January 21, 2021

How Housing Instability Affects Our Health

Show Notes

On this episode, Chuck Gaidica is joined by Eric Hufnagel, Executive Director of the Michigan Coalition Against Homelessness. Together, they discuss the impact housing instability has on one’s physical and mental health.

In this episode of A Healthier Michigan Podcast, we explore:

    • What housing instability is.
    • How it affects the health of those living in the same household.
    • What we can do to help those feeling the effects of housing instability.

For more info on housing insecurity, please visit MI Blues Perspectives.

Transcript

Chuck Gaidica:
This is A Healthier Michigan Podcast episode 72. Coming up we discuss the impact housing instability has on one’s overall health.

Chuck Gaidica:
Welcome to A Healthier Michigan Podcast. This is a podcast that’s dedicated to navigating how we can improve our health and well-being through small, healthy habits we can start implementing right now. I’m your host, Chuck Gaidica. Every other week we sit down with certified experts to dive deeper into topics that cover health, nutrition, and a whole lot more, and today there is a whole lot more. On this episode we’re discussing how housing instability affects one’s physical and mental health, sometimes referred to as a social determinant of health. With us today is the Executive Director of the Michigan Coalition Against Homelessness, Eric Hufnagel. Eric, how are you? You’re well?

Eric Hufnagel:
I’m doing well, Chuck, thank you very much. How about yourself?

Chuck Gaidica:
I’m well, I’m glad that you’re with us because this is a topic that can really reach out into so many different lives when it comes to health and wellness. Because while there are stories we know about within our own family situation, this idea of instability, housing instability is a phrase we hear but we’re not quite sure exactly what it may mean. Can you flesh that out for us?

Eric Hufnagel:
Well, sure. I think as you know there really isn’t a hard and fast definition that’s utilized, whether it be through housing and urban development or other governmental agencies, but there is some work in trying to help to determine what that is to provide some clarity to the public. When we’re talking about housing insecurity or sometimes instability is another term that’s used, that’s really an umbrella term and that really encompasses several different dimensions of housing problems that people experience.

Eric Hufnagel:
So let me talk a little bit about that to help people understand what that is in lieu of having a formal definition. When we’re talking about some of those different dimensions that may affect people’s housing status. We’re talking about affordability, we’re talking about safety, quality and security, et cetera. So there are a number of things that we really look at, kind of categories, and one of them would be housing instability within the context of affordability, severe rent burden. When we’re thinking about the percentage of our income that is devoted to our housing or sustaining housing, that’s a key measure that we look at.

Eric Hufnagel:
So HUD, for example, Housing and Urban Development defines that as a 30% threshold, you shouldn’t be spending more than 30% on your housing needs. That would be your rent, that would be your utilities, if you’re a tenant that would be your renter’s insurance. If you’re paying more than 30% of your income you really are rent-burdened and that’s a calculation that has been used for decades, that’s not something new. So that’s a measurement that we have been able to use to think in terms of how are people doing with respect to ability just to cover their housing needs. So first and foremost that’s what we’re looking at.

Eric Hufnagel:
Then beyond that, when we think about what might put somebody in a position where we’re thinking about them having a housing that’s not stable would include something that we often overlook, it would be something like overcrowding. Do you have more than one person per room? I mean, that’s a measurement that HUD looks at. So excluding the bathroom, do you have more than one person in your household per room and the size of the square feet per person, et cetera?

Eric Hufnagel:
But then you also look at residential displacement which is actually it’s a mobility question. Do you have frequent changes in your residence due to economic or other issues that you’re dealing with? There’s poor housing quality, that also is something that we look at and a lot of people don’t think about that as far as housing instability, but if there are issues with the housing that poses health or safety hazards to someone, if there’s an infestation of vermin, et cetera, those are things that we look at as affecting your housing stability but a lot of folks don’t think about that.

Chuck Gaidica:
Well, I mentioned mental health, and you think about this idea of a leaky roof or drafty windows, or cockroach infestation or mice or whatever it is, there’s a lot of stress for any one of us, much less if the stressor is already super imposed on top of the fact that I can hardly afford to live where I’m living and I’m dealing with those issues. And the last thing I’ve got money for if the landlord isn’t helping out is to call the exterminator. I mean, it just keeps ganging up on you, if you will. It seems like it could anyway.

