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Abstract

Housing is recognized as an important social determinant of health. However, the association between housing and health is predominantly analyzed at the dwelling or neighborhood level. Little attention is paid to the housing-political structures shaping the housing-health nexus. This paper therefore proposes a research focus on the political economy of housing and health. It combines three literatures that rarely join forces: geographical studies on housing and health, the political economy of health, and critical housing studies. It further identifies different causal mechanisms through which political structures generate, reproduce and mediate housing-based health inequalities, and outlines methodological approaches to study these.

Keywords

capital class health geography housing ideology political economy of health

I Introduction

Across a wide range of countries, growing numbers of people are struggling to attain adequate and affordable housing. Notwithstanding important contextual variations, research typically ascribes an important role to housing politics in driving this trend, such as through dismantling de-commodified forms of affordable housing, deregulating rents and scaling back tenant protections (Kholodilin and Kohl, 2023; Madden and Marcuse, 2016), while encouraging private ownership and investment strategies (Aalbers et al., 2021; Christophers, 2023). Housing, then, becomes an important site where social inequalities materialize (DeLuca and Rosen, 2022). Yet increasingly, housing is being conceived of as not merely an outcome but crucially also constitutive of social inequalities. While some cautiously frame housing as “a dimension of stratification” with “potential consequences” for various life domains (Zavisca and Gerber, 2016: 361), other scholars more decidedly emphasize the “centrality of housing to the urban poor” (Desmond, 2018: 168) and consider housing “as the key distributor and driver of life chances” (Adkins et al., 2021: 564), particularly wealth accumulation (Pfeffer and Waitkus, 2021). Housing, in other words, is conceived as an engine of inequality (Hochstenbach et al., 2025).

This also pertains to health, with housing widely recognized as an important social determinant of health (e.g., Marmot et al., 2008) even if it is still all too often overlooked (The Lancet, 2024). Housing in its various dimensions—for example, physical, economic, emotional and symbolic—can have important impacts on both physical and mental health (e.g., Howden-Chapman et al., 2023; Singh et al., 2019; Swope and Hernández, 2019). Housing thus acts as a key source and catalyst of health inequalities, that is, “the systematic, avoidable and unfair differences in health outcomes that can be observed between populations, between social groups within the same population or as a gradient across a population ranked by social position” (McCartney et al., 2019b: 28).

However, and this is the central focus of this paper, where the literature on housing as an engine of economic inequality pays ample attention to the central role of political-economic structures, the literature on housing as a social determinant of health is much more restricted to the level of the individual dwelling. Only rarely do these studies explicitly move beyond snapshots of dwelling-level indicators to consider housing policies and housing systems. This is problematic, as we know little about how such higher-order structures generate health outcomes and inequalities. As a consequence, “housing still presents itself as a ‘black box’ wherein social inequality is an input and health inequality is an output” (Gurney, 2023: 235). Causal mechanisms operating beyond the individual dwelling or immediate neighborhood context remain hidden or implicit.

To address this gap, this paper proposes combining three bodies of literature that so far have remained largely disconnected but offer important complementary qualities. First, there’s the aforementioned literature on housing and health, often rooted in health geography as well as public health, which is strong in unravelling dwelling-level associations but pays little attention to political structures. Second, therefore, this paper draws on the growing literature on the political economy of health which centers the structuring role of politics, welfare systems, legal structures and commercial influences in generating health outcomes and inequalities (e.g., Bambra et al., 2019; Lynch, 2020; McCartney et al., 2019a; Schrecker and Bambra, 2015). However, in assessing “the big picture,” this literature pays scant attention to the precise causal mechanisms operating in specific domains, such as housing systems and politics. Third, the literature on the political economy of housing does provide the tools to understand how housing politics reflect and drive social class inequalities (Aalbers and Christophers, 2014; Adkins et al., 2021; Arundel and Ronald, 2021; Forrest and Hirayama, 2015; Madden and Marcuse, 2016), but typically ignores health.

Combining these literatures enables a research focus on the political economy of housing and health, which studies wider housing-political structures and how these can (re)produce housing as a potential health hazard and generate housing-based health inequalities across populations. Put another way, to paraphrase Schrecker and Bambra (2015), this paper provides a conceptualization of how housing politics can make people sick, and unequally so.

