Racial Disparities in COVID-19 Case Positivity and Social Context: The Role of Housing, Neighborhood, and Health Insurance

The effect of the housing crisis in the Alabama Black Belt on respiratory health

Background

There is a growing housing crisis in rural America with homelessness growing in addition to a growing number of substandard homes due to an inability to afford the costs of repair and maintenance. The goal of the current study was to assess the housing concerns in rural Alabama Black Belt communities which are often understudied and the relationship between housing quality and respiratory health.

Methods

A semi-random sampling of five Black Belt counties was conducted to obtain a sample of 253 rural households. The survey was designed to obtain information regarding household income, housing status including a list of safety concerns and respiratory health. A χ 2 analysis was performed to examine the effect of housing type and income on prevalence of respiratory illness and safety home concerns (e.g., roofing, windows/doors, floors, mold/mildew).

Results

The majority of households surveyed had an annual income below $15,000 and owned their homes with over half of the homes being manufactured homes. Lower income was associated with increased prevalence of asthma [χ 2(2, N = 237) = 7.75, p = 0.021], while living in a manufactured home was associated with increased risk of allergies [χ 2(1, N = 251) = 7.88, p = 0.005]. Additionally, poor windows and doors [χ 2(1, N = 253) = 3.8, p = 0.05] was associated with higher prevalence of asthma.

Conclusions

The results confirm and expand previous results and demonstrate the relationship between quality housing and allergy and asthma prevalence in rural areas with an abundance of aging manufactured homes.

Aboriginal peoples' lived experience of household overcrowding in the Kimberley and implications for research reciprocity in COVID-19 recovery

OBJECTIVE

Household overcrowding was identified early in the COVID-19 pandemic as a risk factor increasing transmission and worsening outcomes. Nirrumbuk Environmental Health and Services designed this project to deepen understanding of Aboriginal peoples' experiences of overcrowding in social housing.

METHODS

Our household survey explored overcrowding, capacity to respond to COVID-19 directives and the Canadian National Overcrowding Standard (CNOS).

RESULTS

For 219 participating Aboriginal households, usual number of residents per household ranged from 1 to 14, increasing with short- and long-term visitors. 17.8% had occupants who themselves were on waiting lists for their own home. Nearly one-third of houses had three generations under one roof. 53.4% indicated isolation of COVID-19 cases as 'extremely' difficult. 33.8% indicated their community could not manage COVID-19 at scale. Overcrowding was defined by interpersonal dynamics or consequences such as plumbing blockages or conflict rather than the number or people or ratio of people to bedrooms. 64.8% welcomed CNOS to determine acceptable and healthy occupancy levels. Participants encouraged research about environmental health in Aboriginal hands.

CONCLUSIONS

Cultural obligations, poverty and social housing waitlist management impose extreme demand on remote housing. CNOS relevance was endorsed but tempered by lived experience.

IMPLICATIONS FOR PUBLIC HEALTH

Aboriginal-led research is directly accountable to communities through reciprocity and kinship. Nirrumbuk has already modified service planning.