ArticlePolicyHousing strain, mortgage foreclosure, and health
Introduction
After a dramatic increase in subprime lending beginning in 2003,1 foreclosure rates increased rapidly through 2008, sending 1.84% of all homes in the United States—more than 2.3 million properties—into some stage of foreclosure during that year.2 A recent forecast by Credit Suisse predicted that 8.1 million mortgages (16% of all mortgages) will be in foreclosure by 2012.3
Considerable evidence suggests that health and wealth are tightly connected, and that financial strain is associated with poor health, but few studies have examined mortgage default or foreclosure, especially in the context of the current US housing crisis.4, 5, 6 Economic stresses such as job loss are associated with health declines and increases in depressive symptoms.7, 8, 9, 10 Debt and self-reported financial strain are also associated with worse health,11, 12, 13 and difficulty making mortgage payments is associated with lower general well-being.14, 15 One recent study demonstrated high rates of uninsurance, major depression, and unfilled prescription medications in Philadelphia-area residents undergoing mortgage foreclosure.4 In contrast, wealth is positively associated with health, and the largest source of wealth for American families is home equity.16 Home ownership has been associated with greater life satisfaction, better psychological health, higher self-esteem and perceived control, and better self-rated health.17 Thus, people undergoing mortgage foreclosure may be more likely to experience poor health.
We address the health implications of the current economic crisis by asking the question: What is the health status of Americans facing foreclosure? We expected this group would exhibit the highest prevalence of poor health of any housing group studied. To date, few studies have demonstrated the interplay between the housing crisis and well-being to inform appropriate interventions.18 In the discussion section, we examine how the results of this study may guide nursing, public health, and community practice and inform policies to assist homeowners in default or foreclosure. These distressed homeowners may benefit from coordinated financial assistance and targeted social and health services. This article first presents empirical data on the health status of distressed homeowners and then explores potential community-based strategies for reaching out to this vulnerable population.
Section snippets
Study Design and Sample
This cross-sectional study relied on 2 sources of data: (1) analysis of foreclosure Internet discussion board posts to identify categories of distressed homeowners’ perceived health and social concerns and inform survey development, and (2) collection of survey data from an online consumer panel to examine whether these health issues were differentially reported by distressed homeowners compared with secure homeowners and renters.
Analysis of Discussion Board Posts and Survey Development
Between January 1 and April 30, 2008, we reviewed all online
Results
Table 1 provides sample characteristics by housing status. Homeowners in the default or foreclosure group spent an average of 63.7% of their monthly income on housing costs. On average, participants in the default or foreclosure group were younger than other homeowners but older than renters. Homeowners in default or foreclosure were less likely to be married and had lower education and income relative to other homeowners. Hispanic and black survey respondents were disproportionately
Key Findings and Implications
This study demonstrated an association between housing strain and poor health. Persons with homes in default or foreclosure reported a particularly high prevalence of mental and physical health impairments. For every measure examined, homeowners in default or foreclosure experienced poorer health relative to homeowners with no housing strain. These differences were observed for general health measures, indicators of days lost because of physical and mental health concerns, a scale of
Conclusion
Because of the poor health status of homeowners in default or foreclosure, increasing foreclosure rates may have important population health implications. Homeowners in default or foreclosure represent an identifiable high-risk group that can be reached using a range of modalities, including foreclosure mediation courts and Internet-based outreach. Distressed homeowners may benefit from coordinated, affordable health and social services, and nurses can lead the way in advocating for effective
Acknowledgments
We gratefully acknowledge the support provided by Jeannette Schroeder, as well as funding support from the Robert Wood Johnson Foundation Health & Society Scholars Program, University of Pennsylvania Center for Public Health Initiatives, and the Office of Practice and Community Affairs, University of Pennsylvania School of Nursing, Investment for the Future Funds. Drs. Asch and Cannusio are supported by the Department of Veterans Affairs, Office of Health Services Research and Development,
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