A political economy of housing and health benefits from a strong geographic approach, one that is comparative, longitudinal, and sensitive to scale (whether geographical or institutional). In doing so, this paper recognizes that the studies discussed here are predominantly based on higher- and middle-income countries. The following three sections further discuss the value of the different literature strands in formulating a political economy of housing and health. It subsequently forwards a research agenda by identifying various causal mechanisms linking higher-order housing structures to individual-level health outcomes, and outlining different methodological approaches to begin studying these.

II Housing and health

The profound impact of housing on both physical and mental health is long acknowledged and increasingly well established, with scholarship in fields such as health geography and public health documenting how housing is responsible for multiple “insults to health” (Baker et al., 2017) and impacts “health in a myriad of relatively minor ways, in total forming one of the key social determinants of health” (Shaw, 2004: 397; also Marmot et al., 2008; Gibson et al., 2011). Even as housing is often associated with positive properties related to home, studies zooming in on housing and health predominantly focus on negative ones. That is, rather than conceptualizing how housing can be conducive to health, they focus on housing disadvantages and how these may undermine health. Inadequate housing is thus compared against the implicit “standard” of adequate housing.

Through direct and indirect mechanisms, housing conditions influence various dimensions of physical health, including but not limited to cardiovascular disease, respiratory disease, brain development and infectious disease (e.g., Bonnefoy, 2007; Howden-Chapman et al., 2023; Jacobs et al., 2009; Shaw, 2004). An expanding literature furthermore focuses on how housing situations influence mental health, focusing not only on self-reported measures but also on outcomes such as “depression, psychological impairment, anxiety, allostatic load, mental strain, and psychological health” (Singh et al., 2019: 262; also Evans et al., 2003).

Furthermore, a wide range of housing features can impact these various dimensions of health. Swope and Hernández (2019) summarize and group these in four “pillars” pertaining to cost (i.e., the affordability of housing), conditions (physical quality), consistency (residential stability), and context (neighborhood). Here, it is important to emphasize that these factors can influence health through various causal mechanisms. Improving affordability, for example, can reduce stress levels but also makes more money available for health care that might otherwise be left avoided (Meltzer and Schwartz, 2016; Pollack et al., 2010). Other studies add a focus on the absence of independent housing, ranging from parental co-residence (Howard et al., 2023) and shared housing arrangements (Wilkinson and Ortega-Alcázar, 2019) to spells of homelessness following evictions (Desmond and Kimbro, 2015; Mejia-Lancheros et al., 2021). However, considering such housing indicators separately may lead to “under-estimating the scale of the overall impact of poor housing” and “ignoring important interactions” (Baker et al., 2017: 2). Baker and colleagues (2017) therefore propose to instead look at “housing bundles” to unravel potential interactions and compound effects (also Clair et al., 2019), while also being attuned to interactions of housing with disadvantage in other key life domains, such as labor precarity (Bentley et al., 2019).

Studies employing in-depth qualitative methods, often rooted in critical geographical traditions, have illuminated the causal pathways through which adverse housing situations have a deep impact on residents’ lived experiences, ultimately undermining their health and wellbeing. They make tangible housing’s affective dimension, emphasizing how housing can be imbued with negative emotions such as low self-worth, hopelessness, diminished social status, increased anxiety and stress, powerlessness, embarrassment and profound feelings of shame (e.g., Harris et al., 2019; Longhurst and Hargreaves, 2019; Marquez et al., 2019; McKee et al., 2020; Waitt and Harada, 2019; Waldron, 2024). An important part of this dynamic is that housing disadvantage can undermine feelings of home, leading to a home unmaking which “emerges from deliberate or unintentional disruptions to home places and sentiments at different scales and times” (Brickell, 2012: 227). Beyond extreme forms of home unmaking such as housing dispossession or demolition (Elliott-Cooper et al., 2020; Pain, 2019), also described as “root shock” (Fullilove, 2004), it often refers to the more gradual and implicit erosion of the house as a site of ontological security, that is, providing stability, control and continuity (Hiscock et al., 2001). To give but one example, the presence of mold in the house does not only have potential repercussions for physical health but also mentally, as it “encroaches on the domestic space and increasingly alienates people from their homes and routinely undermines their attempts to make a home” (Kane, 2023: 8). The experience of living in unaffordable or precarious housing may similarly become deeply embedded in the daily lives of residents while alienating them from their home (Van Lanen, 2022; Lombard, 2023; del Río et al., 2025), connecting personal experiences to systemic crises (Hall, 2019).

