To help homeless families, pediatricians should not focus on equality to make a difference in children’s health outcomes. Rather, they should zero in on equity, according to Megan Sandel, M.D., M.P.H., who spoke at Sunday’s plenary on how affordable housing improves children’s health and future outcomes.
Quality, stability, affordability and location are the four walls that support a healthy home foundation for children, Dr. Sandel said.
Conversely, being homeless is connected to increased risks of injuries, asthma, lead poisoning and high blood pressure for children and giving birth to premature infants or infants with low birthweight for pregnant women, she said.
“We as pediatricians are the best messengers out there,” she said. Rather than focusing on negative messages, however, Dr. Sandel urged pediatricians to advocate for affirmative messages on behalf of homeless and near-homeless families who need more support from their communities.
She likened this unequal but equitable approach to apple picking. Not everyone can reach an apple on a tree by standing on the same size box. Shorter people require a taller box to reach the same apple.
“The tension with equity is you have to treat people unequally,” she acknowledged. “You have to give some people more to get that same fair shot. Equity is how we change that so that everyone gets that same fair shot.”
Studies have shown that access to stable homes for all families would save $111 billion in maternal and child health costs over 10 years, she said.
Pediatricians can identify homeless or at-risk patients by employing screening tools in practice. They also can promote equitable access to quality, stable, affordable housing through community partnerships, by advocating for health care systems to establish assistance program anchors and via policy change, Dr. Sandel said.
At Boston Medical Center, anyone who comes to the hospital is screened using the 10-question Tool for Health & Resilience In Vulnerable Environments (THRIVE). If a patient needs assistance, he or she can access onsite anchor resources such as housing and medicolegal assistance and other supports.
Another pilot program refers patients of medically complex families, such as those with three or more emergency department visits, to resources and supports that can help the family with stable housing, which improves health outcomes and reduces costs.
Structural racism and oppression have changed where people start from, according to Dr. Sandel. But when families have equitable access to affordable, stable housing, children thrive.
“Affordable housing is the solution to child health,” she said.