Housing at the Heart of Health

A Deep Dive into Housing as a Social Determinant of Health, Guided by Social Epidemiologist Dr. Kathryn Leifheit.

May 30th, 2026

By Amia Carrillo Ramanathan

Pictured is an encampment on Arcadia St. in Los Angeles, Wednesday, June 28, 2023. (Photo by Hans Gutknecht/MediaNews Group/SCOPE PHA via Getty Images/Los Angeles Daily News)

At first glance, the connection between housing and health feels obvious. How can anybody truly be mentally and physically healthy without stable housing? As Dr. Kathryn Leifheit, a PhD-trained social epidemiologist and Assistant Professor at UCLA, puts it, when they are told that housing and health are connected, most people respond with a simple: ‘No Duh’.

 “On a gut level,” she adds, “everybody understands that housing matters for health.”

Yet, while people’s intuition is correct, Dr. Leifheit’s work shows why it is still critical to study, quantify, and act on the relationship between housing and health. Her research focuses on finding policy levers that can reduce health inequities, particularly through addressing housing instability and eviction.  

Dr. Leifheit’s interest in housing as a public health issue was shaped during her time at Johns Hopkins, where she received her PhD in Epidemiology and Masters of Science in Public Health. While working in pediatric health research in Baltimore, she surveyed families living in extreme poverty (living on below $2 a day) through interviews in order to record how poverty impacted children's health and development.

Across conversations, one theme consistently resurfaced: housing.

“You know, if we just had safe housing, my kid would be able to go to a better school, and I'd have to worry a lot less. I could spend more money on food and groceries," one parent told her. These weren’t isolated concerns; they reflect a pattern of consistent trade-offs, where every aspect of well-being is defined by one factor: having a stable place to live. “It all seems to hinge on just having a good roof over your head,” Leifheit explains. 

While the connection between housing and health may seem straightforward, Leifheit emphasizes that “there are more academic ways of describing it,” meaning that there are measurable pathways through which this relationship can be studied.

One major pathway is stress. As simple as it sounds, the threat or experience of losing housing creates chronic stress with catastrophic biological consequences. Beyond physiology, stress is responsible for shrinking a person’s cognitive bandwidth. “You have less bandwidth to deal with other things in your life. Like you could forget to renew your Medicaid, you might not be able to get your kids to school on time, that kind of thing,” Leifheit describes. 

Housing instability also creates monetary constraints. Within these constraints, people are forced to allocate all of their resources and savings to housing, thus neglecting their other basic necessities such as food, healthcare, and other essentials. 

Another often overlooked consequence is the destruction of social networks. When communities are faced with evictions and high rates of turnover, the social and community-based networks that they have built disappear, along with the support and nurture that comes with them.

In clinical settings, these effects are tangible, with a common example being patients who struggle with chronic illness. Dr. Leifheit painted a picture of an individual with diabetes struggling with housing insecurity. With the proper support and treatment plan, diabetes is a manageable condition. But without stable housing, a diabetic may not have access to refrigeration for their insulin, turning a manageable condition into a life-threatening one.

Furthermore, childhood development offers one of the clearest windows into the long-term consequences of housing instability. Research has shown that early-life exposure to eviction can significantly alter developmental trajectories. As Dr. Leifheit describes, in a study led by her colleague researcher Gabe Schwartz, children who experienced eviction, particularly before age five, showed lower scores in areas like verbal reasoning and cognitive development compared to their peers.

These early years represent a sensitive period of development, where instability can have lasting effects. The stress of eviction, combined with disruptions to routine, nutrition, and parental attention, can make it harder for children to focus, learn, and keep up in school. As Dr. Leifheit’s work suggests, these early setbacks don’t just disappear; they can compound over time, shaping educational attainment, earning potential, and long-term health decades later.

Dr. Leifheit’s research pushes this conversation one step further by framing eviction as a structural determinant of health, an upstream factor that shapes downstream outcomes. Housing insecurity does not occur randomly; it is driven by policies and systems. Eviction, in particular, is a common and legal process that can destabilize entire households.

Understanding it as a structural issue opens the door to policy-based solutions. 

This perspective became especially important during the COVID-19 pandemic. Dr. Leifheit’s research on eviction moratoria showed that when protections were lifted, communities experienced spikes in COVID-19 cases. As people were forced into shared living situations or shelters, disease transmission increased.

Her work also examines broader health outcomes, including mental health and substance use disorders. By analyzing public health surveillance data, researchers can observe how policies, like eviction moratoria or emergency rental assistance, directly impact population health. For example, when the federal Emergency Rental Assistance Program distributed $46 billion during the pandemic, this provided a natural experiment that showed that regions that received more funding saw different outcomes than those that received less, highlighting the measurable impact of housing support.

Importantly, many evictions are preventable. With average back rent sometimes as low as $700, relatively small financial interventions could keep families housed and avoid cascading health consequences.  

For healthcare providers, understanding housing is essential. In an ideal world, in every clinic, primary care physicians would be screening their patients, particularly youth, addressing their social needs. However, Dr. Leifheit emphasizes that this screening, particularly in regard to housing insecurity, requires a system of questioning that identifies whether patients are worried about eviction, moving between homes, or struggling to pay rent. Identifying these different circumstances is integral to providing families with targeted support.

However, resources remain limited. This creates a gap between recognizing the problem and being able to address it, making advocacy a critical component of healthcare.

Dr. Leifheit described that there are many emerging models attempting to bridge this divide. In certain systems, clinicians can “prescribe” housing support services, with Medicaid reimbursing related interventions. Others use medical documentation to compel landlords to address unsafe conditions, such as mold exposure. A few health systems have even begun developing affordable housing directly.

Ultimately, Dr. Leifheit emphasizes that the housing crisis is not inevitable; it is the result of policy decisions.

“The housing crisis was caused by a set of policies. Therefore, a set of policies should be able to fix the problem. You need political will.” -Dr. Leifheit

Potential solutions include expanding affordable housing, streamlining development approvals, and increasing investment in programs like the Low-Income Housing Tax Credit. These approaches often have bipartisan support, offering hope for policy solutions.

Housing is at the heart of health. It is not just a place to live, it is a community, support, and safety. From childhood development to disease management, the effects of housing instability are layered and convoluted. Dr. Leifheit’s work demonstrates that understanding the mechanisms, quantifying the impact, and advocating for policy change are essential steps toward achieving health equity.