While much of the research, both quantitative and qualitative, on housing and health focuses on individual housing situations, there is a need to move beyond such static snapshots and consider longitudinal housing trajectories and mobilities (e.g., Campbell et al., 2021; Coulter et al., 2016; Morris et al., 2018). For one, marginalized populations’ trajectories are often far from smoothly progressing “housing careers” but instead chaotic and unstable, regularly including spells of homelessness and extremely precarious housing arrangements (Desmond, 2016). Such reproduction of housing disadvantage may generate strong cumulative health outcomes (Bentley et al., 2012; Winter and Sampson, 2017). Furthermore, effects may be cumulative through knock-on effects in other fields. Housing precarity has, for example, been shown to negatively affect children’s school results which may inhibit life chances (e.g., von Simson and Umblijs, 2021), while its experience during pregnancy can also negatively influence birth and infant outcomes (Carrion et al., 2015; Leifheit et al., 2020), reproducing disadvantage across generations.

Beyond the dwelling level, a large literature covers how housing impacts health outcomes through space; the “context” pillar noted by Swope and Hernández (2019) and others. Geographical context determines exposures to environmental pollutants such as air pollution, noise and heat stress and a lack of green space access, while also amenities and population compositions can shape health. These place-based exposures accumulate across life-course and residential trajectories (Prior et al., 2019). Studies emphasize inequalities with lower class and ethnic minority residents more exposed to environmental and socio-spatial ills as a consequence of where they live (e.g., Dreger et al., 2019; Gilbert and Chakraborty, 2011; Motoc et al., 2023; Muller et al., 2018; Rüttenauer et al., 2025; Wolch et al., 2014). Such environmental inequalities can furthermore be a “double-edged sword,” where “the poor pollute the least and are polluted the most” (Barnes et al., 2019: 64). Housing dynamics play an important part in structuring such environmental inequalities, as affordable rental housing is more often built in exposed sites while the opposite is true for expensive homeownership (Ntarladima et al., 2025).

However, while the housing-health literature has thus made crucial strides to understand the complex interactions between a wide range of housing characteristics and health outcomes, it typically stops short of developing a more political understanding (Marí-Dell’Olmo et al., 2017; Rauh et al., 2008). If housing policies or socio-political structures are acknowledged at all, they remain largely implicit: a static backdrop restricted against which micro-level associations are minutely tested. Causal mechanisms linking higher-order (housing) structures to individual health outcomes consequently remain poorly understood.

III Political economy of health

Moving beyond micro-level social determinants of health outcomes and inequalities therein, a growing political economy of health literature calls for a more explicit consideration of the “big picture” (Bambra et al., 2019: 37). In the case of housing, context is routinely reduced to the low scale of the immediate neighborhood, focusing on population compositions and environmental exposures. Influentially, Cummins and colleagues (2007) criticized such narrow conception of “place” in many geographical enquiries into health outcomes. Instead, they propose a relational approach that incorporates a focus on processes “operating at spatial scales other than the local neighborhood” (ibid: 1833). Similarly, in the study of neighborhood effects on life chances, Sampson (2019) argues local processes are embedded in higher-order structures responsible for producing and reproducing social inequalities, for example, through determining the distribution of populations across neighborhoods and housing segments. Bambra and colleagues (2019: 36) have argued that a “rather narrow conceptualization of place” has ultimately “significantly restricted – and probably undervalued – the importance of political processes in shaping health inequalities.” For geographers, there is thus the crucial task at hand of “scaling up” contextual analyses of the housing-health nexus (Pulido, 2000).

