Yale Daily News

Danya Keene and her team are on a mission to improve health care for unhoused people.

Based out of the Yale School of Public Health, the Housing and Health Equity Lab has explored the effects of housing disparities and homelessness on people’s health since its founding in 2020. Her team aims to get a deeper understanding of how access to housing affects health outcomes and develops solutions to address the health issues arising from inadequate housing access.

Since then, the lab has used a combination of data analysis and interviews with community members to develop evidence-based solutions that increase housing access and equity. Keene, an associate professor for public health, noted that her lab also hopes to improve collaboration between researchers while creating a training ground for students interested in the social determinants of health.

“Our mission is to conduct research that is actionable towards the goal of advancing housing and health justice,” Keene wrote in an email to the News. 

Since the COVID-19 pandemic moved much of the lab’s meetings and research online, Keene has been able to expand her research team beyond Yale. Now, her trainees include students at Columbia University, Ohio State University, Emory University and other institutions. 

These collaborations, she said, have strengthened the lab’s ability to investigate a wide range of issues related to housing and health. Some of her team’s ongoing projects explore the effects of evictions on mental and physical health and how the wait time for rental subsidies affects diabetes management.

“If you have spent most of your money on rent, you probably do not have enough left to buy enough food, fill prescriptions or pay utilities,” wrote Penelope Schlesinger, the lab’s manager and program administrator, in an email to the News. “There is a critical need for more affordable housing, [so] it’s critical to continue to explore the ways housing shapes health.”

Systemic health inequities

Whitney Denary, a lab member and doctorate candidate in social and behavioral sciences, noted that one of the lab’s research goals is to contextualize how racially discriminatory housing policies, such as redlining, have produced disparities in housing access — and lead to harmful health consequences.

As a result of these systemic practices, she explained, communities of color have a lower likelihood of home ownership and experience housing insecurity at a higher rate.

“In the 1930s, the Homeowner’s Association provided land in areas that aren’t good to people of color and provided them with higher mortgage rates,” Denary told the News. “People who weren’t able to buy housing at that time may go down the line of renting, which reduces generational wealth and ability to use money.” 

Additionally, redlining reduced public investment in marginalized communities, Denary added, leading to a broad scarcity of social infrastructure and resources in low-income communities. Combined, those impacts of historical housing inequities have produced poor health outcomes for low-income communities.

“The communities that were redlined don’t necessarily have parks, or libraries, or all of these really important community assets that then can push families and neighborhoods to ultimately have successful health,” Denary said.

More recently, homelessness in Connecticut has risen over the past two years, following nearly a decade of declining rates. After 2021, Connecticut saw a 13-percent spike in statewide homelessness rates, according to a publicly available point-in-time count by the organization Advancing CT Together. 

According to their latest available data in January 2023, there were over 3,000 individuals experiencing homelessness in the state — a nearly three percent increase from the year prior. While the number of individuals experiencing chronic homelessness remained the same, the report found a seven percent increase in the number of youth experiencing homelessness in the state.

As the Executive Director of New Haven’s Housing Authority, Karen DuBois-Walton ‘89, has helped many of those individuals and families find affordable housing throughout her career. Her experience mirrors some of the Housing and Health Equity Lab’s key findings: regardless of the cause, housing instability exacerbates health issues.

“It’s harder to stay connected with a treatment, it’s harder to keep up with a good health regimen, it’s harder to get access to healthy food, it’s hard to keep up with your medication,” Dubois-Walton said. “In the absence of stable housing, all of those things become more challenging.”

Housing and health are also a two-way street, she added, since health challenges can often cause housing insecurities, as well. Some health issues create obstacles to keeping a job, earning a consistent income, and paying rent on time, Dubois-Walton said.

Chronic conditions, ‘pure stress’

For individuals with chronic diseases, the financial uncertainty and food instability individuals experience while homeless can make managing their illness a daunting endeavor.

Unhoused patients with diabetes, for example, are often unable to use the medication insulin, since the drug requires long-term refrigeration, Denary said. Without a home, patients also might not have access to safe spaces to check their blood sugar or effectively maintain dietary restrictions doctors recommend for diabetes management.

