think about investing in vaccines. It’s not just about preventing the individual illness; it is about keeping a community healthy. If the child sitting next to our own children in class is homeless and therefore disruptive or struggling with the material, that affects the ability of every child in the classroom to learn. We know that permanent housing vouchers are effective at ending homelessness; now it’s just a matter of harnessing the political will to invest in them.

Photo credit: New York Times