More broadly, studies have noted a general lack of research on “the interrelationship among governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes” (McCartney et al., 2019a: 9). This, in turn, risks depoliticizing health inequalities as primarily requiring technical, behavioral or medical fixes, leading to solutions that “deal with symptoms rather than causes” (Ottersen et al., 2014: 636). For example, in addressing the negative health effects of damp and moldy housing, depoliticized approaches may focus on changing residents’ behavior such as stressing regular ventilation and heating, or fixing individual dwellings, rather than focusing on the broader politics of austerity and neglect as root causes. It is, in other words, not so much about the individual dwelling as it is about the wider social, political and economic systems that structure housing more broadly, as well as interactions between these scales, as studies employing a “health equity framework” emphasize (Peterson et al., 2021). The political economy of health literature is crucial in further conceptualizing the causal links between these systems and unequal health outcomes, particularly by unravelling persistent class inequalities in relation to institutions and socio-political transformations.

While recently burgeoning, the “political economy of health” as concept arguably emerged in the 1970s (e.g., Doyal and Pennell, 1979; also Bambra et al., 2019; Harvey, 2021), around when Baer (1982) distinguished between a political economy of health care, which deals with the production, distribution and consumption of health services, and a political economy of illness which centers the social production of illness across political-economic systems. Particularly this latter strand, with roots that go further back in time building on nineteenth century Marxian thought and particularly the work of Friedrich Engels (Harvey, 2021), seeks to understand how institutions organize power and subsequent unequal exposures to risks and opportunities.

Contrasting biomedical and behavioral approaches, the political economy of health literature thus “focuses on ‘social, political and economic structures and relations’ that may be, and often are, outside the control of the individuals they affect” (Schrecker and Bambra, 2015: 8). The central underlying claim is that “economic and political institutions and decisions that create, enforce, and perpetuate economic and social privilege and inequality are root – or ‘fundamental’ – causes of social inequalities in health” (Krieger, 2001: 670). It furthermore gives central consideration to the question how economic inequalities and class power translate into, and maintain, health inequalities (Lynch, 2020; Schrecker, 2017; Whitley et al., 2022), noting that even if proximal causes of health outcomes change, for instance, due to medical advancement or the rise of new health problems, fundamental causes pertaining to class have remained remarkably stable over time (Link and Phelan, 1995; McCartney et al., 2021; Phelan et al., 2010). Many studies in the political economy of health consider how welfare states function as systems of stratification, particularly in terms of health inequalities and their correlation with socio-economic inequalities. They do so by drawing on the wide range of welfare state or regime typologies available (see Bakhtiari et al., 2018; Bambra, 2007; Navarro and Shi, 2001), considering aspects such as state-market relationships, redistributive policies and the degree of decommodification (notably Esping-Andersen, 1990). Related studies move away from such typologies to instead focus on, for example, the political orientation of main governing parties (Navarro et al., 2006) or state spending on social policies or health care (Beckfield and Bambra, 2016; Goijaerts et al., 2023; Reeves et al., 2014). Broadly speaking, these studies conclude health outcomes are positively associated with more generous and redistributive welfare states, although studies also highlight they nevertheless fail to substantially reduce persistent health inequalities (Bambra, 2011; Lynch, 2020).

Several scholars have attempted to move beyond the welfare state as (solely) a redistributive force. Influentially, Beckfield et al. (2015) propose an institutional theory of health inequalities that considers “the entire approach to accumulation, legitimation and reproduction taken by a welfare state” (p. 2). Beyond redistribution, they propose three other key institutional processes shaping public health, namely, those pertaining to compression (changing the extremes, for example, by ensuring a minimum of health care), mediation (of the relationship between social and health inequality), and imbrication (i.e., the overlap of institutions shaping health outcomes). Reynolds (2021: 499) also suggests moving beyond welfare-state redistribution, focusing instead on the translation of socio-economic resources into health-relevant resources “as the crucial stage at which health inequalities emerge.” This translation is critically shaped by power relations rooted in the welfare state as well as other socio-economic structures.

