by Kim Krisberg
In California, a minimum wage worker has to work at least 98 hours in a week to afford a two-bedroom unit at fair market rental prices. In Texas, that worker would have to work between 81 and 97 hours in a week, and in North Carolina it’s upward of 80 hours per week. In fact, in no state can minimum wage workers afford a two-bedroom apartment working a standard 40-hour week without spending more than 30 percent of their income on rent — the percentage historically used to determine fair rental prices.
“What we’ve been witnessing is basically exactly what we’ve been expecting to see — that consistently the cost of rent is increasing whereas salaries and hourly wages are stagnating,” said Elina Bravve, research analyst at the National Low Income Housing Coalition and a co-author of the coalition’s recently released report, “Out of Reach 2013.” “The primary problem is that there’s just not enough affordable housing across the board.”
During the last decade, and increasingly in the previous eight years, a larger proportion of U.S. residents have chosen to rent instead of buy. The competition is good news for landlords, but bad news for those earning low incomes, Bravve told me. She noted that according to the U.S. Department of Housing and Urban Development’s (HUD) most recent Worst Case Housing Needs assessment, the number of families with very low incomes who either paid more than half their incomes on rent, lived in severely substandard housing or faced both situations rose from about 7 million in 2009 to 8.5 million in 2011 — that’s an increase of nearly 20 percent. Between 2001 and 2003, that statistic only increased by 3 percent, Bravve said.
“Folks who are paying 50 percent of their income toward rent and aren’t making a lot to begin with…they have very little left over and start cutting down on food, health care, other necessities,” she said. “If one thing goes wrong, it’s just like a domino effect.”
According to the “Out of Reach” report, renter households rose by one million in 2011, the single largest one-year increase since the early 1980s. But with increasing demand is coming scarcer resources and costlier living. Rental vacancy rates fell from 8 percent right after the financial crisis to 4.5 percent in 2012, and rent prices went up by nearly 4 percent from 2011 to 2012. For every 100 extremely low-income renter households, there are only 30 affordable and available rental units, the report found.
And with the nation’s overall job growth concentrated heavily within low-wage sectors, the gap between housing affordability and wages is growing wider and wider. Using HUD’s Fair Market Rent estimate, the report’s authors estimated that the 2013 housing wage exceeds the hourly wage earned by the average renter by nearly $4.50 an hour. Report authors Bravve, Megan Bolton and Sheila Crowley write:
The number of full-time jobs that a household must work at the prevailing state minimum wage to afford the average two-bedroom (at fair market rent) ranges from 1.4 jobs (Puerto Rico) to 4.4 jobs (Hawaii). …The one-bedroom housing wage also exceeds the federal minimum wage in each state across the country. In fact, with the exception of a handful of counties in Washington and Oregon (where the state minimum wage is $9.19 and $8.95, respectively), there is no county in the U.S. where even a one-bedroom unit at the (fair market rent price) is affordable to someone working full-time at the minimum wage.
Bravve noted that rental affordability isn’t only an issue in metropolitan areas but in rural communities as well, where there tends to be fewer affordable housing developers, less access to capital and fewer units being built, which all results in even narrower housing supplies. For those families squeezed out of rental markets, their risk of homelessness begins to rise. They’re often forced to bounce around between family and friends or live in substandard and unhealthy housing conditions. And the effects of housing instability can have a pronounced effect on health. For example, according to research from Children’s HealthWatch, children in low-income families with subsidized housing had better growth outcomes than children without the housing benefit. Housing instability is also linked to higher rates of food insecurity and poorer child health outcomes, the nonprofit found.
“(Housing instability) is incredibly disruptive,” Bravve said. “It affects people’s lives, their health, their children’s ability to do well in school. Housing is just so basic, it affects everything.”
Unfortunately, the numbers of low-income families eligible for housing assistance but unable to receive it due to limited affordable housing resources is on the rise, Bravve said. Right now, there are only enough resources for one out of every four families eligible for housing assistance to actually receive it, she said.
According to Bravve and her colleagues, one of the solutions to the growing problem is to fund the federal National Housing Trust Fund, which was created in 2008 to provide more affordable housing for extremely low-income families. The fund, however, was never financed. (President Obama’s fiscal year 2013 budget request provides $1 billion to the fund.) To finance the fund, the National Low Income Housing Coalition is urging lawmakers to place a cap on the maximum mortgage to receive a tax break at $500,000 and convert the current tax deduction to a 15 percent nonrefundable credit. The coalition estimates that such changes will save the federal government about $20 billion, which could then go toward creating additional affordable housing stock.
“(Without access to affordable housing) our economy suffers as a whole — people aren’t going shopping, they’re not going out to eat, they’re not buying new cars,” Bravve said. “People really do need to pay attention to this. It affects us all.”
To read a copy of the “Out of Reach” report, click here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Housing and public health advocates have been ringing the alarm for years: the housing crisis puts the health of Californians at risk. Fulfilling this promise, our state now faces the deadliest outbreak of hepatitis A in contemporary American history. According to the California Public Health Department, over 600 people have been infected with the virus and 21 people have died.
The hepatitis outbreak began amongst the homeless population in San Diego where the unsheltered homeless population increased 14 percent last year. As Krisberg describes in her 2013 article, housing costs have been rising across California, especially in growing economic centers like Los Angeles and San Diego. Rising costs, in combination with the foreclosure crisis and stagnating wages, means that homeownership is out of reach for many families. Meanwhile, the increased demand for rental housing and urban living propels continued increases in average rents. Without access to an affordable place to call home, families endure unstable and substandard housing conditions. Some Californians are left with nowhere to go and become part of the rapidly increasing homeless and marginally housed populations.