Eric Hufnagel:
You’re exactly right. But from a very practical standpoint let’s think about that. If you have a household that is not healthy, let’s say that there’s mold, or let’s say that you have no running water. I mean, these are circumstances that people do encounter. If you have no running water, a municipality is typically going to red tag your home and you need to evacuate your home. So, having those types of environmental issues can put somebody at risk by no fault of their own necessarily, so yeah, it affects your stability.

Chuck Gaidica:
I was doing the math in my head when you said something, it really struck me, this 30% rule because I’m going to think, and I’m just going to use an example, right? Somebody is making 12 bucks an hour, one job, 40 hours a week. They’re working their butt off and they’re bringing home a little over 400 a week so they’re at 21,000 a year in income. Now, that’s without taxes, without withholding, without transportation. And you’re telling me that after all that is subtracted, the 30% rule, they may still have rent of eight or 900 a month, that’s half, that minimally half of their income. So to me that would seem like a gargantuan issue for a lot of people. I mean, it’s a broad brush way to look at it but as you were saying this I thought, “Wow, this has to be a lot of people.”

Eric Hufnagel:
Yeah. And Chuck, that’s an issue I’m glad you raised it because that’s an issue across the entire country when we think in terms of affordability of housing. And we can look at the data and there was a national report that’s done every year through the National Low Income Housing Coalition that looks at affordability. There was only one county, one county in the entire country where an individual who was making minimum wage and working 40 hours a week was able to afford the median income market rental rate for a two bedroom home.

Eric Hufnagel:
That’s an example where we know that we see people who are living beyond their means in some ways and not because they’re living extravagantly, it’s because of the pressures of the market that they have income that cannot keep up with the cost of the housing. And so when the market changes you may see your rent go up but you don’t necessarily see your income go up. So that puts pressure on people and that diverts money away from other necessities that they would need.

Eric Hufnagel:
As I was growing up you always thought in terms of the most important expense you had was your housing. You have to have a place to live so you need to pay that first and so a lot of people will have to make choices about how they spend the rest of their income once they have put the money forward for their housing. And that’s where it gets a little difficult, because that might eat into in transportation, that might eat into their food, that also may eat into their medical expenses, their medications, et cetera. So people have to start making choices and that’s where we start to see some difficulties.

Chuck Gaidica:
And this idea of so many different communities being affected and how their fingers kind of grow out. This isn’t just a UP issue, Lower Peninsula, Detroit. I happened to know that there was a story that I participated in trying to be of some help with a family in a trailer park on the outer edges of Northville Township. You wouldn’t think that you could see that kind of instability, but it doesn’t matter if it’s Grand Rapids or Flint or Detroit or Northville, it can be anywhere that we’re seeing neighbors and sometimes we don’t even see it. We just start to observe the stressors, which can lead to other issues of health and wellness or places they’re falling apart and we think, “Oh, well, that something’s going on with that family, or there’s a divorce, or they need help, but you don’t really see the need all the time, it’s just lurking.

Eric Hufnagel:
You’re absolutely right. It’s one of those things that goes under the radar screen and we don’t necessarily see it in outwardly as people are living their daily lives. This instability may be there and they certainly are not giving any sense that there’s an issue but we look at those underlying issues that people are having to deal with, and you touched on something. The income is one thing, lack of income to keep up with those costs, housing costs being out of reach, the supply diminished or affordability being a challenge.

Eric Hufnagel:
But then we also look at things like health issues. If an individual or a family, let’s not just talk about an individual, we’re talking about the impact on the family, who’s in the household. If an individual has a chronic health issue or even a crisis, that can put them in a position where they are not stably housed. We know that the impacts are there where people will lose work, they’ll lose income, et cetera. Those kinds of things can snowball into situations where someone may not be able to pay their rent or to cover their mortgage.

Eric Hufnagel:
But then we also look at things like domestic violence or a trauma. If somebody experiences a significant trauma, they were robbed, et cetera, whether it’s recent or something within their lifetime we know that that also can play a role in homelessness at times. So there are a lot of things that can go on in people’s lives that we don’t necessarily think about having a direct impact on their ability to stay successfully housed.