Social, economic and political transformations provide a further opportunity to unravel the causal impacts of macro-structures. Studies have, for example, traced the impacts of changing welfare arrangements, austerity regimes, reduced health-care spending and economic stagnation on health outcomes and inequalities (e.g., Case and Deaton, 2020; Kentikelenes et al., 2014; Labonté and Stuckler, 2016; Lynch, 2020; Reeves et al., 2015). These transformations are not the sole drivers of health inequities but should instead be seen as “magnifying trends that are present to some extent throughout the high-income world” (Schrecker and Bambra, 2015: 32).

It remains, however, a challenge to more precisely unravel causal mechanisms linking institutional drivers to health. For Lynch (2023: 400), doing so “relies on both concretizing and contextualizing what might otherwise be nebulous assertions about the nefarious influence of capitalism, neoliberalism, racism, and the like.” Concretizing requires disaggregating and bringing into focus the different components that influence health. Applied to the present paper, this provides a rationale to move from general welfare systems to more specifically consider housing systems and key parts within them. Contextualizing is also key in this regard, acknowledging that meanings and implications of key housing features, such as tenure, differ substantially between places and over time. Geographically sensitive analyses can unravel the impacts and interactions of welfare and housing-system contexts operating across multiple spatial and institutional scales. Ambitions to concretize and contextualize the linkages between institutional drivers and health inequalities present a compelling rationale to zoom in on the specific functioning of housing systems.

IV Critical housing studies

An expanding body of literature in critical housing studies argues for the centrality of housing to contemporary political economy (e.g., Aalbers and Christophers, 2014; Fernandez and Aalbers, 2017; Jacobs et al., 2024; Schwartz and Seabrooke, 2008). It has advanced understanding of housing outcomes in relation to broader political processes and power relations, while also emphasizing housing as an important driver of the economy and socio-economic inequalities. Crucially, literatures on the politics of housing help concretizing the different causal mechanisms through which macro-structures shape housing systems that, in turn, produce and reproduce inequalities (DeLuca and Rosen, 2022). The following highlights three particularly relevant conceptual mechanisms, that is, those pertaining to (1) housing ideology and politics, (2) housing and financial flows, and (3) housing and social class mechanisms. These three mechanisms do not exist in isolation but rather reveal important overlaps.

First, the political economy of housing literature reveals how housing politics are crucially shaped by and embedded in dominant housing ideologies. These are the “norms, values, goals, and categories used to generate knowledge about housing” (White and Madden, 2024: 1371). Concretely, a housing ideology “valorizes some forms of housing while stigmatizing others, creating a hierarchy of tenures and morphologies, and maps this residential hierarchy onto broader social structures” (White and Madden, 2024: 1371). Most pervasive in recent decades has been an ideology of homeownership which “naturalizes” owner-occupancy as the de facto more desirable choice, associating it virtues such as autonomy, control, pride, self-worth, responsibility and good citizenship (Gurney, 1999; Kohl, 2020; Ronald, 2008). The promise of widespread homeownership was that ever-more residents would be able to reap the benefits from property ownership and should therefore be enabled to get on the “property ladder.” The idealization of homeownership subsequently paves the way for far-reaching policies aimed at smoothing access to the tenure, for example, by vigorously expanding homeownership supply and access to mortgage credit, as well as massively subsidizing it to enhance financial appeal, for instance, through mortgage-interest tax deductions or untaxed land-value appreciation, in efforts to create and consolidate homeowner-majority societies. The ideology of homeownership is, in other words, an effort of “idealization, lubrication and subsidization” (Christophers, 2021: 574).

The ideology of homeownership does not stand on its own, but is crucially related to its opposite: the inferiorization and stigmatization of rental housing, particularly public or social-rental housing, with its tenants assumed to lack the virtues ascribed to owner-occupiers. Such discourses can legitimize, or even naturalize, anti-rental politics such as the removal of social-housing supply through urban renewal, austerity regimes severely cutting back on investments in new supply and maintenance, and regulatory reforms weakening tenant rights. Furthermore, they have legitimized a residualization of social-rental housing, meaning the tenure being reformed from broadly accessible and supported to narrowly catering to the poorest in society as a last resort (Byrne and Norris, 2022; Fitzpatrick and Pawson, 2014; Musterd, 2014; Van Gent and Hochstenbach, 2020). Housing ideologies have played a central role in forwarding and legitimizing a housing politics that produces and reproduces inequalities between housing segments, particularly tenures, differentially exposing their residents to risks and endowing them with resources.

