Housing and Social Support as Social Determinants of Health

S. Boodoo, J. Dickens, L. Durai, K. Ehrlich, K. Marin, S. Mays, A. Shodell, I. Wein, R. Pitale

Civic Scholars 2021

01 / 06

Summary

This paper aims to study which variables may account for limits in health outcomes, focusing on availability of homes, the built environment, and proximity to socially determined measures of standards of healthy communities. Studying how these multiple variables in housing and social support affects health outcomes in an effort to better understand and overcome health disparities in the Florida community. We used quantitative datasets to find each county’s standing in housing units, median gross rate, owner-occupied housing rates, its median value, and percentage of population that was walking distance or ½ a mile within a park, off-street rail, fast food place, and healthy food source. From analyzing this data, we found several trends that explained experiences we’ve had and heard in Florida as a collective group after discussing and speculating the possible implications of those trends.

How to use this report

All the maps in this report are interactive. Clicking on a county will display information for that county. There are prompts throughout the report to visualize data. Pressing these prompts will visualize the data on a map and the map will be interactive.

Introduction

Examining important variables involved in housing and the built environment, this report aims to reveal exactly how regional differences in variables in Florida have delineated stark contrasts in the conditions of neighborhoods and real people’s lives. These inequities often arise merely due to where individuals live, and are unable to live.

Social Determinants of Health

Most health inequities are the result of overlapping social structures and economic systems. Due to the pandemic, these health disparities are more visible than ever with disparities in access and trust in healthcare systems. The lived experiences of individual Florida citizens are impacted by a number of social determinants of health. It is important to recognize that the distribution of advantages and disadvantages in society reflect the distribution of health and disease. Social determinants such as socioeconomic status, education, employment, and access to health care are all contributing factors in population health.

Data

The quantitative data on housing topics was collected from the U.S. Census Bureau QuickFacts Florida , which contains the standardized dataset for all of Florida’s counties. This is a free, and advanced application that offers statistics in the form of tables, maps, and charts using the Census Bureau’s censuses, surveys, and Population Estimates Program (PEP).

Data was collected on:

Population (2019) shown on map
Number of Housing Units (2019)
Median Gross Rent in Dollars (2015-2019)
Median Value of Owner-Occupied Housing Units in Dollars (2015-2019)
Owner-Occupied Housing Unit Rate (2015-2019)

For social support topics (built environment), quantitative data was collected using FloridaTracking, which contains the standardized data set for all Florida counties. Like QuickFacts Florida, this is also a free, public application that offers data-based charts, tables, and maps on health-related topics in Florida.

Data was collected on the percentage of population living within half a mile of:

Sources of Healthy Food
Fast Food Restaurants
Public Parks
Off-Street Trail Systems

Housing

Physical environment, specifically housing, comprises an important aspect of the general health and wellbeing of a population and community. Having adequate housing can encourage the physical and mental well-being of individuals in other areas of health as it is somewhat foundational.

The number of housing units in Florida, to an extent, represent some of the larger population centers in the State. On average, there was 144,383 housing units in each county. In the map, areas with a higher than average number of housing units are in red while those areas closer to the average are in green, and those below average are in blue and purple.

The housing to population ratio is a rough indicator of where home prices may be inflated by scarcity. Those areas in red are indicative of counties where there are more people than housing units. Comparatively, those areas in blue are where there is more housing than people.

Generally, in the State of Florida, the largest home values are associated with some of Florida's most scenic tourist destination along the coast. On average, the value of owner-occupied housing was 170,685$, with the most expensive values in Monroe County (494,100$) and the lowest in Liberty County (75,100$). Those areas in red represent counties with higher than average median home value and those in green represent counties with lower than average median housing.

The median gross rent in the State of Florida between 2015 and 2019 was 953.99$. Median rents tend to be higher in those counties that are closer to the coast. The State's highest rents can be found in the South and Southeastern portion of Florida:

Monroe County (1,682$)
Palm Beach County (1,398$)
Broward County (1,392$)
Miami Dade County (1,328$)
Collier County (1,317$)

The Lowest media rents can be found in the "Panhandle" and "Big Bend" regions.

Unsurprisingly, those areas with lower rents and home values tend to have more home ownership. This percentage of the population that owns their home is otherwise known as the owner-occupied housing unit rate. Those counties with above average (71.8%) percentage of home ownership are represented by purple areas while those with below state averages of home ownership are pink.

What are the impediments to home ownership in the State of Florida?

In this map to the right, the size of the circle represents the rate of home ownership in that particular county. The legend is designed to bring your attention to those counties with low rates of home ownership. Larger circles have a less than average home ownership rates. Circles that are a deep purple represent counties with both above average rents and home values. Areas that are more red are counties with above average rent and low home values. Those counties which are more blue have high home values and low rent. Those counties with light pink coloring have both below average rent and housing value.

South Florida Trend

Many counties in South Florida such as those associated with the larger Miami, Tampa, and Orlando areas are subject to above average rent and housing values. This creates barriers to home ownership as high rents make saving for a home impossible, especially when coupled with some of the highest property values in the state. This might explain why Miami-Dade County has the lowest home ownership rate in the state (51.2%), and Orange County (Orlando) has the 4th lowest (55.4), while Hillsborough (Tampa) has the 6th lowest (58.6%).

North and Central Florida Issues

The larger cities of North Florida such as Jacksonville, Tallahassee, and Gainesville are indicative of other problems.

Jacksonville: median gross rent is high while home values are not exorbitantly expensive. However, Jacksonville is the largest city in Florida and has the 5th lowest percentage of home ownership (57.7%).

