The built environment, defined as human-made structures where we live and work, ranging from buildings to streets to neighborhoods, and open spaces, is an important determinant of health. The most proximate built environment is, of course, the indoor home environment (IHE). Physical, chemical, and biological aspects of one’s home are potential health risks to all residents, but especially people with disabilities (PwDs). PwDs face even greater risks because they are more likely to be confined at home, possess impairments that impact their ability to detect dangers, and have fewer financial resources to make safety- and accessibility-related improvements.
However, all PwDs are not the same. PwDs are extremely diverse across multiple dimensions, including race/ethnicity. In fact, people of color with disabilities likely experience compounded disadvantages in terms of prolonged exposure to unsafe and unhealthy IHEs because of institutional barriers encountered by racial/ethnic minorities in the U.S., specifically Black Americans and Hispanics. De facto residential segregation through practices such as zoning and redlining have resulted in higher rates of Black Americans living in communities with low-quality housing. Hispanics also live in inferior housing at higher rates than their White counterparts. Coupled with reports of more frequent housing discrimination faced by PwDs, there is strong reason to believe that people of color with disabilities have greater exposure to unsafe and unhealthy IHEs compared to both their non-disabled racial/ethnic counterparts and also compared to their White counterparts with disabilities.
My recent study seeks to answer just that question: are people of color with disabilities experiencing greater exposure to poor conditions in the IHE than people of color without disabilities and White Americans with disabilities? Using nationally representative data of U.S. housing stock, my study considers a wide range of housing characteristics beyond just physical inadequacies of the IHE among Black, Hispanic, Asian, White, and Mixed Race/Ethnicity households. There are nine IHE outcomes – eight distinct IHE problems: five physical deficiencies (low indoor air quality, high indoor temperatures, low indoor temperatures, injury hazards, inaccessibility of water/sanitation), two biological conditions (pests/allergens and dampness/mold), and one chemical condition (lead), as well as a final count of the total number of IHE problems.
I found for eight out of the nine IHE measures, a higher proportion of households with at least one resident with a disability (HWDs) report an inadequate condition compared to their non-disabled racial/ethnic counterparts (households without any residents with a disability, or HNDs). For example, dampness and/or mold is present in 23.9% of Black HWDs compared to 15.8% of Black HNDs, and 15.8% of Asian HWDs compared to 9.2% of Asian HNDs. Furthermore, for Black, Hispanic, and Mixed Race/Ethnicity HWDs, these disadvantages compared to their non-disabled racial/ethnic counterparts persist even after controlling for demographic, socioeconomic, and geographic characteristics.
Focusing on the population with disabilities, Black, Hispanic, and Mixed Race/Ethnicity HWDs have exposure to a greater number of IHE conditions than White or Asian HWDs, even after controlling for a range of household-level demographic, socioeconomic, and geographic characteristics. Black HWDs remain more likely to be exposed to four out of the five physical IHE deficiencies, pests/allergens, and lead than White HWDs. Hispanic HWDs also continue to be exposed to three out of the five physical IHE deficiencies (low indoor air quality, low indoor temperatures, injury hazards), pests/allergens, and lead than White HWDs. For Mixed Race/Ethnicity HWDs, they more likely to be exposed to four IHE conditions (low indoor temperatures, injury hazards, inaccessibility of water/sanitation, and lead) relative to White HWDs.
These findings support the adoption of an intersectional approach to designing targeted interventions that address specific inadequate IHE condition(s) which are distributed unequally across the U.S. population. Specifically, Black, Hispanic, and Mixed Race/Ethnicity HWDs experience elevated health risks in their own homes. Furthermore, given the increased frequency of weather-related events associated with climate change, identifying ways to mitigate specific unhealthy IHE conditions such as extreme indoor temperatures and poor air quality will become even more critical to the health and well-being of the U.S. population with disabilities.
Sung S. Park is an Assistant Professor in the Department of Gerontology at the University of Massachusetts Boston. Her research focuses on racial/ethnic economic and health disparities among the aging U.S. population. You can learn more about her work here. She is on Twitter @sung_s_park.