Housing instability encompasses several challenges, such as having trouble paying rent, overcrowding, moving frequently, staying with relatives, or spending the bulk of household income on housing. These experiences may negatively affect physical health and make it harder to access health care. 

Households are cost burdened if they spend more than 30% of their income on housing and severely cost burdened if they spend more than 50% of their income on housing. Cost-burdened households have little left over each month to spend on other necessities such as food, clothing, utilities, and health care. Black and Hispanic households are almost twice as likely as white households to be cost burdened. 2022 NC SHIP, pg. 60.
 

• Housing quality refers to the physical condition of a person’s home as well as the quality of the social and physical environment in which the home is located. Aspects of housing quality include air quality, home safety, space per individual, and the presence of mold, asbestos, or lead. 
• Housing quality is affected by factors like a home’s design and age.
• Poor-quality housing is associated with various negative health outcomes, including chronic disease and injury, and mental health. 
• The quality of a home’s neighborhood is shaped in part by how well individual homes are maintained, and widespread residential deterioration in a neighborhood can negatively affect mental health.
• Both home design and structure significantly influence housing quality and may affect mental and physical health. 
• Steps, balconies, and windows are features of home design that may present a threat to safety, especially for individuals with physical disabilities. Breakable glass, low windowsills, and poorly constructed stairs may increase the risk of injury from a fall.   2022 NC SHIP, pg. 62

• Consider regulatory change allowing trailers to be registered as homes, not vehicles
• Enforce fair housing laws
• Examine ways to reduce retaliation or rising rents on properties that have been repaired
• Implement “right to counsel” policies for times tenants need to take their landlord to court
• Improve access to social services and resources for affordable housing
• Improve inspection process for migrant farmworkers
• Increase education to community members about housing environmental issues like lead and mold
• Increase involvement of community members in decision-making
• Increase living wage employment opportunities
• Increase understanding of issues for clinical providers and create partnerships to address issues that are uncovered
• Provide education for Latinos on rights and how to file a complaint
• Support programs designed to increase home ownership for people of color
• Update housing standards (H2A housing) required by OSHA
• Update the NC Migrant Housing Act

County Health Rankings and Roadmaps - Comprehensive Housing Affordability Strategy (CHAS) *Should not compare ranked data from year to year

DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of SDOH screening questions to address and acquire data on the following:

• Food insecurity 
• Housing instability 
• Lack of transportation 
• Interpersonal violence

https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions