Rob McCann and Bob Lutz: Pandemic has highlighted housing’s role in health

By Rob McCann and Bob Lutz

“Medicine is a social science … the answer to the question as to how to prevent outbreaks is quite simple: education, together with its daughters – freedom and welfare,” wrote Rudolf Virchow, a Polish physician in the 1800s. He and others recognized that social factors, such as unstable housing, working environments, squalor and poverty adversely impacted health. Marginalized by their governments and the wealthy, the poor suffered greatly and their suffering was worsened by outbreaks of infectious diseases. Social determinants of health were then, and remain today, foundational to understanding what makes communities healthy or not. As stated by Dr. Karen DeSalvo, the acting assistant secretary for health at the U.S. Department of Health and Human Services in 2016, “Your ZIP code is more important to your health than your genetic code.”

Because we do not all start from the same place, we do not all have the same opportunities. Health is impacted by social and societal factors, such as an individual’s education, occupation, income and environment, as well as by how they are perceived and treated by society. Privileges and burdens are distributed unevenly, such that marginalized and stigmatized individuals and communities experience the worst impacts of every crisis. Their burden of disease is not unique to this pandemic; rather, it has highlighted the connections between inequities of health, society and the economy – a society with long-standing inequities makes people more susceptible to contracting and dying of COVID-19.

Poor health can lead to less work, poverty and unstable living conditions – a “degenerative dynamic,” especially for those already living on the margins often working physically demanding and low-paying jobs. Those living unhoused experience chronic stress, which worsens health more profoundly – higher rates of chronic conditions, such as heart disease and diabetes, behavioral health conditions, such as depression and substance abuse disorder, and infectious diseases, such as hepatitis C and HIV, as compared to those living housed, are common, increasing their risk for severe COVID-19.

Homelessness was increasing prior to the pandemic, in part due to the hard reality of intergenerational poverty and income inequality which, in our community, means nearly 25% of our citizens live at or below the Federal Poverty Line. This is a group of people, more than 100,000 strong, that are but one lost shift/job, one broken-down car or one unexpected medical bill away from becoming homeless. For every homeless person moved from the streets or the shelters to permanent housing, another becomes newly homeless from fleeing domestic violence, being released from prison with nowhere to go, being kicked out of a couch-surfing situation or being thrown out of their home due to untreated behavioral health issues which have become too much for their families to handle.

The COVID-19 pandemic has highlighted the importance of housing as a social determinant of health. A society that does not respect the rights of all its citizens equally will see those who are most vulnerable suffer unequally. COVID-19 and a suffering economy have made the homeless even more vulnerable not just to day-to-day survival risks but to a growing rhetoric that promotes fear of, and anger against, the homeless themselves. COVID-19 has made things hard and chaotic for all of us and how we respond, indeed, how we step up to assist the most fragile among us is how our community will be judged.

As Pope Leo XIII wrote, a basic moral test is how our most vulnerable members are faring. In a society marred by deepening divisions between rich and poor, our tradition recalls the story of the Last Judgment (Mt 25:31-46) and instructs us to put the needs of the poor and vulnerable first. Luckily, our community is one of tremendous compassion and generosity. We believe a spirit of love and service has and will carry Spokane through its toughest moments.

Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me. Matthew 25:40

Rob McCann, is CEO of Catholic Charities Eastern Washington. Dr. Bob Lutz, the state medical adviser for the Department of Health, is a board member of Continuum of Care.