Residential instability and chronic illness: Examining the relationship between housing and health in the U.S. safety-net

• In Event: 3129 - Section on Medical Sociology Refereed Roundtables (1 hour)
  In Refereed Roundtable 60min: Table 27. Financial Strain and Health

Abstract

Background: While sociologists, urbanists, and city demographers have long explored residential mobility, researchers have focused almost entirely on voluntary mobility, neglecting until recently how involuntary displacement—disproportionately experienced by low-income individuals and households—may be consequential to health. Gaps remain about how residential instability, including forced moves, shape the health and health care of low-income patients with chronic illnesses in the U.S. health care safety net.

Methods: Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine efforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support.

Results: Our findings illustrate the range of challenges facing homeless and unstably housed individuals in the context of a regional affordable housing shortage. Residential instability and mobility work to create vulnerability for low-income chronically ill individuals, and in turn, poor health undermines safe, stable, and health-promoting places to live. Our findings capture the complex reciprocal, and often cyclical, relationship between residential instability and health.

Conclusion: Low income individuals with precarious housing status simultaneously experience involuntary movement and involuntary immobility—forced out with eviction notices or higher rents and forced to stay in overcrowded and more expensive neighborhoods to be near their health care providers.

Authors

• Tessa M Nápoles, University of California, San Francisco

• Nancy J Burke, University of California, Merced/ University of California, San Francisco

• Mark Fleming, University of California, Berkeley/ University of California, San Francisco

• Ariana Thompson-Lastad, University of California-San Francisco

• Meredith Van Natta, Duke University

• Irene H. Yen, University of California, Merced/ University of California, San Francisco

• Janet K. Shim, University of California-San Francisco