Chuck Gaidica:
Well, as we come back around and focus this on health and wellness there’s a stat that I’ve seen here that reads that more than 80% of what goes into a healthy person is really determined by something other than maybe medical care or even what they’re eating. We know about the food deserts and how it’s hard to get fruits and vegetables and the Mediterranean diet, which is one of the healthiest ever, into certain urban centers because it’s not there. But in this case the stats are showing a tremendous impact of this idea of instability related to housing and how it’s impacting directly on people’s health. Can you speak to that?

Eric Hufnagel:
Yeah, I mean, you’ve touched on some things there and I like to boil it down to a couple of things. One would be access another would be affordability. So, when we think about housing and you’re talking about the food desert and for those listeners who aren’t aware of what that term is talking about, it’s not being closely located to a grocer that would have fresh produce, limited choices on what groceries you can purchase that are within a reasonable distance. So that’s one example and that’s an access issue. So when we think about housing instability we’re also always thinking in terms of people’s inability to choose where they want to live or where they would prefer to live, or maybe better served to live.

Eric Hufnagel:
And what I mean by that is if you can only afford a certain type of housing it may be in a certain area and that may not be close to some of your regular support needs, which might mean family to assist with childcare. It may mean you don’t have as much access to public transportation. You may not have access to the groceries like we’ve just been talking about, or to your physician, any number of things that are dictated by where you live which often is dictated by what you can afford. So you see those things all tie in together.

Chuck Gaidica:
And this idea of family members, we think of the working people of the household, a mom or a dad or a grandma or an auntie that’s in the house, but you have to talk about the children. I remember another effort that I was watching the team in the day approach the Art Van Furniture company. All they wanted was some mattresses, whatever isn’t selling well. It blew my mind to hear the stats and you’ll forgive me, Eric, I don’t remember the stats exactly but the number of kids that were sleeping on the floor, and then we expect them to wake up after a bad night’s sleep, go to school and perform well. And so these dots that you connect with everything you’ve already discussed and the stressors within the household, I never even gave it a thought. Not that I didn’t care, I just never thought, “Oh, well, everybody must have a mattress.” Not really, and so it’s that kind of stuff.

Eric Hufnagel:
We take it for granted. You’re giving an example of not getting a good night’s sleep, so that could be a mattress issue. But let’s think about that if you are not stably housed you may be sharing a household with someone else. Your family may be living with another family, your extended family. There are those situations where people become somewhat, I don’t want to use the word inappropriate, kind of transient in nature that you don’t have stable housing because you are with someone by their good graces. So you find that children may be living with grandparents temporarily.

Eric Hufnagel:
I’m giving you a real example. The kids are living with the grandparents and the mom and dad are living with someone else because they don’t have adequate housing available to them. And think about the impact on the kids from a health standpoint. If you are sharing a bedroom and having to sleep on the floor, your sleeping patterns could be thrown off, the access to food may be somewhat limited. The kinds of food that you’re eating and being able to prepare yourself for going into school may inhibit the kind of learning that you’re able to achieve. We know that the trajectory of kids, whether it be academically or when we look at their health over the course of their lifetime is at risk when they have experienced an episode, a single episode of homelessness.

Eric Hufnagel:
And when we talk about homelessness we’re not necessarily just talking about somebody who is living in their car somewhere, we’re talking about moving to different households over a period of time. That really is homelessness in the way that we think in terms of how it can impact kids and their development, potentially moving to multiple school districts over a period of time, et cetera. Those are all those complicating factors that really, when we drill down to it affect the kids in their trajectory moving forward. That’s why it’s so important for us to think in terms of how are we investing our resources now with kids before we think in terms of what those impacts might be later.

Chuck Gaidica:
And I want to talk to you about that now, about some of the good news or the hope that’s there. But as you were speaking of this it also struck me that we’ve all got to be mindful and careful of and understanding that this isn’t necessarily the fault of the people that we see that became homeless, in other words, they may not be living in their car. I just remember downtown Detroit or New Center, Detroit, when some developer was coming in a gentrification, this idea of remodeling a neighborhood happens in many different places, but people who were paying six to 800 bucks a month in rent for an apartment were told, “You’ve got about 90 days and rent is going up to 12 to 1500 a month.”

