Tim Tai, Photography Editor

When Whitney Denary, a first year PhD student at the Yale School of Public Health, began speaking to community members struggling to pay rent, one theme stood out: how high rent forced families to choose between housing and healthy food. As a result of rising housing costs — she noticed — families opted to purchase cheaper, unhealthier foods in lieu of fruits and vegetables.

To quantify that burden, Denary and her team at the YSPH Housing and Health Equity Lab published a report identifying the link between rental assistance, food insecurity and nutrition intake. Published in the April edition of journal “Preventive Medicine,” their study found that tenants in rental assistance programs were less likely to experience food insecurity and consumed more daily cups of fruits and vegetables than those on program waitlists.

“When it comes to housing and food security, the two are linked,” Denary told the News. “And being able to alleviate one aspect of that, ideally, will help with another. If we use rental assistance as a proxy to take away the housing affordability dilemma that so many households are having, can they be able to afford better food security than they otherwise would?”

To examine how rental assistance affects food security and nutrition in low-income households, the researchers used food security and nutrition data from the National National Health and Nutrition Examination Survey, or NHANES. They then linked that data with housing records from the Department of Housing and Urban Development, which provides a database of individuals who received rental assistance between 1999 and 2016. 

However, according to Andrew Fenelon, an assistant professor at Penn State University and one of the YSPH team’s collaborators, studying the health impact of rental assistance programs is “difficult.” Individuals receiving rental assistance already tend to experience economic hardship — or homelessness — that exacerbate health disparities.

“These untoward life events can increase the risk of poor health, and can make it more likely that a household experiences food insecurity,” Fenelon said. “So if one does a simple comparison of families receiving rental assistance to those renting market-rate units, it might appear that rental assistance leads to poor health and food insecurity.”

By linking the two databases, the researchers could create a more accurate control group for families receiving rental assistance. 

They then divided the data into two groups: those receiving assistance when they entered the NHANES database and those who would eventually receive rental assistance within two years — a typical wait period for families seeking entry into rental assistance programs.

In theory, Fenelon added, the waiting-period group should experience similar socioeconomic determinants, varying only in that they have not yet received “the benefit of the program.” As a result, he said, the researchers were able to more accurately assess the effects of the programs themselves, rather than “picking up” other factors that would affect the health outcomes of rent-burdened individuals.   

Analyzing the results, the team recognized that project-based housing assistance was correlated with a decreased likelihood of food insecurity, as measured by metrics from the NHANES survey. 

Likewise, rent-assisted individuals consumed 0.23 more daily cups of fruits and vegetables on average than those in the control group. 

When the researchers further broke down the data by the type of rental assistance, they found that only project-based assistance was tied to statistically significant increases in fruit and vegetable consumption. However, both project and voucher based housing were positively associated with increased fruit and vegetable consumption. 

“The major implication then is that investments in housing have benefits beyond just shelter, including improving household food access and healthy food consumption, which may in turn improve health outcomes for these families,” Fenelon wrote in an email to the News. “This is important evidence for housing advocates and policymakers hoping to support further investments in affordable housing, especially given the wide health disparities we see in the United States.”

For Denary, the link between rent burden and food accessibility makes sense. Oftentimes, she explained, families facing high housing costs choose cheaper food or products with a long shelf life rather than healthier, more expensive alternatives. 

Especially for families with kids, parents with more limited expendable income often prioritize feeding their kids above themselves.

“Doctors will often recommend that people with diabetes eat more fruits and vegetables, and those changes can be expensive,” Denary said. “Their pocketbooks will dictate what their food choices are more so than what their doctors recommend for them.”

According to Denary, the study was a part of the Housing and Health Equity Lab’s ongoing investigation into the link between rental assistance, nutrition and diabetes. To continue exploring that relationship, she explained, the lab is tracking a cohort of 120 individuals in Connecticut with diabetes who are on rental assistance waitlists.

Over two and a half years, they intend to monitor diabetes metrics like A1C levels, blood pressure and glucose levels to assess how their diabetes status and management behaviors change as the individuals transition to rental assistance programs. The researchers also plan to conduct a series of longitudinal interviews on a subset of those individuals throughout the study. 

Denary noted that they hope to complete data collection in 2025. 

According to Kasia Lipska, an endocrinologist and Associate Professor of Medicine at the Yale School of Medicine who collaborated on the study, diabetes care can be “complex and challenging” for patients experiencing unstable housing. Improving outcomes for her patients with diabetes “means addressing their housing needs.”

“Social determinants of health play a critical role in shaping outcomes for patients with diabetes,”  Lipska wrote in an email to the News. “Our research suggests that many of these social determinants of health are interconnected … all critical to the health and well-being of people living with diabetes.”

According to Karen DuBois-Walton ’89, Executive Director of the Housing Authority of the City of New Haven, the link between health outcomes and housing makes housing an urgent issue. The government’s failure to meet housing needs, she added, is “unconscionable” and requires “continued advocacy by people in every community. 

“The clear connections between housing and health are borne out by this study and many more,” Dubois-Walton wrote in an email to the News. “Housing is essential to health, education, employment and all other wellbeing outcomes and must be a priority of local, state and federal officials and policy makers.”

However, Luke Melonakos-Harrison DIV ’23, a member of the Connecticut Tenants Union, pushed back on the notion of  rental assistance programs as the solution to housing shortages and spiraling rent. Instead, Melonakos-Harrison favors social housing initiatives, rather than rental assistance, as a means to address high rental costs.

“[Rental assistance] programs funnel public funds into the pockets of private investors and are laden with burdensome and disciplinary regulations on tenants,” Melonakos-Harrison said, “While social housing can solve the same problems without publicly funding the real estate industry.”

Even so, for members of the research team, investigating rental assistance produces research that informs the lives of people struggling with rental costs. 

Denary, for instance, pointed to rental assistance as a means to “save people money down the line.” By reducing the health consequences of unstable housing, she added, policies like rental assistance could healthcare costs and allow individuals to better manage their health. 

Denary also emphasized rental assistance as a research-tested tool to combat the high rent burden and adverse health consequences.

“Housing is linked to health, point blank,” Denary told the News. “We’re able to say that rental assistance does alleviate this rent burden, and it does subsequently have health benefits for folks that obtain it and are able to stay within the program. We really recommend that [policymakers] prioritize spending in this area for people to be able to have healthier lives.”

YSPH is located at 60 College St.

Giri Viswanathan was a Science and Technology Editor for the News. Previously, he served as a Photography Editor while covering the School of Public Health for the SciTech Desk. Originally from Pittsburgh, PA, Giri is a junior in Timothy Dwight College majoring in Global Affairs with a certificate in Global Health Studies.