Second, political economy of housing perspectives emphasize the increasing penetration of finance and capital in the field of housing. This is typically referred to as the process of financialization, which can be defined as “the increasing dominance of financial actors, markets, practices, measurements, and narratives at various scales, resulting in a structural transformation of economies, firms (including financial institutions), states, and households” (Aalbers, 2016: 2). Housing financialization is often associated with an inflationary logic, the essential dynamic being that increasing volumes of liquid financial capital are invested in, or absorbed by, a viscous housing stock (Aalbers, 2019). Central in this dynamic is the decades-long deregulation of mortgage markets and concomitant explosion of mortgage credit which have, after a certain point, not so much increased housing supply or ownership rates but mostly fueled demand, pushing price levels upwards (Favara and Imbs, 2015; Kohl, 2021). A “housing-finance feedback cycle” then develops (Ryan-Collins et al., 2017) in which house-price increases need to be matched by ever greater mortgages, or down payments, fueling further rounds of price increases. Following the GFC, however, many countries imposed restrictions on mortgage lending. Restricted access to mortgage credit did not break this feedback cycle though, as the reinvestment of accumulated wealth has increasingly come to augment mortgage credit (Hochstenbach and Aalbers, 2024).

Why are these dynamics important? For one, they advantage some while disadvantaging others. Generally speaking, for insiders house-price inflation implies housing-wealth accumulation. For outsiders, increasing prices represent a barrier to access the tenure. These dynamics are associated with a regressive redistribution of both housing opportunities and housing wealth. Access to homeownership became increasingly restricted to those that are both credit worthy and already asset rich, that is, “prime households” (Forrest and Hirayama, 2015) for whom house-price appreciation translated into further wealth accumulation. At the same time, these dynamics particularly exclude the poor and young from homeownership, who subsequently face restricted alternatives (Howard et al., 2024; McKee et al., 2020). While the promise of widespread homeownership was to expand opportunities and reduce inequalities, contemporary trends point in the opposite direction (Arundel and Ronald, 2021; Smith et al., 2022).

Stagnating or declining access to homeownership, in combination with social-rental residualization, set the scene for a regrowth of private rental markets across countries. For both wealthy insiders as well as corporate landlords, rental housing emerged as an appealing asset class to both store wealth and generate rent revenues (Fields, 2018; Hochstenbach, 2022). This has been further accommodated or enabled by a housing politics focusing on liberalizing rents, weakening tenant protections and enticing investors (Aalbers et al., 2021). The increasing emphasis on investing in ownership of scarce assets to generate rents has also been conceptualized as “assetization” (Adkins et al., 2021; Birch and Ward, 2024) or “rentierization” (Christophers, 2023; Ryan-Collins and Murray, 2023). At the same time, the increasing numbers of households excluded from homeownership and social rent ensure high and increasing levels of private-rental demand, albeit typically out of necessity due to a lack of alternatives. In this tenure, they are typically exposed to the greatest housing disadvantages, for example, due to high rents and weak tenant protections (Howard et al., 2024). The private-rental revival, in other words, represents a source of accumulation for some and increased precarity for others.

Third, as already alluded to, these housing dynamics feed into important social class dynamics. It builds on the recognition that housing position is not just an outcome of class or social inequality, but can that housing itself can play a central role in reproducing, exacerbating and instigating important social inequalities. Scholars have theorized housing to be co-constitutive of social class, as the decades-old concept of housing classes underwrites (e.g., Rex and Moore, 1967; Saunders, 1984). Recently, various scholars have revisited this concept, arguing for the increasing importance of housing in determining social class following stagnating labor incomes and increasing returns on real estate in terms of both wealth accumulation and potential rent revenues (Adkins et al., 2021), meaning—to put it colloquially—many homes now earn more than jobs (Ryan-Collins and Murray, 2023). This is only one part of the dynamic. At the other end of the spectrum, the poor spend increasing shares of their income on housing costs while still being increasingly exposed to residential instability (Desmond, 2018; Dewilde, 2018). Housing, then, is responsible for a re-stratification of society (Forrest and Hirayama, 2018).

