Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.

Energy insecurity is a multi-dimensional construct that describes the interplay between physical conditions of housing, household energy expenditures and energy-related coping strategies. The present study uses an adapted grounded theory approach based on in-depth interviews with 72 low-income families to advance the concept of energy insecurity. Study results illustrate the layered components of energy insecurity by providing rich and nuanced narratives of the lived experiences of affected households. Defined as an inability to adequately meet basic household energy needs, this paper outlines the key dimensions of energy insecurity-economic, physical and behavioral- and related adverse environmental, health and social consequences. By thoroughly examining this understudied phenomenon, this article serves to raise awareness of an increasingly relevant issue that merits more attention in research and policy.

Household energy is increasingly vital for maintaining good health. Unaffordable and inadequate household energy presents adverse consequences that are amplified by poverty and a changing climate. To date, the connections between energy, socioeconomic disadvantage, and well-being are generally underappreciated, and household energy connection with climate change is under-researched. Building on the energy insecurity framework, this review explores literature related to household energy, poverty, and health in order to highlight the disproportionate burdens borne by vulnerable populations in adequately meeting household energy needs. This paper is based on a comprehensive review of books, peer-reviewed articles, and reports published between 1990 and 2019, identified via databases including JSTOR and PubMed. A total of 406 publications were selected as having potential for full review, 203 received full review, and 162 were included in this paper on the basis of set inclusion criteria. From the literature review, we created an original heuristic model that describes energy insecurity as either acute or chronic, and we further explore the mediators and pathways that link energy insecurity to health. In the discussion, we posit that the extant literature does not sufficiently consider that vulnerable communities often experience energy insecurity bundled with other hardships. We also discuss energy, poverty, and health through the lens of climate change, making the criticism that most research on household energy does not consider climate change. This evidence is important for enhancing research in this field and developing programmatic and policy interventions as they pertain to energy access, affordability, and health, with special emphasis on vulnerable populations, climate change, and social inequality.

The split incentive problem concerns the lack of appropriate incentives to implement energy efficiency measures. In particular, low income tenants face a phenomenon of energy poverty in which they allocate significantly more of their household income to energy expenditures than other renters. This problem is substantial, affecting 1.89% of all United States' energy use. If effectively addressed, it would create a range of savings between 4 and 11 billion dollars per year for many of the nation's poorest residents. We argue that a carefully designed program of incentives for participants (including landlords) in conjunction with a unique type of utility-managed on-bill financing mechanism has significant potential to solve many of the complications. We focus on three kinds of split incentives, five concerns inherent to addressing split incentive problems (scale, endurance, incentives, savings, political disfavor), and provide a detailed policy proposal designed to surpass those problems, with a particular focus on low-income tenants in a U.S. context.

Following the Great Depression and related home foreclosures, the federal government established new agencies to facilitate access to affordable home mortgages, including the Home Owners’ Loan Corporation (HOLC) and Federal Housing Administration (FHA). HOLC and FHA directed widespread neighborhood appraisals to determine investment risk, referred to as “redlining,” which took into account residents’ race. Redlining thereby contributed to segregation, disinvestment, and racial inequities in opportunities for homeownership and wealth accumulation. Recent research examines associations between historical redlining and subsequent environmental determinants of health and health-related outcomes. In this scoping review, we assess the extent of the current body of evidence, the range of outcomes studied, and key study characteristics, examining the direction and strength of the relationship between redlining, neighborhood environments, and health as well as different methodological approaches. Overall, studies nearly universally report evidence of an association between redlining and health-relevant outcomes, although heterogeneity in study design precludes direct comparison of results. We critically consider evidence regarding HOLC’s causality and offer a conceptual framework for the relationship between redlining and present-day health. Finally, we point to key directions for future research to improve and broaden understanding of redlining’s enduring impact and translate findings into public health and planning practice.

The costs for rent and utilities account for the largest share of living expenses, yet these two critical dimensions of material hardship have seldom been examined concurrently in population-based studies. This paper employs multivariate statistical analysis using American Community Survey data to demonstrate the relative risk ratio of low-income renter-occupied households with children experiencing “rent burden,” “energy insecurity,” or a “double burden” as opposed to no burden. Findings suggest that low-income households are more likely to experience these economic hardships in general but that specific groups are disproportionately burdened in different ways. For instance, whereas immigrants are more likely to experience rental burden, they are less likely to experience energy insecurity and are also spared from the double burden. In contrast, native-born African Americans are more likely than all other groups to experience the double burden. These results may be driven by the housing stock available to certain groups due to racial residential segregation, decisions regarding the quality of housing low-income householders are able to afford, as well as home-country values, such as modest living and energy conservation practices, among immigrant families. This paper also points to important policy gaps in safety net benefits related to housing and energy targeting low-income households.

The confluence of energy supply- and demand-side dynamics links vulnerable communities along the spectrum of energy production and consumption. The disproportionate burden borne by vulnerable communities along the energy continuum are seldom examined simultaneously. Yet, from a justice perspective there are important parallels that merit further exploration in the United States and beyond. A first step is to understand links to vulnerability and justice along the energy continuum by way of theoretical constructs and practical applications. The present article posits energy as a social and environmental justice issue and advances our current understanding of the links between energy and vulnerability, particularly in the U.S. context. Drawing on several emerging concepts including, “energy sacrifice zones,” “energy insecurity” and “energy justice,” this article lays a foundation for examining critical sacrifices along the energy continuum. To conclude, four basic rights are proposed as a starting point to achieve recognition and equity for vulnerable populations in the realm of energy.

Using detailed sociological and public health qualitative interview data, we demonstrate that energy poverty is more pervasive, and results in a greater energy burden for low-income tenants, than many policymakers would assume. This is due in part to a lack of funding, policy non-coordination, and a lack of understanding of the social and economic benefits of energy conservation, energy education, and flexible utility billing policies. Examining LIHEAP, weatherization, utility, and housing assistance policies, we suggest that a coordinated, regional approach to home energy and housing policy that integrates programs in each area will provide a more coherent policy solution.