Housing is an important social determinant of health and well-being. Unfortunately, many Canadians, including British Columbians, do not have access to adequate housing. Statistics Canada defines a household as being in core housing need if their housing is unsuitable (e.g., not enough rooms), inadequate (e.g., in need of repairs), or unaffordable, and if they are not able to afford alternative housing in their community. In 2021, 10.1% of Canadian households faced core housing need, with BC having the highest provincial rate, at 13.4%.[1] There are several pathways through which housing can impact physical and mental health, including housing affordability, residential stability, housing conditions and quality, and neighborhood factors.

Housing affordability

While there is no single definition of housing affordability, the Canada Mortgage and Housing Corporation defines it as housing costs that are less than 30% of a household’s pretax income.[2] The 2021 census showed that 25.5% of people in BC spend more than 30% of their income on housing, the highest of any province.[3] The health impacts of housing affordability are generally understudied, but there is evidence for adverse physical and mental health impacts. Additionally, a lack of affordability can strain people’s ability to pay for things such as nutritious food or prescriptions.[4]

Residential stability

Residential stability refers to a household’s ability to voluntarily remain in their home, free from dispossession or harassment.[5] Involuntary moves can occur due to the inability to afford increasing rents or mortgage payments, eviction, foreclosure, or natural disasters. Residential instability is associated with many negative health outcomes, including poorer self-rated health and increased emergency department use.[6] Housing foreclosures following the recession of 2007–2009 were associated with increased depression, anxiety, alcohol use, psychological distress, and suicide.[7]

Housing conditions and quality

Housing conditions and quality encompass a wide variety of factors that occur within the home that can impact human health.[5] For example, people can be exposed to lead through drinking water running through lead pipes or through lead-based paints in older homes. Thermal regulation is another important component of housing quality, and the inability of some homes to provide sufficient cooling contributed to mortality and morbidity experienced during BC’s 2021 heat dome and other extreme temperature events. Additionally, pests, molds, and allergens can contribute to allergic sensitization, asthma, and other respiratory health issues.

Neighborhood factors

Neighborhood factors and the built environment where people live shape opportunities that can have significant impacts on health.[5] There is evidence that areas with high socioeconomic deprivation have poorer access to health-promoting resources and greater exposure to environmental harms.[8] Having access to reliable and affordable public transportation can promote access to health-promoting activities such as seeking medical care, going to the gym, accessing healthier food, and building social connectedness. Living in a neighborhood that is more walkable and has more green spaces and parks can promote increased physical activity, while greater access to full-service supermarkets can contribute to healthier diets.

The evidence linking housing and health is clear, but there is a need to further understand impacts in the BC context. Regardless, it is important for clinicians to recognize the many ways housing can both positively and negatively impact health.
—Jia Hu, MD, MSc, CCFP, FRCPC
Medical Lead, Prevention and Health Promotion, BCCDC
—Rebecca Hasdell, PhD, MPH
Lead, Determinants of Health and Health Equity, BCCDC
Adjunct Faculty, Northern Medical Program, Faculty of Medicine, UBC

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This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [11].

References

1.    Statistics Canada. Core housing need in Canada. Modified 23 April 2024. Accessed 26 September 2024. www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2022056-eng.htm [12].

2.    Canada Housing and Mortgage Corporation. About affordable housing in Canada. 2018. Accessed 26 September 2024. www.cmhc-schl.gc.ca/professionals/industry-innovation-and-leadership/industry-expertise/affordable-housing/about-affordable-housing/affordable-housing-in-canada [13].

3.    Statistics Canada. Map 4: Unaffordable housing rates are down across Canada in 2021, except in Alberta. Modified 21 November 2022. Accessed 26 September 2024. www150.statcan.gc.ca/n1/daily-quotidien/220921/mc-b004-eng.htm [14].

4.    Taylor LA. Housing and health: An overview of the literature. Health Affairs. 7 June 2018. Accessed 26 September 2024. www.healthaffairs.org/content/briefs/housing-and-health-overview-literature [15].

5.    Swope CB, Hernández D. Housing as a determinant of health equity: A conceptual model. Soc Sci Med 2019;243:112571.

6.    Jaworsky D, Gadermann A, Duhoux A, et al. Residential stability reduces unmet health care needs and emergency department utilization among a cohort of homeless and vulnerably housed persons in Canada. J Urban Health 2016;93:666–681.

7.    Tsai AC. Home foreclosure, health, and mental health: A systematic review of individual, aggregate, and contextual associations. PLoS One 2015;10:e0123182.

8.    Doiron D, Setton EM, Shairsingh K, et al. Healthy built environment: Spatial patterns and relationships of multiple exposures and deprivation in Toronto, Montreal and Vancouver. Environ Int 2020;143:106003.