Re-stratification along the lines of housing is relational. This is most evident in the case of landlord and tenant relations, where the former achieves accumulation and solidifies their class position through the extraction of rents from the latter. Particularly in contexts of high residential demand, landlords are furthermore in a dominant position from which they can exercise class power over tenants (Harvey, 1974) and push their interests through lobbying and politics (Jacobs, 2015; Nethercote, 2022).

But these relational dynamics also operate more indirectly, through the politics of housing. A substantial body of literature shows that housing position shapes political preferences and voting patterns (for an overview, see Ansell, 2019). A general mechanism is that homeowners, particularly those who see the value of their property rise, are less likely to support redistributive policies (e.g., André and Dewilde, 2016; Ansell, 2014). This suggests a trade-off where house ownership contributes to a sense of economic security and represents an important future source of individualized asset-based welfare (Doling and Ronald, 2010), undermining support for collective welfare provisions. Ansell (2019) has termed this the anti-redistribution cycle in which the expansion of homeownership reduces support for redistribution and public spending as owners are less likely to be the beneficiaries of such policies. This, in turn, necessitates individuals to buy a house to secure their welfare individually, again driving right-wing voting. More recent studies have complicated this argument however, showing that the expansion of homeownership, rather than shifting political allegiance, can also contribute to an “embourgeoisement” of center-left parties who reorient their politics to cater to these groups and capture their votes (Boterman and Van Gent, 2023; Chou and Dancygier, 2021; Hadziabdic and Kohl, 2022). Other research furthermore suggests that factors such as increasing housing unaffordability or the rise of financialized housing investors may increase both homeowner and tenant support for redistribution (Dancygier and Wiedemann, 2024; Furtado and Flynn, 2025; Reisenbichler and Koenig, 2024), and may increase welfare spending by governments to offset increasing housing cost burdens (Kohl and Wood, 2024). Regardless of the specific dynamics, these studies all underscore homeowner majorities constitute a powerful electoral force, solidifying pro-homeownership policies and general homeownership ideology, potentially disadvantaging renters and outsiders when their interests do not align.

A political economy approach to housing thus outlines how housing can be an engine of inequality, while also arguing contemporary housing dynamics set the scene for stronger housing-based inequalities. These housing dynamics are not “natural” but rather result from a particular housing politics, for example, those pertaining to ideology, capital flows and class mechanisms outlined here. However, as is also evident from this discussion, these studies mostly focus on housing in relation to economic inequality, paying little to no attention to the causal mechanisms producing health outcomes even if it is suggested that “the political economy of housing today produces anxiety, stress and illness” (Madden and Marcuse 2016: 61).

V Studying the political economy of housing and health

The previous sections have illuminated how the literatures on housing and health, the political economy of health and critical housing studies are marked by important complementarities. Bringing these into dialogue enables formulating a political economy of housing and health. Such a perspective stresses that the impacts of housing on health, and inequalities therein, do not simply exist, but are actively produced and embedded in macro-structures, notably those pertaining to housing politics. Recognizing this, this section formulates three, by no means exhaustive, causal, or conceptual, mechanisms to think through, the political economy of housing and health. It subsequently offers three methodological approaches to study the links between housing politics and health.

1 Conceptual mechanisms

The conceptual mechanisms outlined here seek to link political-economic macro-structures to individual health outcomes. They therefore focus on explanatory factors that are not situated at the dwelling level, but rather at the level of housing policies and systems. They pertain to the (1) material, (2) regulatory, and (3) symbolic dimensions of housing, reflecting the centrality of housing as physical structure, as a set of legal rights and claims, and as identity, respectively (Atkinson and Jacobs, 2017).

