October 19, 2018
How Housing Affects Health
Expert Q&A

How Housing Affects Health

by Jeanine Barone  

sam davisSam Davis is Professor Emeritus of Architecture at the University of California, Berkeley. He researches and designs affordable housing, facilities for the homeless, and housing for people with special needs. He spoke with us about how the characteristics of housing influence the health of residents.

Housing for high-income people often is near good public spaces, such as parks. But this may not be the case for people at other income levels. How does this affect health?

It affects health negatively. Many low-income and minority families do not live near public spaces that encourage physical activity. In New York City, for example, most people who live in the area surrounding Central Park are well off. They can exercise there or have an emotional release. Green spaces in a city reduce heat, attenuate noise, increase physical activity, and reduce obesity. Some buildings have communal spaces within them, but the proximity to good public spaces near housing is just as important to the health of the residents.

You’ve studied the benefits of creating “healthy housing” for the homeless and very low-income populations. What have you learned?

It’s right and it’s the humane thing to do. Other countries treat good housing as an entitlement. We never think of housing as a right in the U.S., and that’s a shame. Without stable housing, any health issues that exist will be exacerbated. I did the first housing for homeless young people with HIV/AIDS, through Larkin Street Youth Services. The organization found the kids needed to be more compliant with their meds, but they didn’t know where the kids were living. Once the kids were in stable housing, their health improved. If children are homeless and they go from school to school and must travel a long way to get there, this exacerbates any health problems they may have. And that’s the case for everyone. Housing is the underlying solution to everything else. Research has shown that if you house homeless people, they use social services and the emergency room less, so it ultimately reduces costs and ends up paying for the housing itself.

Low-income housing units often rely on tall apartment buildings. Does this negatively impact health?

It can, to the extent that it inhibits a sense of community. Tall buildings will more likely have anonymous spaces—elevators, hallways, and so forth—that don’t encourage social interactions. That building type also removes people from ground-level space, where there is likely to be more activity. Large complexes, if done well, can still achieve housing density with well-observed ground-level activity space that encourages social interaction and exercise. It’s what we learned in the mid-20th century with Coop City or Lefrak City [large housing communities in the outer boroughs of New York City]. They were too large to have a sense of community, particularly in the large expanses of what was viewed as park-like space.

In contrast, if you go to Roosevelt Island [also in New York City], there’s a housing project there designed by Jose Luis Sert. The corridors have doors on one side and windows looking out to the courtyard on the other. There’s a vestibule that allows access to a unit and to the unit above and below. So you have a cluster of three units that share a vestibule, and those people know each other. There’s also cross ventilation and more light. The corridor is no longer completely anonymous or dark. Furthermore, each building surrounds its own courtyard, which people are more likely to use because it’s easily visible from the corridor and not isolated. People are more likely to know their neighbors and interact. They’re more likely to view an open space, see neighbors within it, and decide to join them. And there's a greater chance that children to be able to play outside and still be observed.

There’s some interest in the U.S. in the idea of “intergenerational housing,” in which older adults live in the same buildings as families and young adults. Is this a beneficial model?

It’s not entirely clear yet, in part because these types of projects tend to be built by nonprofits, and their funding often isn’t flexible enough to allow seniors in the same building as families. Consequently, I don’t know if there are many intergenerational housing developments. In San Jose, there’s multigenerational housing, with several buildings on the site, some with seniors and others with families. Sharing a site like this may be advantageous if you have families who work and have young children and they may need help with childcare; and the seniors may want to help. But seniors may want quiet, in which case having young children around may be disruptive. So it’s not clear that it’s advantageous in all cases.

What are the most important things you’d like readers to know based on your research?

Two things. As an architect, I’ve learned it’s critical for housing to provide a sense of community and sharing—not with hundreds of people, but with clusters of units that connect to communal spaces, so that neighbors share responsibility and oversight. This provides a sense of security and helps facilitate healthful behaviors such as going outside and being physically active. We have to figure out how to foster this even in large buildings. The second thing that’s needed is to make sure that there’s equity to the placement of housing near public parks and open spaces with recreational opportunities. We know that this has an important bearing on health and it is something that everyone deserves.

This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the Editorial Board at BerkeleyWellness.com.