Chuck Gaidica:
That factor was not directly related to their income. Their income didn’t change, they weren’t slackers, they weren’t trying to get a break on anything but they were about to see their rent almost double, well, there you go. Now they have instability, now they have to go look for a place to live or maybe go live with somebody else and it had nothing to do with the fault of their own. And I don’t want to castigate aspersions on other people, I’ll just use me. Sometimes I think, “Well, it’s got to be their fault.” It’s not my fault, but maybe it was in a way.

Eric Hufnagel:
Yeah. You’re talking about an example of something that was really what I think falls under the heading of the law of unintended consequences. When you are doing something from a public policy standpoint, where you’re thinking development is a good thing, which it is, but you don’t necessarily have a positive impact for everybody, and are you anticipating that from a public policy standpoint in thinking about how you’re addressing that issue proactively so that you don’t have somebody with a net loss who is negatively impacted by something that happens?

Eric Hufnagel:
Also, you made that comment about that within the context of decisions, and is it about the individual making poor decisions? I think that that’s kind of a default that many people have when they think about someone who may be experiencing some difficult times, whether it be homelessness or any other type of social impact that we see where someone may be affected by substance use disorder, for example. It’s not all about our choices at times, sometimes there are those wider forces that we can’t control. Sometimes we have health issues that we cannot control, by virtue of our choices they just happen. Poverty is not necessarily something that somebody chooses.

Eric Hufnagel:
And we often see judgment that takes place because in our minds we want to rationalize things, we want to believe that the only reason that that person is living on the streets is because of something they did, because of this, this, and this. It’s harder for us to grasp the fact that there are factors that have created a scenario that have contributed to somebody being homeless. Without then us feeling like we have some ownership of that issue and a responsibility of trying to address that issue. So I think that’s a natural thing for us to put blame on people, but let’s think about the makeup of demographics when we think in terms of who is homeless.

Eric Hufnagel:
There is a significant percentage of individuals in this state who have multiple health issues going on, whether it’s substance use disorder, which is not the primary issue, mental health issues are pretty significant, and we have chronic health issues as well that are contributing to people’s disabilities and inability to be successfully housed or to maintain their housing. But we often forget that, we think that it’s obviously because of choices that we’re making, people are there because they deserve it or have done something wrong yet we really need to step back and think about what are those contributing factors? And particularly when we’re thinking about health, we’re talking about access to treatment for substance use disorder, we’re talking about treatment for mental health issues, we’re talking about treatment for those chronic health conditions that people are experiencing.

Eric Hufnagel:
And those cut across in a lot of ways, they’re not always isolated that we see people can have co-occurring issues, mental health, substance use, chronic health, et cetera. People who have disabilities, a large percentage of people who are homeless encounter disabilities and are what I would say fragile and are people that are in most need of assistance. So that happens when we think about families, quite often you’re talking about situations where one person in that family may be encountering a health issue, whether it’s substance use or whether it be another major physical disability, those things also I think contribute to the impact on the family and its ability to have stable housing. So sometimes when we’re talking about kids it’s not by their choice, those things happen and they’re part of the homelessness that takes place. Anyway, I’m on my soap box.

Chuck Gaidica:
No, no, I’m glad you are because it is heartbreaking and I want to come to some action items and things that we can all try to do to help. And I left out kind of I buried the lead story here about coming through and out of COVID, hopefully out of, and that super imposed thing on top of underlying health conditions. We saw the stats on people of color, brown and black people being overly affected throughout this process especially at the beginning with COVID, and you super impose underlying health issues, which are enough, and then you take, hey kids, two or three kids, mom, dad.

Chuck Gaidica:
We got to put all of our belongings in black trash bags, hefty bags and take them to a new place to live, and we’ve got to work because if we don’t work we won’t have an apartment, all those complications leading directly to image issues and self-image and mental health issues. It’s just overwhelming for so many families, I bet, but I’m just hopeful you can give us something that if people are experiencing housing instability that there are ways for all of us to help, even if it’s contacting lawmakers or whatever. So give us hope, give us the ways that we can get involved, Eric.

