A rise in the cost of housing hurts the physical and mental health of societies’ poorest people, while boosting the health of its richest, a systematic review of 23 studies around the world has found.
The research, published last month in the journal BMC Public Health, examined the impact of changing housing prices on renters, homeowners and multiple income levels across East Asia, North America and Australia.
The review found a strong link showing rising housing prices improved the health of homeowners and higher-income people. But for renters and low-income people, a surge in the cost of housing was correlated with a decline in overall mental and physical health.
Ashmita Grewal, the lead author and a master's student in the faculty of health sciences at Simon Fraser University (SFU), said while the review did not include any studies in Canada, she hopes the work will inspire more investigations into what is happening in places like B.C.
“Housing is incredibly important for our health and well-being. It’s not just important for gaining capital or as an investment tool,” said Grewal. “It’s a basic living requirement.”
Supervised by Kiffer Card, an assistant professor in SFU’s faculty of health sciences, the research team was able to identify a “tale of two markets” by looking at an aggregate of all the studies’ results.
Card said they were not able to quantify the effects of housing on health because the impacts were so widespread — influencing everything from people’s mental health to their daily decisions.
Stress leads to direct health problems
When it comes to mental health, Card said that living under a chronic state of stress has been show to increase rates of heart disease and dampen immune responses.
“When people experience financial strain, they perceive that as a stressor, their hypothalamic pituitary adrenal access ramps up, and that causes physical wear on the body,” said Card.
The stress of not owning a home, can also wear people down due to social pressures and expectations around being safe and secure in life. Homeownership is often a core part of the American, Canadian or European dream, and a way people evaluate their overall quality of life, Card explained.
Take that prospect away, and you remove people’s sense of stability. The resulting feelings of insecurity is a natural evolutionary response, and one that further feeds people’s stress.
Card has identified that same chronic stress mechanism in past research into the health impacts of social isolation and climate change.
Housing prices influence decisions on health
A second way rising housing prices negatively impact the poorer population is behavioural, said Card.
“Obviously, people being priced out of the housing market leads to homelessness, and that is catastrophic for people's health and well-being...” he said.
But even before people are homeless, they start making sacrifices. They stop buying quality food or give up a meal altogether so their children can eat. They stop exercising because they have to get second job or pick up another shift at work.
Penny Gurstein, a professor emeritus and co-director at UBC’s Housing Research Collaborative, said the results line up with a longitudinal study she co-authored over a decade ago.
That three-year study, which included interviews with single mothers on income assistance every six months, found many of the participants faced a number of health challenges. Those included allergies and asthma due to living in damp, mould-filled homes, and a lack of food.
“These mothers were taking their children in for medical assistance. And they knew it was because of where they were living,” said Gurstein. “People were finding at the end of the month, they weren’t being able to eat adequately.
“I imagine it’s even worse now. It’s gotten so much more extreme.”
According to Card, when a problem is outside a person’s control (like the housing market), people tend to turn to passive coping strategies. Often that includes some form of escapism, whether through scrolling endlessly on social media or turning to substances like alcohol, tobacco, marijuana or opioids to lower stress, distract oneself or find other sources of joy and entertainment.
“That's a major reason people end up using substances, is to escape from the pressures that they're experiencing in their daily lives,” Card said.
In the end, all of those reactions stack up to more negative health outcomes — and not just for individuals.
“When you look at a population level, like many of these studies did, you start to see that this is driving up health-care costs from that added stress, that behavioural pressure,” said Card.
Homeowners, rich see improvements with rising housing prices
On the flip side, homeowners and those with a higher income tend to see their wealth increase as the cost of housing — where many hold their investments — increases. That increase in wealth brings greater security, which in turn, helps them lead happier, healthier lives, the review found.
UBC political scientist Stewart Prest said the research speaks to other studies showing a growing class gap between renters and owners in Canada and around the world.
“A lack of housing has a variety of costs. Some are explicit. Some are implicit,” he said. “This kind of study allows us to see some of the hidden costs.”
UBC business professor Tom Davidoff warned against attributing health impacts on rising home prices without controlled experiments. He said a rise in housing prices may have started in a booming economy, or the root cause of falling health outcomes could be due to worsening air quality — a result of an industrial boom.
“There’s lots of ways these studies can go wrong,” he said. “Without an experiment, there’s a lot of other stuff going on. But my instinct is that it’s pretty true. Having looked for homes in Vancouver, it’s pretty stressful — I can attest to that.”
Card said the implications of their review are enormous and have repercussions for societies around the world, including Canada. For policymakers and voters, making choices about how to regulate the housing market and the economies they reside in comes with trade-offs.
“Are we going to choose policies that really address health inequalities, particularly those affecting low-income people, or are we going to prioritize, those kind of the mainstream homeowner and higher-income groups?” Card said.
“That's a real tension.”
