Housing and Health: The Importance of Being Able to Stay

A healthy home should protect us from cold and heat, provide good air quality and sufficient natural light, and allow us to rest. But health also depends on something less visible: being able to afford that home and having the security of knowing that we can continue living in it.

Housing is much more than four walls and a roof

For some time now, housing has been understood as much more than the physical space we inhabit. According to the United Nations, the right to adequate housing includes, among other aspects, security of tenure, affordability, accessibility, and a location that provides access to services and opportunities for education and employment. A home cannot be considered adequate if its cost compromises a household’s ability to meet other basic needs.

This broad understanding of housing is also important from a public health perspective. A conceptual framework recently published in The Lancet Public Health proposes three pillars of housing systems that are particularly relevant to health:

• Affordability (affordability): The relationship between housing costs (mortgage, maintenance, energy, etc.) and the household’s available resources. The evidence is particularly consistent regarding mental health.
• Residential security (security): The possibility of remaining in the home without fear of forced eviction or other threats. Residential security has both an objective and a psychosocial dimension, linked to a sense of control, privacy, continuity and permanence.
• Adequacy (suitability): The ability of a home to meet the specific needs of its occupants, in terms, for example, of size, location, physical conditions, design or accessibility.

These three pillars are closely interconnected. A home may have good physical conditions and yet be unsuitable for the needs of its occupants, difficult to afford or fail to provide sufficient security of tenure. Similarly, affordability problems can ultimately affect both the characteristics of the home we can access and our ability to remain in it. Understanding how these dimensions relate to one another also helps us understand the different ways in which housing can affect our health.

When housing costs crowd out other needs

When rent, mortgage payments and other housing-related expenses absorb a large proportion of household income, fewer resources are available for other needs that are important for health, such as adequate food, transport, or social and educational activities. It may also become more difficult to pay energy bills and keep the home at a suitable temperature, increasing the risk of energy poverty, which has been associated with poorer physical and mental health outcomes.

Difficulty meeting housing costs, uncertainty about future rent increases or the possibility of losing one’s home can generate a persistent sense of insecurity and stress. Residential security is not only about physically remaining in a home, but also about having a reasonable expectation of being able to continue doing so.

A lack of affordable housing can also increase the risk of living in overcrowded conditions, which particularly affects single-parent households in Europe and has been associated with multiple adverse health effects in both adults and children.

A widely used benchmark for assessing housing affordability is that housing costs should not exceed 30% of household income. However, recent studies suggest that the relationship between housing cost burden and mental health may be gradual and begin below this threshold. In Catalonia, in 2024, one in four households renting at market prices spent more than 40% of their income on housing, the threshold used by Eurostat to identify housing cost overburden.

The importance of being able to stay

Affordability is also closely linked to another pillar of housing: residential security. Difficulty meeting housing costs, uncertainty about future rent increases or the possibility of losing one’s home can generate a persistent sense of insecurity and stress. Residential security is not only about physically remaining in a home, but also about having a reasonable expectation of being able to continue doing so.

It is not necessary for the loss of a home to actually occur for associations with health to be observed. A systematic review of studies on people facing the threat of eviction found associations with poorer mental health outcomes (including depression, anxiety and psychological distress) as well as physical health outcomes (including poorer self-rated health and higher blood pressure). These effects can also extend to the household as a whole. In families with children, for example, recent studies have associated family stress related to the possibility of losing the home with a higher incidence of mental health problems in children, particularly depression and anxiety.

When this insecurity eventually results in an unwanted move, other consequences may also arise. Residential instability can disrupt continuity in everyday life, affecting social and care networks, schooling or access to services. This continuity may be particularly important at certain stages of life, such as childhood and youth or as we age.

Beyond tenure status

Numerous studies have historically found better health indicators among homeowners than among renters. However, interpreting these differences as a direct effect of tenure status would be overly simplistic. Homeownership and renting are also related to income and wealth, housing characteristics and, particularly importantly, residential security and stability.

Recent evidence helps to nuance this relationship. A study published in 2026 found that the mental health gap between homeowners and renters in the United States had widened in recent years, particularly in areas where rents had increased the most. Another study, conducted among low-income renters in Australia, found that a rent increase of 10% or more was associated with subsequent deterioration in mental health.

Thinking about housing from a public health perspective means looking beyond its physical conditions. A home needs to meet the needs of those who live in it, but its cost should not force people to sacrifice other essential needs, and there should be sufficient security to build a home and a life with continuity.

But perhaps one of the most interesting findings comes from a longitudinal study that examined what happened when renters remained in the same home: although they initially had poorer mental health indicators than homeowners, after more than five years of stable residence, this difference was no longer statistically significant.

These findings point to an important distinction: renting a home and living in residential insecurity are not necessarily the same thing. Rather than tenure status alone, it is important to consider the conditions associated with it, including the possibility of maintaining affordable housing and having a reasonable expectation of being able to stay.

Thinking about housing from a public health perspective therefore means looking beyond its physical conditions. A home needs to meet the needs of those who live in it, but its cost should not force people to sacrifice other essential needs, and there should be sufficient security to build a home and a life with continuity.