Crowded Housing in United States

United States

Overcrowding (housing with multiple occupants per room) negatively affects physical health and well-being. Residential crowding increases the risk of spreading diseases like tuberculosis and other respiratory infections. Further, overcrowding and lack of ventilation can promote a moist environment that encourages mites, roaches and molds, all of which contribute to respiratory problems. Many studies have established links between asthma and environmental triggers such as air pollution, urban density, poor ventilation and crowding. Living in crowded conditions can also give rise to psychological distress and is associated with behavioral issues and poor academic performance in children.

Between 2007 and 2017, the number of households living in rental units with more than one occupant per room increased from less than 37 million to an estimated 43.4 million.

Those at greater risk of experiencing housing-related health conditions include:

• Low-income families and individuals. 
• Renters compared with homeowners.
• Racial and ethnic minorities. 
• Individuals with mental illness.
• Children. 
• Older adults.

Evidence supports various interventions to prevent and minimize the impact of housing problems on health. Healthy Home programs have improved health by remedying hazardous housing conditions. The Centers for Disease Control and Prevention offers more information and guidelines in their Healthy Housing Reference Manual, a comprehensive resource for public health and housing professionals. The National Low Income Housing Coalition provides additional resources and policy recommendations for housing challenges.

Increasing affordable housing options through local and national housing development policies, rental vouchers, subsidized housing and utility assistance programs can help reduce overcrowding. More collaboration between the housing and public health sectors is needed to promote healthy home environments and better integrate health care into the housing system, particularly for those with chronic health needs.

Healthy People 2030 identifies the quality of housing as a key issue in the neighborhood and built environment domain and has a goal to reduce the proportion of families who spend more than 30% of their income on housing.

Braveman, Paula, Mercedes Dekker, Susan Egerter, Tabashir Sadegh-Nobari, and Craig Pollack. “Housing and Health.” Issue Brief #7: Exploring the Social Determinants of Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, May 2011. https://www.rwjf.org/en/library/research/2011/05/housing-and-health.html.

Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development. Healthy Housing Reference Manual. Atlanta, GA: U.S. Department of Health and Human Services, 2006. https://stacks.cdc.gov/view/cdc/21748.

Howard, Amber, Adelle Mansour, Georgia Warren-Myers, Christopher Jensen, and Rebecca Bentley. “Housing Typologies and Asthma: A Scoping Review.” BMC Public Health 23, no. 1 (September 11, 2023): 1766. https://doi.org/10.1186/s12889-023-16594-8.

Lee, Ju-Yeun, Namhee Kwon, Ga-yeon Goo, and Sung-il Cho. “Inadequate Housing and Pulmonary Tuberculosis: A Systematic Review.” BMC Public Health 22, no. 1 (December 2022): 622. https://doi.org/10.1186/s12889-022-12879-6.

Marcia Fernald, ed. “The State of the Nation’s Housing 2022.” Cambridge, MA: Joint Center for Housing Studies of Harvard University, 2022. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_State_Nations_Housing_2022.pdf.

Pevalin, David J., Aaron Reeves, Emma Baker, and Rebecca Bentley. “The Impact of Persistent Poor Housing Conditions on Mental Health: A Longitudinal Population-Based Study.” Preventive Medicine 105 (December 2017): 304–10. https://doi.org/10.1016/j.ypmed.2017.09.020.

Pollack, Craig, Susan Egerter, Tabashir Sadegh-Nobari, Mercedes Dekker, and Paula Braveman. “Where We Live Matters for Our Health: The Links Between Housing and Health.” Issue Brief 2: Housing and Health. Robert Wood Johnson Foundation Commission to Build a Healthier America, September 2008. http://www.commissiononhealth.org/PDF/e6244e9e-f630-4285-9ad7-16016dd7e493/Issue Brief 2 Sept 08 - Housing and Health.pdf.

Pollack, Craig Evan, Beth Ann Griffin, and Julia Lynch. “Housing Affordability and Health Among Homeowners and Renters.” American Journal of Preventive Medicine 39, no. 6 (December 2010): 515–21. https://doi.org/10.1016/j.amepre.2010.08.002.

Sandel, Megan, and Matthew Desmond. “Investing in Housing for Health Improves Both Mission and Margin.” JAMA 318, no. 23 (December 19, 2017): 2291–92. https://doi.org/10.1001/jama.2017.15771.

Weitzman, Michael, Ahmareen Baten, David G. Rosenthal, Risa Hoshino, Ellen Tohn, and David E. Jacobs. “Housing and Child Health.” Current Problems in Pediatric and Adolescent Health Care, Housing and Child Health, 43, no. 8 (September 1, 2013): 187–224. https://doi.org/10.1016/j.cppeds.2013.06.001.

World Health Organization. “WHO Housing and Health Guidelines,” 2018. https://www.ncbi.nlm.nih.gov/books/NBK535289/.