Access to Care

Housing instability and food insecurity among low-income children are linked to diminished access to health care

Homelessness and hunger among low-income children are associated with poor access to health care. Housing instability and food insecurity also diminish access to care, although to a lesser extent, according to a recent study. It found that nearly 30 percent of children (12,746) in households with incomes of less than 200 percent of the Federal poverty line (less than $40,000 for a family of four in 2006) suffered from housing instability and 39 percent from food insecurity.

The researchers defined housing instability as the inability of the family to pay their mortgage, rent, or utility bills. They defined food insecurity by affirmative answers to at least two of four questions asking about: worrying about running out of food and lacking money to buy more; running out of food and lacking money to buy more; and whether and how often meals were reduced in size or skipped.

The researchers found that both housing instability and food insecurity were independently associated with children's poor access to health care. The rates of access to health care and of use of care for children experiencing housing instability and food insecurity were intermediate between those reported for children living in poverty and homeless children. For example, 11.9 percent of children with housing instability had no usual source of care compared with 6 percent of children living in poverty and 19 percent of homeless children. Also, 36.1 percent of children with housing instability had an emergency department (ED) visit, compared with 20 percent of children living in poverty and 38 to 48 percent of homeless children.

Food insecurity was independently associated with postponed medical care and postponed medications. Given housing instability and food insecurity and the poor health care access and high ED use, clinicians should consider screening for housing instability and food insecurity to provide more comprehensive care. The study was supported by the Agency for Healthcare Research and Quality (HS11415).

See "Associations between housing instability and food insecurity with health care access in low-income children," by Christine T. Ma, M.D., Lauren Gee, M.P.H., J.D., and Margot B. Kushel, M.D., in the April 2008 Ambulatory Pediatrics 8(3), pp. 50-57.

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