Hidden costs of unaffordable housing: Exploring the multidimensional and intersecting health effects on Black Americans.

Background: Housing, a key health determinant, is increasingly unaffordable. Black/African-American communities are disproportionately affected due to a long, documented history of structural racism in housing. To date, much unaffordable housing research is economically focused, leaving holistic health consequences underexplored. Design and methods: We used a multidisciplinary lens to explore potential effects of unaffordable housing (30%+ of income) on mental, emotional, physical, and social well-being. In-depth, semi-structured interviews were conducted with 33 individuals who were residents and/or staff members of organizations that provide housing or support resources in three historic, Black neighborhoods in westside Atlanta. Thematic analysis identified key themes. Results: Unaffordable housing can have direct and indirect adverse effects on health and wellbeing. Participants described ways that rising housing costs can increase stress, worsening mental health (e.g. depression, anxiety) and negatively impacting relationships within one's household (e.g. spouse/partner, children) and outside of the home (e.g. friends, neighbors). Spending a disproportionate amount of income on housing can make other basic necessities unaffordable, such as food and medication. Working overtime or additional jobs to cover expenses can lead to mental and/or physical exhaustion and increase opportunities for injury for physically demanding jobs, and may also decrease time available to adequately care for oneself and their family or to invest in relationships. Conclusion: This qualitative study helps increase the breadth and depth of knowledge regarding potential effects of unaffordable housing on mental, emotional, physical, and social well-being that should be considered in the development of health-promoting housing practice, policy, and funding allocation.