Children’s HealthWatch Releases Article on the Intersection of Household Hardship and Health 

By Ella Izenour, Opportunity Starts at Home Intern

Children’s HealthWatch, an Opportunity Starts at Home campaign Steering Committee member, shared a recent APJM Focus article, “Hardship-Free Households Are Associated With Optimal Caregiver and Child Health.” The article explores how the absence of material hardships among families with low incomes impacts child health, healthcare utilization, and caregiver health outcomes. Material hardships, including housing instability, energy insecurity, food instability, and healthcare hardship, result from tradeoffs households with low incomes must make for basic needs. The findings are based on an ongoing, repeated cross-sectional research study conducted at medical centers in five U.S. cities: Baltimore, Boston, Little Rock, Minneapolis, and Philadelphia. The authors find that low-income households experiencing fewer material hardships report better physical, developmental, and behavioral health outcomes among both children and caregivers.

The authors analyzed data from an ongoing research study conducted by Children’s HealthWatch. The study monitors the impact of economic conditions and public policies on the health and well-being of young children and families with low incomes seeking care in safety-net hospitals, which predominantly serve low-income and publicly insured patients. Four measures of material hardship, housing instability, household food security, energy insecurity, and healthcare hardship were assessed to create a combined scale of hardships experienced.  

Based on the data, the authors find that households experiencing little to no hardship tend to have better health outcomes and healthcare utilization compared to families facing multiple hardships. Caregiver health and depressive symptoms were especially impacted by hardship, suggesting that caregivers may act as buffers for their children—prioritizing their children’s needs over their own when resources are limited.  

The authors note that participation in programs such as the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and subsidized housing differed by less than 9% between hardship-free households and those facing two or more hardships. This indicates that, while essential, current safety-net programs may lack the capacity to fully mitigate the health effects of material hardship. They attribute these limitations to factors including insufficient funding, structural barriers, and restrictive policies that limit access and outreach. The authors also identify the lack of adequate income to support families as the primary driver of material hardship. They advocate prioritizing policies that provide unrestricted cash transfers, such as the Child Tax Credit and the Earned Income Tax Credit, as effective tools to reduce hardship and improve both short- and long-term health outcomes. These cash supports are most impactful when combined with existing public assistance programs.  

The article concludes by endorsing comprehensive strategies for preventing hardship, rather than focusing solely on families already experiencing multiple hardships. The authors call for more research into the strengths of hardship-free households and stress the importance of understanding how programs and services can effectively alleviate hardship. Such research could inform the design of public policies and investments aimed at improving the material well-being of low-income households.  

Read the article here.  

To learn more about the intersections between housing and health, read the OSAH fact sheet here.