Can Doctor Intervention Affect Housing Conditions?

Landlord Behavior After Receiving Pediatrician-Generated Letters to Address Poor Housing Conditions
Yonit Lax, MD; Gabriel Cohen, BS, Amy Mandavia, BA; Steven Morrin, BS; Jeffrey R. Avner, MD
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Poor housing quality can be detrimental to children’s health. Some interventions, such as relocating families, can mitigate health challenges associated with poor housing conditions, but they’re often expensive and time-consuming. This study evaluates how one low-cost intervention—physician-generated letters—may lead to improved housing conditions.

The authors focused on three hospital-based pediatric primary care sites in New York in 2019. They used a screening tool that asked about housing, food, and child care to identify families with housing challenges (those who answered “yes” to questions about overcrowding, roaches, rodents, utilities, mold, and lead to which their landlords were unresponsive). They offered these households a physician-generated letter advocating for the landlord to fix the conditions and explaining the health consequences. They then surveyed the households about the landlords’ actions two to six months later.

Though the study focused on a small sample, the authors found physician-generated letters may be an effective way to improve children’s and families’ living conditions.

Key findings
  • Nine percent of the 2,800 families screened had challenging housing conditions. Of that sample, more than half (55 percent) requested and received a physician-generated letter advocating for housing repairs, and of those, 76 percent completed the follow-up survey.
  • Of the 35 families (36 percent) who reported giving the letter to their landlords, 31 (89 percent) reported that the landlord acted to resolve the issue, and 26 (74 percent) reported complete resolution of the concern.
  • Families who reported housing challenges were more likely to also experience food insecurity (32 percent versus 17 percent) or child-care or developmental concerns (27 percent versus 12 percent).
Policy implications
  • Employing the medical system in housing interventions may be an effective way to compel housing providers to improve local conditions.