The Highest Form of Love

(Illustration by Marcos Chin) 

The greatest form of love is healthy, safe, and thriving communities. The best way to ensure that is to secure adequate, safe, and affordable housing for all.

At its core, health care is about helping people live healthy lives. Clinical care is only one piece of the puzzle, however. Research shows that medical services contribute some 10 percent to overall health outcomes. Whereas genetics account for another 30 percent, 40 percent comes from behaviors such as diet, exercise, and substance use. The remaining 20 percent arises from social and environmental conditions. These “social determinants of health,” which include our jobs, neighborhoods, access to food, education, and community support, shape our well-being to a greater extent than our work inside clinics and hospitals. Among these social determinants of health, housing is foundational.

Without safe, stable housing, the rest falls apart. Housing is the literal and figurative basis of health: a place to sleep, store food and medicine, recover from illness, and feel safe. Without stable housing, it is difficult to prioritize or receive health care. Families and individuals without it face cascading challenges that no amount of clinical care can solve.

The Weight of Housing Costs

For decades, Americans have faced a growing gap between incomes and housing costs. Families that spend more than 30 percent of their income on rent are considered “rent burdened.” Today, nearly half of US households fall into that category, and more than one-quarter spend more than 50 percent of their income on housing (“severe rent burden”). Many of these families are forced to make impossible choices: rent or food, rent or medicine, rent or transportation to work.

The math is unforgiving. According to the National Low Income Housing Coalition, the United States faces a shortage of 7.1 million affordable and available rental homes for extremely low-income households. For each 100 such families, only 35 units exist. No state in the country has an adequate housing supply, and there is no city where someone working full time at the federal minimum wage can afford a modest two-bedroom apartment. This is not an urban or coastal crisis but a national one, encompassing everything from rural towns to major cities, and it is getting worse.

Housing and Health Outcomes

The absence of safe, stable, and affordable housing has profound health effects. Substandard housing exposes families to mold, pests, and lead, and exacerbates asthma and other chronic illnesses. Poor insulation and heating systems leave residents vulnerable to extreme heat and cold. Overcrowded units worsen stress and poor sleep and accelerate the spread of infectious diseases, a problem laid bare during the COVID-19 pandemic, when household density proved a major driver of viral transmission.

For people struggling to balance rent payments with other expenses, and for those living on the edge of eviction, constant stress takes a toll. Researchers have linked housing stressors to depression, anxiety disorders, and poorer control of chronic conditions such as diabetes and hypertension. Children in unstable housing experience developmental delays, worse school performance, and higher rates of hospitalization.

Homelessness sits at the extreme end of this continuum of housing insecurity. On any given night, more than 770,000 Americans face homelessness—it’s a public health emergency. People without homes experience rates of chronic illness that greatly exceed that of the general population, and their life expectancy is decades shorter. Exposed on a regular basis to violence, extreme weather, and the psychological strain of living without safety or privacy, unhoused individuals endure much higher rates of hospitalization. Discharges are fraught. Patients are often sent “home” to a shelter cot or the street, undermining recovery and setting the stage for readmission.

Providers face impossible decisions. Sometimes patients are admitted not because they require hospital-level care, but because they have nowhere safe to go. Medications are lost or stolen. Patients without phones or addresses miss follow-up appointments. The system strains under the weight of treating symptoms that stem not from biology, but from the absence of shelter.

Structural Inequities in Housing

These crises are compounded by structural inequities that are baked into US housing policy. For generations, discriminatory practices such as redlining, mortgage denials, predatory lending, and exclusionary zoning locked Black, Indigenous, and other people of color out of stable housing opportunities. These policies denied individuals access to homes but also denied families the chance to build wealth, stability, and health across generations.

The consequences are visible today. Black families are more likely to be rent burdened and more likely to experience eviction or homelessness. Native communities face extreme housing shortages and overcrowding. Latino families disproportionately live in substandard housing with environmental exposures. These inequities reverberate in health statistics: higher rates of asthma, hypertension, maternal mortality, and life expectancy gaps that span decades.

Housing insecurity is not evenly distributed and neither are the health impacts. If we want to achieve health equity, we must confront housing equity head on.

Housing as Health Care

What does it mean to say that housing is health care? It means recognizing that prescriptions and procedures cannot compensate for the absence of a home. It means understanding that rent subsidies, eviction prevention, and affordable housing production are as vital to health as flu shots and cancer screenings. It means that if health systems are serious about improving outcomes, they must step outside the clinic and invest in housing stability.

Some hospitals and health systems are beginning to invest in affordable housing, partnering with developers, leveraging their land, or providing capital to stabilize housing for vulnerable populations. Medicaid waivers in some states now allow funds to be used to support housing navigation services and short-term rental subsidies. Philanthropic and public-private partnerships are expanding permanent supportive housing, providing stable housing, and ending homelessness for individuals with the most significant behavioral health challenges. But these efforts pale in comparison to the scale of need. While pointing the way forward, they cannot substitute for comprehensive policy solutions.

The Path Forward

We know what works. Universal rental assistance would dramatically reduce rent burdens and prevent homelessness. Expanding the Housing Choice Voucher program, strengthening eviction prevention services, and investing in affordable housing construction and development are essential. Inclusionary zoning and fair housing enforcement can chip away at structural inequities. We must scale permanent supportive housing for those with complex health needs. 

For health systems, the imperative is clear: move from pilots to permanence. Partner with housing authorities, community-based organizations, and policy makers to address housing as a core determinant of health. Reframe “return on investment” as not only dollars saved on avoidable hospitalizations but also healthier, more resilient communities.

Instead of an abstract debate, this is about whether families can afford groceries without skipping rent. Whether an older adult can safely recover from surgery inside a warm home. Whether a child can grow up free from the trauma of repeated evictions.

The highest form of love is healthy, safe, and thriving communities. To achieve it, we must guarantee safe, stable, and affordable housing for all.

Read more stories by Marc Dones & Margot Kushel.