Housing Bites: Vacancy, Ticks and Demographics
By Mario and Andrew
Since the early 1980s, the conversation surrounding tick-borne illness has primarily focused on Rocky Mountain Spotted Fever and Lyme disease. But, over the past 25 years, experts have come to realize that there is an increasing public health threat posed by a broader number of tick-hosted pathogens. In fact, the U.S. Centers for Disease Control now recognizes 18 disease causing pathogens carried by ticks. As awareness has increased, so has the incidence of Lyme disease and other tick-borne illnesses. There are now more than 300,000 cases of Lyme disease annually. The cost of Lyme disease alone is approximately $1.3 billion each year in direct medical costs before social costs are factored in (social costs, for example, including the economic impact of missed work, at least double the costs).
When that number is extrapolated to include the 18 other tick-borne illnesses, we are likely looking at billions more annually in associated costs. This is an estimate, however, as we don’t have an accurate measure of the totality of tick-related impact. Unfortunately, tick-borne disease diagnosis is difficult and delayed treatment can cause significant complications and consequently, chronic illness.
HEALTH DISPARITIES IN TICK-BORNE ILLNESS RATES
Economists Springer and Johnson used a series of modeling techniques to measure the “associations between county-level disease [Lyme disease and human monocytic ehrlichiosis] incidence and six variables representing racial/ethnic and socioeconomic characteristics of counties (percent white non-Hispanic; percent with a bachelor's degree or higher; percent living below the poverty line; percent unemployed; percent of housing units vacant; and per capita number of property crimes). Associations across each of the six variables was significant, with key findings including:
“Lyme disease was highest in counties with relatively higher proportions of white and more educated persons and lower poverty and crime rates; and
The incidence of human monocytic ehrlichiosis was highest in counties with relatively higher proportions of white and less educated persons, higher unemployment rates and lower crime rates.”
Also, they found that the “percentage of housing units vacant was a strong positive predictor for both diseases with a magnitude of association comparable to those between incidence and ecological variables [percent forest cover and density of white tailed deer].”
What does all of that mean? While it is well established that health equities are impacted by socioeconomic variables, this was the first study that showed that an association of social determinants against tick-borne illnesses could be similarly mapped. These findings make for an interesting academic discussion and for additional research. Where these findings become more interesting, and frankly, more troubling, is when they are considered in the context of a larger housing vacancy crisis across the United States.
HOUSING VACANCY AS A FUNCTION OF ECONOMIC STRUGGLE
Last year, Richard Florida wrote an interesting piece published on CITYLAB that highlighted a report published by the Lincoln Institute of Land Policy which examined the massive economic and social costs associated with housing vacancy in America. Florida argues that when we think of the “housing crisis,” our association is often limited to the rising costs of housing in cities where demand outstrips supply.
But, as it turns out, there is another housing crisis just as problematic. In fact, in far more areas of the country, the problem is actually one of abundant vacant and derelict properties. These vacancies surged after the 2008 economic crisis, and while rates have dropped in the past several years, they still exceed numbers from 2005. The Lincoln study authors tracked nonseasonal vacancy rates across 25 cities in the United States and found that high-vacancy and hyper-vacancy rates (rates of greater than 12 and 20 percent, respectively) had increased in a number of these cities with large and small legacy cities faring the worst, while magnet and Sunbelt cities had lower rates. The Lincoln report demonstrated that rates of high-vacancy and hyper-vacancy, “reduce the value of neighboring properties and of entire neighborhoods,” citing Youngstown, Ohio as an example.
Vacancy rates are also strongly associated with increased rates of drug abuse, crime, and violence—in some cities, blocks with vacant properties face crime rates twice as high as blocks without them. But, solving the problem is not as simple as just knocking the properties down and clearing the land. The demolition itself is often expensive and the city then has to figure out how to maintain the property afterward. There is also a loss of property tax revenue to consider. This, in turn, creates a vicious cycle that becomes increasingly difficult for the city to escape and the problems of poverty, economic decline, and market failure propagate themselves further.
POLICY IMPLICATIONS
As we saw, ehrlichiosis is more prevalent in areas of higher poverty, lower education, higher housing vacancy rates, and a higher percentage of white individuals (as a percentage of total residents). It is thus not a surprise that the Midwest, Appalachia, Southeast, and parts of the Northeast are struggling with ehrlichiosis. Anecdotally, Mario has seen this increase in his own clinical emergency medicine practice in Tennessee where testing for tick-borne illness is done with much greater frequency than just a few years ago.
Large scale problems rarely exist in isolated opportunity verticals. In this case, tackling the problem of increased housing vacancy rates and its second order effects on property values, crime, and economic despair has significant implications for an issue of significant public health consequence. Although pest mitigation measures can be employed to help stop the spread of ticks themselves, stopping the further spread of the parasites they carry will require a sharper focus and deeper understanding on the influence of underlying social issues associated with housing and poverty.
Florida closed his article with several good recommendations that include home repair programs and property tax “circuit-breakers” to cap taxes for low-income home buyers. Subsidized mortgage financing could be extended to buyers of vacant lots and lots that cannot be sold should be ultimately converted into parks or community space. Other interesting ideas include land banks that acquire vacant properties in the hope of packaging the land for new projects and limiting tax foreclosures.
Ultimately, addressing the tick-borne illness crisis must include solutions to the misunderstood side of America’s housing crisis.