Eric Hufnagel:
Well, that question gets asked a lot when I’m interviewed. People want to know, “Well, what can we do?” And of course the low-hanging fruit, so to speak, when we think in terms of what is the obvious thing it’s donating, whether it’s your resources or your time and talents as a volunteer. But beyond that, what I found is that people don’t spend enough time educating about issues. And I’m not saying that people need to be studying 40 hours a week on the topic of homelessness but I think it’s important for us as individuals to know our communities and to understand our communities and to talk about issues that we think are important.

Eric Hufnagel:
Homelessness as we’ve talked about earlier, it’s one of those things that’s under the radar screen because first of all, we think in terms of the numbers of people who are literally homeless, so we can look at those numbers. But it’s like that iceberg where we know you can see part of that that’s above water, we know that when we think about housing insecurity there’s a whole lot that’s below the water. So, we have a lot of risks in our communities, a lot of people who are at risk because of that instability and we need to be thinking in terms of educating ourselves about our own communities, understanding what their needs are and being comfortable and competent in being able to reach out to our elected officials, as well as those people who are not elected but aren’t working within government to talk about issues that we’re thinking are important, and making sure that they understand that these are things that they as public servants need to be paying attention to and get involved in.

Eric Hufnagel:
Because the squeaky wheel gets the grease, I hate to say it, but that’s the reality. If we can understand more about the issues in our communities and speak about them publicly, whether it be in social media or an email to an elected official, we are going to help raise the visibility about the issue. Now, that’s that community-wide approach and how do we get engaged, but it’s also important for us to be thinking about family and friends that we have and paying attention to some of those factors that may be putting someone at risk. And I think it’s important to have that difficult conversation every once in a while, particularly with a family member who you think may be in a situation where they are putting themselves at risk or encountering situations that they don’t know how to deal with, to find out what you can do to help them and to help do research maybe to link them to services or provide them some tools that can assist them.

Eric Hufnagel:
One of the things that we find quite often is anyone who is really experiencing the trauma that might lead to an eviction. For example, it’s difficult to function as you alluded to before, some of the stressors that you encounter in an unstable housing situation really can interfere with a person’s ability to function, to do the kinds of things that they need to do to address the issue and they shut down. Now, I’m getting specific here about stuff but the reality is we all need help at times. And as friends and family members if we’re in a position where we can detect something and we can talk with someone and we can offer assistance, that support is really, really important because we want to see folks helped before they actually encounter homelessness.

Eric Hufnagel:
We know it’s cheaper, we know that we can reduce the kind of trauma that an individual or family can experience if we’re able to attack it ahead of time and prevent the homelessness from occurring. So there really is a value to trying to help people work through some issues or access services or resources prior to actually becoming homeless. So getting engaged with friends and family and your community, that’s where it’s all about.

Chuck Gaidica:
Well, and a lot of people are suspect of where their money goes when they donate. We’ve got GuideStar and lots of places to look but when it’s somebody’s family or friends or the inner circle, and I know they’re going to be pride issues involved here, if you wanted to know of somebody you could help who’s dear to you what better place to start where 100% of your time, talent and treasure, as you were saying, goes to someone who you know who’s within a circle and that provides healthfulness for your own family and maybe even a broader connection, a deeper connection to the love and respect of somebody who maybe was distant or maybe not. I just think that there’s a huge upside to that idea.

Eric Hufnagel:
Yeah. We need to look at that human approach to things and not think it’s just all about somebody else having to deal with it. We have a role, we have a responsibility.

Chuck Gaidica:
Yeah. And this idea of treasure, we sometimes default to the donating of canned goods or drive up and let’s drop off some clothes. But I have found that the donating of funds, some people are literally just a gas bill away from a problem in their life, or half the month’s rent. It’s not the I got to take care of somebody for a whole year thing. And I think that that’s helpful for even me to visualize is that sometimes whether it’s a Visa card a charity gives out or something, that there’s some way that somebody could afford groceries and it may literally be one or two months as a bridge to get them to more healthful and wellness in their life, and I find a great encouragement in that.