Even for patients without diabetes, tenuous housing conditions can make it difficult for individuals to access nutritious, regular food sources. In 2023, Denary led a study that found that tenants in rental assistance programs were less likely to experience food insecurity. Those tenants also consumed more daily cups of fruits and vegetables than those not covered by the programs.

However, Keene said, it is often not enough that unhoused individuals try to keep a healthy diet. The body’s response to the stress of experiencing homelessness itself can be damaging, leading to post-traumatic stress symptoms and an increased rate of emergency department visits among unhoused people, her research has found. 

Particularly for individuals with chronic diseases like diabetes that require careful dietary regulations, those chronic stress factors can have damaging biological effects, even if patients try to eat as recommended by their doctors.

“Even if individuals that deal with housing insecurities eat healthy food and try to stay healthy, the pure stress of their housing situation leads to a release of hormones that cause blood sugar levels to rise,” Keene told the News.

Mark Colville, a New Haven-based housing activist, highlighted some of those cascading stressors that unhoused people face. Individuals who are evicted and lose their jobs are left unable to pay for rent, forcing many into overburdened shelters, he said.

“However, most shelters will kick out individuals in the morning and leave them stranded on the streets,” added Colville.

Colville said he has also come across scenarios where homelessness has exposed individuals to health and sanitation risks. He described his experience working with a woman who experienced unhygienic and environmentally hazardous conditions while unhoused.

“When she was living under the bridge, there were rats everywhere,” Colville told the News. “She knows that she was consuming rat waste in her food and that she was using her inhaler [for asthma].”

Blending research and activism

For Keene, a major component of her lab’s work entails advocating for practical policy interventions that combat crises at the intersection of housing and healthcare.

In 2021, she published an editorial in the CT Mirror that urged the state legislature to pass laws that ensure universal access to legal counsel when faced with eviction, based on the lab’s findings that evictions are linked with increases in maternal depression, climbing rates of sexually transmitted infections and worse child health outcomes, Keene said. 

Members of the lab have also submitted testimony that describes how raising rent can lead to higher rates of homelessness among low-income families, Denary said. Denary’s testimony encouraged the legislature to implement a stable rent cap in the state and regulations against owners raising rent when new tenants arrive. 

DuBois-Walton said she believes that there is a critical need for research that highlights the connections between housing and health to inform policymakers about the far-reaching consequences of homelessness. 

Given how widespread the impacts of stable housing are, she said, it is economically favorable to keep people in stable housing, instead of disrupting their education, employment and health.

“My hope is that housing researchers and health researchers will continue to keep that kind of research in front of policymakers so that we don’t just do it in a moment of crisis, like [COVID-19],” DuBois-Walton said. “It’s a basic human rights measure that everybody deserves.”

Moving forward, Keene said she aims to increase awareness about housing and healthcare research by participating in conferences nationwide. She also said she hopes the lab can establish a support network for students interested in the research field, especially among students who have experienced housing insecurities. 

Meanwhile, Keene also said she is planning to increase the lab’s engagement with groups that advocate for improved housing access — like tenant organizations, housing activists and legislators—to bridge the gap between research and policy.

“I think if we continue to have good research that shows [housing] is what is good for human development and for human wellbeing, it will get policymakers…to invest in those areas,” DuBois-Walton said. 

But for Keene, public health recommendations are only the first step.

“We’re identifying the health impacts of an unmet housing need, and we’re not going to address through public health interventions; the only way to address that is through housing,” Keene said. 

As of Jan. 15, there were over 800 unhoused people in Connecticut, 177 of whom were in the New Haven area, according to the Connecticut Coalition to End Homelessness.

Abel Geleta covers Yale New Haven Health (YNHH) for the Science and Technology desk at the News. Previously, he covered stories and topics at the intersection of Science and Social Justice. Originally from Ethiopia, Abel has lived in northern Virginia for the past 12 years. He is currently a junior in Berkeley college studying History of Science, Medicine and Public Health as a scholar in the Global Health Studies Program