In my last post, I wrote about a study we conducted using results of the 2015 Behavioral Risk Factors Surveillance System survey that measures the relationship between food and housing anxiety and health outcomes. Among the observations we made, for the 12 states (including the District of Columbia) for which there was data, we calculated a 48.12% probability that people who are always or usually worried about having enough money for food and housing have poor or fair health, compared to 27.28% for people who only sometimes worry about having enough money for food or housing. Noting that these relationships are complex and multi-directional, we calculated similar results when we reversed the direction of the linkages and considered the probability that people with poor or fair health will experience increased food or housing anxiety.
The results suggest that by addressing both health and food/housing insecurity, we could see a statistically significant improvement in health status, which may imply an improvement in individual and community health and lower total cost. Although beyond the scope of this study, the impact may be greatest for the Medicaid population.
But those were the overall results for all 12 states combined. What do the data tell us when we look at the results by state? Here is a graph by state, showing the percentage of people who self-reported their health was poor or fair along with the percentage that report they are always or usually worried about having enough money for food or housing (each shown separately).
The pattern of the relationships between food and housing insecurity and health status is evident and is reasonably consistent across all 12 states. Eight states report more than 17% of the population have poor or fair health and 4 states (including the District of Columbia) report less than 17% have poor or fair health. For the eight states reporting more than 17% with poor or fair health, the mean was 21.44% compared to a mean of 13.60% for the four states reporting less than 17% having poor or fair health. This suggests significant disparity along all three variables between states.
For all 12 states, the mean of the percentage reporting poor or fair health was 18.83% percent. The overall mean of the percentage reporting always or usually worried in answer to the food and housing questions were 12.40% and 17.63% respectively. Arkansas had the highest percentages for each question while Utah had the lowest percentage of people with poor or fair health while Minnesota, with the second lowest percentage of poor or fair health, had the lowest percentages of people worried about having enough money for food or housing.
Although the percentage of people who are always or usually worried about having enough money for housing is higher in every state than the percentage of people who are worried about food, the range of variation in the percentages reporting housing security was greater for housing (10.85%) than for food (8.28%). This suggests that food anxiety is more consistently linked to health status than is housing anxiety.
More research is needed to understand these complex and multi-directional relationships. Nonetheless, the difference in probabilities among the three variables suggest that interventions which address the intersection of food, housing and health may offer tremendous opportunities to improve health and lower cost.
For our next paper, we are conducting a literature review to identify interventions by healthcare systems that address the intersection of food/housing insecurity and health. We hope to report the results of real world solutions and to compare those to the estimates in the present study. We also hope to work with some of the states in this study to estimate the financial impact of moving people to improved health status and reducing their levels of food and housing anxiety.
For more information about the present study, please contact Doug Dormer at firstname.lastname@example.org.