Eric Hufnagel:
Yeah. You’re bringing up a great example of donating canned goods, that’s wonderful. The food banks are really hard-pressed right now because we know there’s a lot of food insecurity which is the predictor. We know that if families are having a hard time putting food on the table there are strains on their housing. But let’s think about that you’re donating food stuffs but the macaroni and cheese that you donated requires butter and it requires milk. And I mean – small example but that means that a family needs additional resources at times even to be able to use the product that you have donated.

Eric Hufnagel:
And we don’t think about those things when we donate, but that’s where the resource is being donated, the cash being donated to an organization that’s in a position to help families with some of those other things that they need through general fund donations really is important. Don’t stop donating the canned goods for crying out loud, but think about a greater engagement beyond that is being just as important as well.

Chuck Gaidica:
Well, there’s a touch on a lot of your points today that’s really helpful and it has to do with the heart because this is a heart issue for a lot of people who may have a hard time getting involved or wanting to be involved. And let’s face it for some people writing a check is their way of helping and for others it is getting deep into volunteering and not everybody’s wired the same way, but I think you can leave us here with some takeaways of what can we all look to? You’ve mentioned a lot of them, we’ve covered a lot of ground, give us some specific ways that in the early part of this calendar year we can really be helpful in our neighborhoods, in our own families and beyond.

Eric Hufnagel:
As I said, learn what’s going on, reach out to organizations that are engaged in some of this work, find out what they’re doing, find out how you might be able to get involved and do not hesitate in sharing your views of the importance of trying to address some of these underlying issues, these many underlying issues that affect homelessness and contribute to homelessness. And talk to people in your community, talk to elected officials, as well as those who are just your public servants who work or even your local community and be engaged, raise awareness and be a part of this in the long-term, because we need to have a sustained voice and you have a role in doing that. But then on the micro level, I’ll call it micro, working with the people that you know, trying to educate them, connect them to resources and being a support system to them. That’s the most important thing that most folks need when they’re encountering housing instability, is having someone who can be a support system to them.

Chuck Gaidica:
Yeah, that’s great advice. And I should encourage everybody. I encourage myself too when I think about this, I don’t need to reinvent the wheel and start a whole new organization. I mean, you’re part of a great organization as executive director but I mean, there are places we can go and say, “Listen, I’m here. Just show me which way, what I can do, is it packing lunches, is it taking the canned goods and moving them from here to there with Gleaners?” Whatever it is. Lots of great organizations.

Chuck Gaidica:
This is not their first rodeo and they know how to employ us if we show up and that’s what I think we have to consider and dig deep in our own hearts is this the thing we could begin, one of the things for a new year as we’re coming out of the stressors and strains that have been part of life. But Eric, I can’t thank you enough. This is eye-opening and heartbreaking at the same time but also offering great hope of ways that we can direct our energies for the new year. Thanks.

Eric Hufnagel:
Well, thank you, Chuck. I appreciate the opportunity to talk about and help raise awareness and encourage people to get involved.

Chuck Gaidica:
Eric Hufnagel is the Executive Director of the Michigan Coalition Against Homelessness. We thank him and we thank you for listening to A Healthier Michigan Podcast. It’s brought to you by Blue Cross Blue Shield of Michigan. If you are interested in learning more about housing instability and the topics that make up social determinants of health, because there are those direct connections that you heard Eric talking about, search housing on mibluesperspectives.com or check out the link in our show notes, we’ll post those there. And throughout the year Blue Cross Blue Shield of Michigan journalists will be diving into some of the environmental and socioeconomic reasons behind poor health for certain neighborhoods and groups of people. So that’ll be all kinds of great stuff coming your way as we head into 2021.

Chuck Gaidica:
And we’ll be looking at topics such as food insecurity, poverty and employment, or unemployment, education, and a whole lot more. Along the way, we’ll talk to community partners and examine what Blue Cross is doing to improve the whole health of Michiganders, and isn’t that what we’re all after?

Chuck Gaidica:
If you like our show by the way, you want to know more, check out ahealthiermichigan.org/podcast. You can get all of our previous episodes, you can leave us a review or rating on Apple Podcasts or Stitcher, and to get new episodes on your smartphone or tablet be sure to subscribe to us on Apple Podcasts, Spotify, or your favorite podcast app. I’m Chuck Gaidica, thanks for being with us. Stay well.