Associate Vice President of Community Collaboration
Office of the President
I recently heard the phrase “housing is medicine”. I was struck at how simple this really is, but from a medical perspective, this concept is revolutionary.
What is a medical intervention? How large of a leap is it to include something like housing as medicine? In our medical system, the treatments are prescribed by medical providers with specific credentials and based on evidence. These prescriptions are paid for by your medical insurance, whether public or private, and medical providers are paid for each treatment or prescription that is provided. So, the idea that our medical system would pay for something else—not prescribed and paid for by medical insurance—that’s the revolutionary part!
As a physical therapist, I was educated and practiced in the medical model of health. The patient was the center of your practice, and you focused on healing the condition or disease. There is so much to know about human physiology, disease, and what treatments work best to cure or control disease that years of medical education and advanced training are needed for practice. Physical and Occupational therapists have their specialties too, which are to address the limitation that keeps the person from being able to participate fully in their societal role by both improving the patient’s function and adapting the environment in which they function. Over the years, our understanding of this interaction between the individual and the environment has advanced worldwide, with a classification system designed to identify whether the main focus should be on the patient or environment—the International Classification of Functioning, Disability and Health (ICF).[i]
The concept that other factors besides disease contribute to health is not new. A growing recognition of the role social and economic factors have in determining health is seen in all public health perspectives. The Centers for Disease Control states that biology and healthy behaviors account for about 25% of what influences your health. Medical care is even less influential. It is the social and economic factors that contribute to more than 50% of the influence on your health![ii]
If we know that social and economic factors contribute so much to health, why then have we never called these “medicine”? For housing to be considered medicine, who would write the prescription and who would pay for it? Certainly not your health insurance!
In the United States, we’ve created separate systems that pay for medical care and public health. Your medical insurance will only cover treatments provided by skilled professionals to an individual patient. Public health departments are not paid with medical insurance, they are supported by state and local funding, relying heavily on grant funding. They do address some of the social and economic factors that influence health, such as water and air quality and infectious diseases. Sometimes we call this prevention. In practice, the funding provided to prevention provides some cost savings in medical care. Other countries have a more comprehensive view of health, such that funding for both public health and health care are in the same system, making it clearer that money in prevention costs less overall.
In the US, we have limited the efforts to connect public health and medical care, although it was somewhat expanded under the Affordable Care Act (ACA).
“The Affordable Care Act established the Prevention and Public Health Fund to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality.”[iii] However, in the recent congressional discussions about the Affordable Care Act, funding for the Prevention fund is threatened. Here’s a link to more information about the fund: http://healthyamericans.org/report/134/. This kind of limited thinking takes us further from being able to connect housing to health in any meaningful way.
I’m encouraged by progressive thinkers such as Dr. Joshua Bramberger, who appears to be one who coined the phrase “housing is medicine”.[iv] He connects public health and medicine and goes further by including public policy such as housing as part of the health care system. If we can provide adequate housing, we can prevent disease and improve people’s health. Revolutionary!
If healthy and thriving communities is our focus, we could take a broader view and consider the concept of regenerative development. In the big view of the ecosystem, how we design and build housing can ultimately contribute to healing of the earth, improving health for all creatures. We would use techniques that regenerate rather than harm living things. But, of note, regenerative development is not to be confused with regenerative medicine.
In medicine, the term regenerative is used to describe treatments that allow the body to heal itself, in the same sense regenerative is used in regenerative development. Regenerative medicine is an emerging field of medicine in which certain types of cells are introduced into the body and can lead to healing of tissues or conditions. The focus is on regeneration of body tissues or cells, and stem cells are used widely in this field.
In a broad sense, regenerative medicine and regenerative development are based on the premise that nature can take care of itself, given the tools or practices that allow for healing. Even so, connecting these perspectives is difficult. There is progress in seeing how housing connects to medicine, but we are limited in seeing how our environment, development and health connect together, especially when we see these fields through different financial lenses. I am encouraged by the shift in perspective that social and environmental factors are key contributors to health. And I hope this short reflection allows you to connect the dots between new ways of seeing the interconnectedness of our worlds.
[i] International Classification of Functioning, Disability and Health: http://www.who.int/classifications/icf/training/icfbeginnersguide.pdf
[ii] The Centers for Disease Control: https://www.cdc.gov/nchhstp/socialdeterminants/faq.html
[iv] Dr. Joshua Bramberger: http://www.santacruzsentinel.com/article/NE/20160323/NEWS/160329868
About Sue Scherer
Sue is the Associate Vice President of Community Collaboration at Regis University. She is the founder of Cultivate Health and Invest Health Westminster and other key Regis community engagement projects.
- Community Collaboration article (2016): http://www.regis.edu/News-Events-Media/News/2016/October/Regis-University-Bolsters-Community-Collaboration-Efforts.aspx
- Regis Proud article (2013): http://www.regis.edu/Giving-Gateway/LookWhoIsGiving/Scherer-S.aspx