Tallahassee: rent is low but home values remain high. High home values could explain why home ownership in Leon County is the 2nd worst in the State of Florida (53%).

Gainesville: Considering the relatively small population of Gainesville and Alachua County more broadly, some may be surprised this county has the 3rd worst home ownership rate in the state (55%).

Top Ten Lowest Home Ownership Rates:

Miami-Dade (51.2%)
Leon (53%)
Alachua (55%)
Orange (55.4%)
Duval (56.7%)
Hillsborough (58.6)
Monroe (59.5%)
Osceola (61.6%)
Escambia (62%)
Broward (62.1%)

Built Environment

We evaluated the SDoH social support in regards to the built environment. The variables we chose to analyze are the percentage of the population living within:

1/2 mile of a healthy food source
1/2 mile of fast food restaurant
ten minute walk to a park
ten minute walk to an off-street trail system

Healthy Food Access

In the map to the right, the counties are organized by Florida Health Planning Region. The map emphasizes those counties that have a smaller percentage of the population within a 1/2 mile of a healthy food source with larger circles. Those areas with smaller populations generally have a smaller percentage of their population that lives within a 1/2 mile of a food source. This pattern is much more common in rural areas.

Fast Food Access

Accessibility to a healthy food source, and by contrast, the convenience of being closer to a fast food restaurant determine food consumption and associated illnesses such as obesity, diabetes, high blood pressure, and high cholesterol. An issue which is detrimental to societies who live farther from healthy food sources is food insecurity; a “lack of consistent access to enough food for an active, healthy lifestyle” (USDA).

In the map to the right, counties are represented by their predominant category. Those counties in red are where a larger percentage of the population lives within a half-mile of fast food. Those counties in yellow are where a larger percentage lives within a half-mile of a healthy food option. The darker the color, the stronger the predominance.

Activity

Living near a park or an off-street trail system is essential for physical activity and overall happiness. Access to a safe outdoor area predicts how often the population exercises or simply enjoys the natural world, leading to higher wellbeing.

In the map to the right, red areas represent counties with a smaller than average percentage of the population living within a 1/2 mile of a park. Green areas represent counties with a larger than average percentage of the population living within a half-mile of a park. To draw your attention, larger circles represent counties that have a below average population living within a 1/2 mile of an off-street trail system. Many counties in the "Panhandle," "Big Bend," and "Suwannee River" area lack access to parks and trails.

Discussion

Housing

Wellbeing of residents is determined by quality and secure housing, and without it, the ability of residents to live a healthy life is greatly hindered. A critical issue that emerged from this study is the relationship between rates of rent and the owner-occupied unit rate. This could possibly connect to the rent rate: since the average rent in southeastern counties was higher than the Florida average of $974, it may be harder for residents to afford and access secure housing. However, this correlation does not mean causation, evident in the Northeastern counties of Florida, which has an average rent below the Florida average but a high ratio of population to housing at 25:1.

Expanding affordable housing options can lessen the impact of housing insecurity in each of the regions. By increasing affordable, safe, and secure housing, residents will gain a foundation that will allow them to lead healthier lives. In addition, protecting this housing from situations like gentrification will increase financial security and create positive health outcomes.

In future studies, policies relating to affordable housing should be examined closely. By looking at what governments are doing to protect and expand affordable housing, we will be able to see what more needs to be done and how specific policies have played a role in creating positive health outcomes. In addition, studies of a causal link between housing insecurity and food deserts can be conducted, to show whether or not areas with increased housing insecurity and poverty are more likely to only have access to unhealthy food options.

Built Environment

Populous urban cities have higher percentage of their populations living within half of a mile of healthy and unhealthy food. Proximity and convenience are strong factors in predicting a person’s dietary consumption and health outcomes. Overall wellbeing and quality of living are determined by the accessibility to nutritious and healthy food. If cheaper and unhealthier food options such as fast food are nearby, there is a higher likelihood of unhealthy consumption leading to diseases and illnesses. Similarly, those who cannot afford healthy food sources are then more likely to develop illnesses such as obesity, eating disorders, diabetes, high blood pressure and high cholesterol.

A critical issue which emerged from the data is food insecurity. This is a term describing not being able to afford or have consistent access to enough food for a healthy lifestyle. Low food security is defined as “reducing the quality, variety, or desirability of diet… disrupted eating patterns and reduced food intake” (USDA). Food insecurity is associated with living farther away from a healthy food source, or food in general. This leads to undernutrition and malnutrition. Another issue is food deserts which disproportionately affect marginalized communities and minority groups in Florida. This can be extrapolated to food deserts and associated health outcomes occurring in America.

Expanding public transportation could lessen the problematic health outcomes of food deserts and food insecurity. In future studies, the effects of living in close proximity to healthy sources of food versus unhealthy sources of food can also be studied. Such variables as average lifespan, disease, and other health outcomes can be studied to show whether or not living close to healthy sources of food plays a role in better health of community residents.

Parks and off-streets trails provide green and natural spaces, which are linked to increased medical benefits such as “lower blood pressure and cholesterol levels, enhanced survival after a heart attack, more rapid recovery from surgery, fewer minor medical complaints, lower self-reported stress, attention disorders for children, and behavioral disorders for teens" (American Planning Association, 2003). In the overall findings of accessible parks and trails within a half mile reach in Florida’s regions, it is easily identifiable that urban areas in South Florida are with the closest reach for residents. Critical issues to be considered is that areas that lack in such spaces are dominantly rural or suburban. Studies have shown that rural children and adults have significantly higher rates of obesity than their urban counterparts. While such rural areas may not lack natural areas, human-made built environments are crucial as they provide safe and quality spaces for physical activity (Toliver, 2016).