New Directions In Housing And Health In The United States

counter with drawers and cupboards below and two shelves of labelled bottles above. Lab coats hanging from hooks in the background. There is a rabbit in basket on the counter
An Internal Medicine laboratory, circa 1900. Today, the Internal Medicine profession also looks outside the lab to understand illness.

Research in the United States has pinpointed connections between safe, stable affordable housing with health care1. This post is the first in a short series about how that research is spreading throughout institutions across the country.

This post is inspired by an article published in the Annals of Internal Medicine and written by American College of Physicians (the ACP). The ACP commissioned a review of academic literature about the relationship between health and homelessness. The researchers investigated factors that affect the poor health outcomes and premature mortality among people who are homeless. The article directly addresses the issue of personal characteristics and structural conditions as contributors to homelessness:

“Although there are numerous individual risk factors for becoming unhoused, including adverse childhood experiences, economic disadvantage, mental illness, and drug use, homelessness rates largely reflect structural factors and societal decisions (emphasis added) around how to allocate resources, such as an inadequate supply of affordable housing.”

The ACP used the paper to develop and endorse eight recommendations about changes in practice that are needed to improve health outcomes for people who experience homelessness. The recommendations that top the list are about ensuring an adequate supply of affordable housing. The wording of these two recommendations follow from the evidence linking homelessness with structural issues:

    • “ACP recognizes the essential role of stable housing on well-being and the negative impacts of homelessness and housing instability on health and health outcomes. ACP views health as a human right and that access to safe and affordable shelter is an essential component of recognizing and implementing that human right.
    • ACP believes that public policy efforts must prioritize the facilitation of safe and affordable housing for all. ACP urges policymakers to commit to addressing the structural underlying drivers of homelessness within society.”

Why does this matter?

The ACP’s membership includes doctors trained or training in internal medicine. Internists are physicians who specialize in treating adult patients and considering all the internal systems in the body2. They diagnose and treat complex health issues. Internists are well positioned to understand health issues experienced by people who are homeless. It is significant that a professional college with these qualifications is calling for more housing that is stable, safe and affordable, along with health services that are able to respond to complex health issues.

As well, the ACP’s report includes recommendations about training for students, which will alert doctors entering the field about structural barriers like housing, which underlie health issues for people who are homeless3.

The article linked to this post is available to all readers and posted at Annals of Internal Medicine: Meeting the Health and Social Needs of America’s Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians


  1. For example, try: Connecting The Housing And Health Dots
  2. For more on this specialty, try: About Internal Medicine
  3. The next post in this series discusses academic innovations designed to improve health outcomes for people who are homeless. Try: