Housing Instability and Homelessness in Pediatrics: A Narrative Review of Health Impacts and Multi-level Interventions.

OBJECTIVE: Safe and stable housing is foundational for child and adolescent health; likewise, housing instability and homelessness are associated with significant pediatric health risk. This narrative review sought to 1) describe the impact of stable housing, housing instability, and homelessness on child and adolescent health, and 2) explore advocacy interventions for pediatricians to support unstably housed children, youth, and families. While the relationship between health and housing is complex, here, we describe three primary mechanisms through which housing impacts pediatric health. Safe, stable, and affordable housing supports educational and economic opportunity for children and their families, and is associated with positive health outcomes. Poor quality and unsafe housing negatively affects health through increased exposure to risk factors for illness and injury. Finally, housing instability and homelessness create chronic stress that is detrimental to health, increase exposure to risk factors for poor health, and disrupt supportive connections to community resources. Though screening is a prerequisite for identifying housing needs among patients, it must be coupled with clinical and systems-level advocacy to improve youth and family health. We describe advocacy interventions that pediatricians can incorporate into their practice that target needs at the clinical, institutional, community, and policy levels This review highlights the importance of housing as a driver of pediatric health, and the opportunities that pediatricians have to address housing challenges through advocacy. By synthesizing the current evidence on the health impacts of housing, this work hopes to inform further research, clinical practice changes, and policy.

WHAT THIS NARRATIVE REVIEW ADDS: This review explores the health implications of housing on children, youth, and families and describes impactful advocacy opportunities for pediatricians to support patients with barriers to stable housing.