The Unintentional Effects of Low-Income Housing on Health

Third year biology and Spanish major and Healthcare Policy Team co-lead Angela Nguyen discusses the implications of low-income housing on health, as well as what the state of Georgia is doing to address these concerns.

While the United States spends the most GDP per capita on health compared to other wealthy countries, healthcare in the US only accounts for about 10% of modifiable contributors to health outcomes. (1, 2). Meanwhile, social determinants of health (SDoH) account for about 90% of those contributors (2). SDoH are health-related behaviors, socioeconomic factors, and environmental factors. Housing is considered an SDoH. Considering recent surges in housing costs within the past five years, it is evident that more affordable housing is required especially through the lens of public health (3). Without affordable housing, individuals face increased risk of chronic disease, mental health issues, and higher mortality rates, not to mention the considerable financial strain placed on families for other necessities such as food and medical care (4). 

However, the affordable housing that currently exists often has structural deficiencies such as plumbing issues, mold, and poor insulation (5). This, in turn, can lead to higher rates of asthma, cardiovascular disease, and respiratory disease. Individuals who are low-income and/or racial minorities are more likely to live in housing with adverse health attributes, as well as face residential instability and affordability issues (6). A lack of affordable housing disproportionately effects historically marginalized populations, necessitating a need to improve not just the availability of affordable housing but also its quality.

Approximately 15.2% of occupied housing units in Georgia have one or more problems, such as a lack of complete kitchen facilities, a lack of plumbing, overcrowding, or severely cost-burdened occupants (7). Additionally, 30% of homes in Georgia were built prior to 1978, so they likely contain lead paint. This connects to elevated blood lead levels among 3,450 Georgia children in 2024 (8). Although having housing, even if inadequate, provides better health outcomes than being homeless, all housing should still be constructed and maintained to meet basic living standards. 

Currently, Medicaid care management organizations (CMOs) can be contracted by states to reinvest in communities they serve for the sake of improving health (9). A proposal from the Georgia Department of Community Health in September 2023 requires that CMOs reinvest in communities to address non-medical health risk factors like housing, yet this requirement would only apply to new contracts (10). Furthermore, community reinvestment is voluntary in Georgia, through which Medicaid funds could otherwise be used to further address housing needs.

Georgia has existing contracts with three CMOs: Amerigroup Community Care, CareSource, and Peach State Health Plan (11). In 2022, CareSource invested $2.5 million to increase the amount of affordable housing available in Metro Atlanta in collaboration with the Atlanta Neighborhood Development Partnership (ANDP). This helped to expand the number of ANDP’s single family rentals from 20 to 200 homes. However, there is no record of formal health assessments evaluating the quality of these homes and whether they adequately mitigate health hazards beyond measuring lead levels (12).

In addition to current initiatives that increase the availability of affordable housing, Georgia should also allocate resources for a statewide healthy home inspection program that comprehensively assesses health safety and provides remediation support for repairs. Such a program should provide routine standardized health evaluations for affordable and low-cost housing developments in particular, evaluating environmental quality or hazard mitigation for homes typically occupied by individuals that are more likely to be vulnerable to health risks. 

As Georgia navigates different solutions to resolve health disparities in our state, it is important to recognize that no single solution is sufficient to remedy a large-scale problem such as a lack of affordable housing. By incorporating measures to assess the quality of affordable housing, the state can better evaluate the efficacy of its Medicaid spending and overall effectiveness in addressing social determinants of health.

Sources:  

1. McGough, M., Telesford, I., Rakshit, S., Wager, E., Amin, K., & Cox, C. (2025, April 9). How does health spending in the U.S. compare to other countries? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#GDP%20per%20capita%20and%20health%20consumption%20spending%20per%20capita

2. Magnan, S. (2025, January 2). Social Determinants of Health 101 for Health Care: Five Plus Five - NAM. NAM. https://nam.edu/perspectives/social-determinants-of-health-101-for-health-care-five-plus-five/

3. Federal Reserve Bank of St. Louis. (2018). Average Sales Price of Houses Sold for the United States. Stlouisfed.org. https://fred.stlouisfed.org/series/ASPUS

4. How Affordable Housing Impacts Public Health | Habitat Charlotte Region. (2025, August 12). Habitat for Humanity Charlotte Region. https://www.habitatcltregion.org/blog/how-affordable-housing-impacts-public-health

5. Culli, L. (2025, March 14). New Insights into Connection Between Housing Quality and Population Health | Johns Hopkins Bloomberg School of Public Health. Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2025/new-insights-into-connection-between-housing-quality-and-population-health

6. Swope, C. B., & Hernández, D. (2019). Housing as a determinant of health equity: A conceptual model. Social Science & Medicine, 243(1), 112571. https://doi.org/10.1016/j.socscimed.2019.112571

7. Explore Severe Housing Problems in Georgia | AHR. (2026). Americashealthrankings.org. https://www.americashealthrankings.org/explore/measures/severe_housing_problems/GA#measure-trend-summary

8. CRITICAL FEDERAL FUNDING FOR HEALTHY HOUSING. (2025). https://nchh.org/resource-library/fact-sheet_state-healthy-housing_ga.pdf

9. Shippy, A., Silver, S., & McClendon, S. (2024). Community Reinvestment: Forging New Partnerships in Medicaid. Manatt.com. https://www.manatt.com/insights/newsletters/health-highlights/community-reinvestment-forging-new-partnerships-in

10. Dong, H. (2025, May 28). How Medicaid Can Fund Housing Support in Georgia - Georgia Budget and Policy Institute. Georgia Budget and Policy Institute. https://gbpi.org/how-medicaid-can-fund-housing-support-in-georgia/#_edn8

11. Care Management Organizations (CMO). (n.d.). Georgia Medicaid. https://medicaid.georgia.gov/programs/all-programs/georgia-families/care-management-organizations-cmo

12. Healthy Homes and Lead Poisoning Prevention. (n.d.). Georgia Department of Public Health. https://dph.georgia.gov/environmental-health/healthy-homes-and-lead-poisoning-prevention