The Health Effects of Home Design
Recommendations
- Use flexible funding sources to connect individuals and families emerging from homelessness with home design services including furniture assistance
- Ensure that services are delivered in a care-driven fashion
Introduction
The United States continues to face a homelessness crisis. Not only are a great deal of individuals and families experiencing homelessness, but many transition out of homelessness only to fall back in again.1 While returns to homelessness can largely be explained by housing costs and widespread economic precarity, the connections between homelessness, housing, and health are a contributing factor.2 As such, it is important to understand how housing conditions for people emerging from homelessness support or undermine holistic health and wellbeing.
Housing Versus a Home
There is an important distinction to be made between having housing and having a “home.” While access to housing provides the material conditions to feel physically safe, feeling at “home” happens when one has a sense of wellbeing. Home as a concept encompasses a sense of security, control, and permanence: markers of mental health.3 When people transition out of homelessness, they often move into housing with very few belongings. Such “furniture poverty”4 makes it hard for individuals to feel at home. Those populations most at risk of experiencing furniture poverty include low-income individuals, single parent households, persons living with disabilities, and persons who identify as Black, Indigenous, and other People of Color.5
Social determinants of health6 are the environments in which one lives, learns, works, and plays. Shaped by public policies, structural poverty, and historical racism, these environments produce health inequities. Housing is one of the most central social determinants of health as differences in housing affordability and quality are consistently linked to diverging financial, physical, and mental health outcomes.7 Widespread housing cost burden8—where households spend more than 30% of their income on housing— impacts physical and mental health as anxiety levels increase and nutritious meals and medical care become harder to afford.9 Housing quality additionally impacts resident wellbeing as poor housing conditions, including exposure to toxins, mold, and unsafe neighborhoods, negatively impact health.10 While much has been written on housing cost and quality, the health impacts of furniture poverty remain under researched.
The Holistic Health Benefits of Home Design: An Evaluation of Humble Design San Diego
A recent evaluation of Humble Design San Diego has shed some light on the holistic health impacts of home design.11 Humble SD is a nonprofit organization that provides care-driven home design services to individuals and families emerging from homelessness. These services, delivered with dignity, respect, choice, and attention paid to histories of trauma, include free furniture assistance and guidance on how to maximize living space. Clients meet with designers and are asked about their furniture needs and their preferences and interests. These meetings culminate in a full home redesign.
The evaluation revealed that Humble SD’s home design services boost client physical, mental, social, and financial health. Clients consistently highlighted that improvements to their total health were the result of both their new home environment and the care with which Humble SD delivered their services. New beds meant better quality sleep. New dining room tables meant people felt proud to host their family and friends. Improved mental health inspired people to find better jobs and increase their incomes. That Humble SD took the time to ask them about their furnishing needs and did not pry into their experiences of homelessness made the experience even more impactful for clients as they felt truly cared for and were reminded of their self-worth.
Why this Matters
The holistic health impacts of home design boost client resilience. Humble SD clients not only highlighted their own sense of resilience—remarking that they were in moments of self-actualization and new goal setting, including finding new job opportunities or going back to school—, but such resilience helps to explain an incredible finding:
While 25% of San Diegans who had exited homelessness in recent years returned to homelessness,12 only 2.3% of Humble SD clients returned to homelessness.
Due to the connections between housing, home, and health, it is important that flexible funding be allocated to assist individuals and families emerging from homelessness with their furniture needs. So many people exit homelessness into furniture poverty to the detriment of their holistic health and wellbeing. Services to combat furniture poverty can improve health and help to end the cycle of homelessness, especially if they are delivered with care. Ending returns to homelessness matters. Not only is homelessness a traumatizing event13 — one that negatively affects one’s physical, mental, social, and financial health — but it is a costly social problem.14 Breaking the cycle of homelessness by ending furniture poverty will thus have salubrious individual and community-level impacts as people will remain healthy and housed, set new goals for themselves, and meaningfully contribute to their surrounding communities and as funds to alleviate homelessness can be used to combat new challenges.
Works Cited
[1] Department of Housing and Urban Development. (n.d.) CoC Performance Profile – All States, Territories, Puerto Rico, and DC – as of 2022.
[2] Padgett, Deborah K. (2020). “Homelessness, Housing Instability, and Mental Health: Making the Connections.” BJ Psych Bulletin 44(5): 197-201.
[3] Skobba, Kim. (2024). “The Elusiveness of Home and Ontological Security among Homeless Youth.” International Journal of Housing Policy. doi: 10.1080/19491247.2023.2284855
[4] Furniture Bank. (2023). Furniture Poverty.
[5] End Furniture Poverty. (2023). The Extent of Furniture Poverty in the U.K.
[6] Office of Disease Prevention and Health Promotion (2024). Social Determinants of Health.
[7] Office of Disease Prevention and Health Promotion (2024). Housing Instability.
[8] Whitney, Peyton. (2024). More Than 42 Million U.S. Households Were Cost Burdened in 2022. Joint Center for Housing Studies of Harvard University.
[9] Kushel, Margot B., Gupta, Reena, Gee, Lauren, and Jennifer S. Haas. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine 21(1), 71-77.
[10] Rolfe, Steve., Garnham, Lisa., Godwin, Jon., Anderson, Isobel., Seaman, Pete., and Cam Donaldson. (2020). Housing as a social determinant of health and wellbeing: developing an empirically-informed realist theoretical framework. BMC Public Health 20, 1138.
[11] Livingstone, Stacey, Rabinowitz Bussell, Mirle, and Lewis, Leslie R. (2024). An Evaluation of Humble Design San Diego. Homelessness Hub UC San Diego.
[12] Regional Taskforce on Homelessness. (2024). Homelessness Crisis Response System 2023 Data and Performance Report.
[13] Somerville, Peter. (2013). “Understanding Homelessness.” Housing, Theory and Society 30(4):384-415.
[14] Kendall, Marisa. (2024, April 9). California Fails to Track Its Homelessness Spending or Results, A New Audit Says. CalMatters.
CRB Nexus Guest Author
Stacey Livingstone is currently a postdoctoral research fellow for the Homelessness Hub in the Department of Urban Studies and Planning at UC San Diego where she will be working on several collaborative, community-engaged research projects including an evaluation of emergency shelters and street outreach efforts in San Diego and a study of the individual and communal impacts of advocacy work conducted by those with lived experience of homelessness. In addition to her dissertation, which focused on the health consequences of vulnerability assessment tools and limited resources for those experiencing homelessness, Stacey has conducted public sociology research projects on student housing insecurity and permanent supportive housing with students and homelessness lived experience advocates respectively. Her academic work has appeared in Teaching Sociology and Transformative Dialogues and she has written policy briefs for Scholars Strategy Network. Her research has been supported by the Global Health Institute and the Yankelovich Center for Social Science Research.