IN-PERSON Lisbon Livable Cities. Section B

Abstract

Background: Unmet social needs such as housing can have significant effects on health outcomes. Lack of affordable adequate housing often brings hidden costs to health. The RxHL study examined chronic disease self-management among federally-qualified health center patients in a small minority-majority U.S. city. Methods: African-American, Latinx, Vietnamese, Russian-speaking and White American participants completed self-report surveys assessing socioeconomic barriers to health. A subsample of 97 participants completed in-depth interviews, home visits, and chronic disease diaries. Results: Housing insecurity was common among RxHL participants. Of 459 participants, 13.8% (63) lived with a relative or in someone else’s place, and 6.9% (32) lived in a shelter, emergency housing, halfway house or rented room (hotel or rooming house). 10.2% (47) considered themselves to be currently homeless. People experiencing homelessness, as well as those who lived somewhere other than their own house or apartment, were less likely to be able to afford their prescribed medications and to have transportation to a provider or pharmacy visit. Qualitative interviews included frequent narratives of housing instability and stints of homelessness. Housing transitions were often associated with major or traumatic life events such as leaving prison or dislocation due to a fire. Family and faith communities often provided critical support through such transitions, but family members could also be the source of conflict that led to housing transitions. Participants also described the impact of their housing situations on their access to pharmacies, medication adherence and medication management strategies. Conclusion: RxHL participants experienced major housing instability which had a significant impact on their access to healthcare and pharmacy services. For optimal health, livable cities must offer affordable and secure housing especially for low-income patients with chronic conditions.