Beginning in San Diego in late 2016, the outbreak of hepatitis A spread person-to-person amongst the homeless population through the “fecal-oral route,” which involves ingesting something contaminated with the feces of an infected individual. The virus thrives in unclean conditions – the conditions that more and more low-income Californians must endure due to the housing crisis. Epidemiologists report that the disease spread quickly due to poor hygiene and lack of access to clean bathrooms for the homeless population. Hepatitis A affects the liver and symptoms include fever, nausea, and jaundice.
Like the resurgence of other diseases across the globe, such as the return to prominence of malaria in Venezuela, the resurgence of hepatitis A is influenced by healthcare governance and regulation, social and environmental factors, and disease management and progression. For people who are homeless or marginally housed, disparities in access to healthcare and disease management resources (e.g., vaccines, health education, etc.) combined with disparities in social and environmental determinants of health, creating a perfect storm for the spread of hepatitis A infection and especially high fatality rates.
People or are homeless or marginally housed are chronically underserved by our current healthcare system. Even though the recent expansion of Medicaid in California reduced the uninsured rate for low-income Californians, including people who are homeless, these populations continue to be disproportionately uninsured. Enduring lack of insurance is often due to the high costs of private insurance or the bureaucratic requirements to enroll in public insurance programs. Even people who are homeless and have insurance often find it hard to access care due to their transient living situations, mistrust of the medical community or government, or stigma. As a result, homeless and marginally housed individuals often do not receive critical preventative care services or engage in consistent chronic disease management, increasing their burden of more severe, uncontrolled illnesses. Research has shown that access to healthcare, controlling for all other factors, increases life expectancy.
Limited access to care also means missed opportunities to receive vaccinations. California adopted the hepatitis A vaccine as a recommendation for all children beginning in 1999. The vaccine is 100 percent effective after the second dose. Due to its recent introduction, most adults in California are not vaccinated. People disconnected from the healthcare system, such as people who are homeless and/or uninsured, are even less likely to have received the vaccination.
In addition to access to care, research has shown that significant variation in health and life expectancy can be explained by a combination of socioeconomic and behavioral factors. The evidence is overwhelming that the social and environmental conditions of being homeless or marginally housed puts individuals at greater health risk for health concerns, including stress, communicable diseases (e.g., tuberculosis, respiratory infections, hepatitis, etc.), malnutrition, and violence. On top of the housing affordability crisis more generally, high-risk social and environmental factors include limited access to clean water and a lack of resources to support hygiene and nutrition (i.e., lack of bathrooms). These structural factors leave people who are homeless or marginally housed with a constrained set of options within which they make their day-to-day decisions. Faced with these limited options, people are more likely to engage in behaviors that put their health at risk, such as not washing hands or eating utensils or living in overcrowded conditions.
Due in great part to these disparities in access to care and social, environmental, and behavioral risk factors, people who are homeless or marginally housed have disproportionately poor health and disproportionately suffer from chronic conditions that compromise the immune system. This means that disparities in access to care and risk factors created not only an ideal environment for the spread of hepatitis A but also conditions ripe for unnecessary fatality. Hepatitis A is usually a non-fatal disease. The California Department of Public Health (CDPH) reported that nearly all the 21 people who died from the recent outbreak had other underlying illnesses, which made them particularly vulnerable to hepatitis A.
Our next steps for disease management and prevention must span immediate and long-term solutions. First, to curb the spread of the virus, sanitation efforts and public bathrooms are an immediate priority. San Francisco currently uses a portable public restroom model, known as the “Pit Stop,” which could be a model for other cities. Other sanitation interventions should include temporary sanitation stations for washing hands, bathing, and cleaning cooking utensils. Municipalities should also increase street washing.
Also, a robust vaccination program is imperative moving forward. The CDPH and the Centers of Disease Control (CDC) are already managing a concerted effort that has protected more than 65,000 Californians. To be responsive to the disparities in both access to care and health status, this campaign should focus its resources on the groups most vulnerable to hepatitis A (e.g., people who are homeless, people who are marginally housed, service workers in direct contact with the public such as first responders, etc.). Reaching these populations will also require tailored outreach efforts. For example, CDPH deputy director for infectious diseases, Dr. Gil Chávez described how the CDPH team worked to overcome barriers reaching the homeless population in their vaccine campaign. “We send teams of people . . . into the field, literally walking down riverbeds, embankments, going down under freeways and talking to people and asking them to be vaccinated,” she explained. “This community tends to have a distrust of government and (doesn’t want) to talk to you if you’re a government official. Over time, we’ve come to realize that we’re making inroads and that more and more homeless individuals are agreeing to be vaccinated than when we first started.”
Besides vaccine supply efforts, it may be useful to consider demand-side incentives to help compel people who are homeless or marginally housed to participate in a vaccination program. Such a program could provide financial compensation conditional upon receiving the vaccine. Conditional incentives could serve as a strong motivator for people who are struggling to make ends meet and must choose between spending the day at a health clinic or working. Especially because the hepatitis A vaccine requires two doses, a financial incentive could help ensure that people return for the second dose.
Looking long-term, we must also address upstream causes of the housing crisis. Tenant protections such as rent control and just cause eviction protections can help keep people in their homes and off the streets. Supportive housing programs are an effective strategy to house and support individuals who were homeless. This is especially true for programs that embrace a “housing first” model, which does not require individuals to have secured a job or to have been sober for a certain number of months before becoming eligible. This past year the California state legislature passed a package of over a dozen bills to support the development of affordable housing. These efforts are critical, but development is inherently slow, and future building does not absolve us from addressing the crisis in the short-term.
The hepatitis A resurgence must compel us to see the California housing crisis as a public health crisis and aggressively pursue policies and programs that provide short-term relief and long-term prevention.