Prescribing Housing: A Scoping Review of Health System Efforts to Address Housing as a Social Determinant of Health

Koeman, Jamison; Mehdipanah, Roshanak

doi:10.1089/pop.2020.0154

Cited by 22 publications

(46 citation statements)

References 41 publications

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“…Like homelessness, these less severe but more prevalent dimensions of housing insecurity are associated with less access to health care, worse mental and physical health, and increased mortality. [6][7][8][9][10] Recognizing the health implications of housing insecurity, health systems have begun to invest in housing, 2,11,12 and Medicare Advantage plans can now provide rental assistance to eligible enrollees if there is a reasonable expectation of health improvement. 13 Prior reviews have evaluated the association of primary prevention interventions for housing insecurity with health outcomes, but decades-old data, 14 pediatric focus, 15 and inconclusive findings 14,15 limit their utility for stakeholders deciding where in the prevention pathway to target housing investments to improve adult health in a contemporary context.…”

Section: Introductionmentioning

confidence: 99%

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes

et al. 2022

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ImportanceHousing insecurity—that is, difficulty with housing affordability and stability—is prevalent and results in increased risk for both homelessness and poor health. However, whether interventions that prevent housing insecurity upstream of homelessness improve health remains uncertain.ObjectiveTo review evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access.Evidence ReviewPairs of independent reviewers systematically searched PubMed, Web of Science, EconLit, and the Social Interventions Research and Evaluation Network for quantitative studies published from 2005 to 2021 that evaluated interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households (targeted primary prevention) or by enhancing community-level housing supply and affordability in partnership with the health sector (structural primary prevention). Risk of bias was appraised using validated tools, and the evidence was synthesized using modified Grading of Recommendations Assessment, Development, and Evaluation criteria.FindingsA total of 26 articles describing 3 randomized trials and 20 observational studies (16 longitudinal designs and 4 cross-sectional quasi–waiting list control designs) were included. Existing interventions have focused primarily on mitigating housing insecurity for the most vulnerable individuals rather than preventing housing insecurity outright. Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance. No studies evaluated health system–partnered structural primary prevention strategies.Conclusions and RelevanceThis systematic review found mixed and mostly low-certainty evidence that interventions that promote housing affordability and stability were associated with improved adult health outcomes. Existing interventions may need to be paired with other efforts to address the structural determinants of health. As health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway interventions should focus for the most effective and equitable health impact.

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Section: Introductionmentioning

confidence: 99%

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes

et al. 2022

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“…Scoping reviews are successfully applied across many disciplines including planning and the built environment, such as Carnemolla and Bridge (2020), Koeman and Mehdipanah (2020), and Wolf et al (2020).…”

Section: Methodsmentioning

confidence: 99%

“…This approach enabled us to identify gaps in the literature, pointing the way for researchers of the future to focus their efforts. Scoping reviews are successfully applied across many disciplines including planning and the built environment, such as Carnemolla and Bridge (2020), Koeman and Mehdipanah (2020), and Wolf et al (2020).…”

Section: Scoping Reviewmentioning

confidence: 99%

Outcomes Associated with Providing Secure, Stable, and Permanent Housing for People Who Have Been Homeless: An International Scoping Review

Carnemolla

Skinner

2021

Journal of Planning Literature

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As governments and service agencies across the world grapple with chronic rates of homelessness and housing instability, there is a growing need to understand the value that providing secure, stable housing brings to the lives of people who are homeless and the broader community. The complex nature of homelessness is revealed across a variety of academic fields including planning, pharmacology, urban affairs, housing policy, nutrition, psychiatry, sociology, public health, urban health, and criminology. We undertook a scoping review according to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis) that mapped the breadth and scale of the evidence-base and identified themes and gaps. We identified 476 reports and after excluding duplicates and ones that did not relate to our criteria, were left with 100 studies from eight countries. Each of them identified benefits and/or changes that occurred when people experiencing homelessness or housing insecurity transitioned into a secure, stable home. Outcomes measured were distributed across a range of domains including physical and mental health, well-being, mortality rates, criminal justice interaction, service use, and cost-effectiveness. Findings varied by degree but overwhelmingly found improvements in all domains once people were permanently housed. Housing provided a foundation for people to envisage a better life and make plans for the future. As one woman who had fled a violent home was quoted as saying: “housing made everything else possible.” The research identified savings for taxpayers and the wider community once people left homelessness for the stability of a permanent home, even after factoring in the cost of housing and rental help. We found numerous gaps. For example, there was a prevalence of studies that focused on those who are visibly homeless, in particular chronically homeless men with mental illness and/or substance use issues. Much less research looked at women whose patterns of homelessness are more varied and even less at homelessness involving children and families. Women who had left domestic and family violence were investigated in a very small number of studies and sample sizes were small. Few reports undertook the complex task of quantifying and comparing cost savings. Other notable gaps were older women, older people more generally, refugees, recent migrants, veterans, Indigenous people and those with a disability.

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“…For example, a recent study reported that at least seven hospitals in California were implementing PSH programs, more than found in other states (Potter et al, 2020). However, health plans have conducted limited research on the outcomes from implemented PSH programs (Koeman and Mehdipanah, 2020;Kuehn, 2019).…”

Section: Supportive Housing Interventions and Implications For Health...mentioning

confidence: 99%

Implementation and 12-Month Health Service Utilization and Cost Outcomes from a Managed Care Health Plan's Permanent Supportive Housing Program

Hunter¹,

Scherling²,

McBain³

et al. 2021

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This document represents our third report on a permanent supportive housing (PSH) program operated by a large not-for-profit Medicaid and Medicare managed care plan in Southern California. This PSH program combines a long-term housing subsidy with intensive case management services for adult plan members experiencing homelessness who have one or more chronic physical or behavioral health conditions and represent high utilizers of inpatient health care. In this report, we provide an update from our previous reports in terms of program implementation through September 2020, describing participant characteristics, program referrals, enrollment timelines, housing placements, and program exits. We also assess the impact of the program by examining health care service utilization and associated costs in the 12 months prior to and the 12 months following program enrollment, in comparison with an observational control group of adult plan members who were not enrolled into the program. We describe the health care utilization and associated costs between the transitional period (i.e., after program enrollment but before receipt of housing) and the housed period (i.e., after individuals are placed into PSH). Finally, we report PSH programmatic costs to provide an overall picture of the impact of the program on payer costs. This report should be of interest to public and private health care organizations and other entities considering the potential of PSH programs to lower their costs, improve service quality, and reduce homelessness in their communities. The Inland Empire Health Plan sponsored this research. Community Health and Environmental Policy ProgramRAND Social and Economic Well-Being is a division of the RAND Corporation that seeks to actively improve the health and social and economic well-being of populations and communities throughout the world. This research was conducted in the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being. The program focuses on such topics as infrastructure, science and technology, community design, community health promotion, migration and population dynamics, transportation, energy, and climate and the environment, as well as other policy concerns that are influenced by the natural and built environment, technology, and community organizations and institutions that affect well-being. For more information, email

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Prescribing Housing: A Scoping Review of Health System Efforts to Address Housing as a Social Determinant of Health

Cited by 22 publications

References 41 publications

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes

Outcomes Associated with Providing Secure, Stable, and Permanent Housing for People Who Have Been Homeless: An International Scoping Review

Implementation and 12-Month Health Service Utilization and Cost Outcomes from a Managed Care Health Plan's Permanent Supportive Housing Program

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