The material dimension pertains to the politics and economic structures that pattern investment in different parts of the housing stock. A political economy approach charts landscapes of housing investments, unravelling involved actors, their rationales, and geographies (Kadi et al., 2025; Taşan-Kok et al., 2021; Taylor and Aalbers, 2024), pointing to the importance of capital and housing financialization. Overall, investments can directly improve resident health, through maintenance, renovations and improvements (e.g., Clair and Baker, 2022; Thomson and Thomas, 2015). However, other studies suggest that the entrance of private equity and large investors may profoundly unsettle everyday experiences of housing and home (Fields, 2017). For these actors, investments are tools “to extract value from the built environment while tenants experience rising rents, a lack of information, poor property maintenance, and apprehension” (Gustaffson, 2024: 1555). Simply put, the key question is whether investments improve living comfort, or alternatively are used to increase rents and force displacement, ultimately undermining health.

Furthermore, while investments in new supply may improve health outcomes by expanding housing opportunities, it is likely that these benefits will be unequally distributed across populations and geographies. Literatures on uneven development suggest capital flows to be highly unequal (Brenner, 2004) and increasingly so under the conditions of financialization (Amaral et al., 2024; Arundel et al., 2024a; Hochstenbach and Arundel, 2020). Selective investments furthermore shape the conditions for disinvestment in other geographies, tenures or submarkets. Many governments have, for example, slashed public investments in affordable housing provision, whether as part of austerity politics during economic crises (Blyth, 2013), or of market-driven housing restructuring (Byrne and Norris, 2022; Van Gent and Hochstenbach, 2020). In the context of escalating housing crises, such state withdrawal can be conceived of as a form of “institutional neglect” (Kiely and Warnock, 2023). A political economy approach therefore not only charts investments in housing, but also the lack thereof, and links both to health impacts. In case of lacking investments, this is challenging, as this concerns many populations that are indirectly impacted including, but not limited to, those that consequently have little choice but to live in overcrowded conditions or shared housing (Hadziabdic and Kohl, 2024; Wilkinson and Ortega-Alcázar, 2019), or stay in the parental home (Howard et al., 2023).

The regulatory dimension pertains to the sets of measures that determine the legal rights and obligations of property owners and residents (also Montez et al., 2021). Importantly, in the case of rental housing they, for example, refer to the type and degree of rent controls and tenant protections, indicative of state-market constellations. The overarching trend of rental-market liberalization across higher-income countries (Kettunen and Ruonavaara, 2021; Kholodilin and Kohl, 2023) has remade rental tenures, particularly private rental, into sites of stress, anxiety and alienation (McKee et al., 2020; Van Lanen, 2022). Such changes in regulation, accommodating market forces at the expense of residential security, illustrate how precarity isn’t simply a natural condition but imposed and unequally distributed from above (Han, 2018). A political economy of housing and health seeks to assess how ever-changing regulatory landscapes play a role in shaping and altering housing-based health inequalities, such as by amplifying mental health disparities between owners and renters (Arundel et al., 2024b).

There is furthermore crucial variety in the type and nature of regulation. They serve different populations in different ways. Studies in political science have long shown politics to be particularly responsive to the demands and concerns of the higher-class electorate, while being largely unresponsive to lower-class preferences (Elsässer et al., 2021; Schakel 2021). Regulatory landscapes are therefore more likely to benefit the privileged, who can exert class power to hoard opportunities and maintain social and, crucially, health advantages over others (Phelan et al., 2010; Reynolds, 2021), reinforcing health inequalities rooted in housing.

The symbolic dimension, finally, particularly refers to the idealization of some housing types versus the inferiorization of others through political discourse, media representations, socialization, and other means. As meritocratic beliefs have gained prominence along with deepening societal inequalities (Mijs, 2021; Sandel, 2020), homeownership is perceived as a prominent marker of success, status, good citizenship and class attainment, and a source of pride. This may lead to self-congratulatory positions among owners (Han and Kwon, 2024), further undermining support for policies supporting rental tenures and potentially stigmatizing social-rental housing, its tenants, and its territories (Born, 2023; Sisson, 2021; Wacquant et al., 2014; White and Madden, 2024). One outcome may be that tenants internalize the inferiorization and stigmatization, translating into feelings of failure, hopelessness or shame for not being able to attain the social norm of homeownership. This will particularly be the case in contexts dominated by owner-occupancy and residual social-rental sectors, and a socialized preference for the tenure.

Of course, tenure is but one aspect, albeit an important one in many housing systems. Residents may feel ashamed for the poor state of repair their house is in, and deploy strategies of concealment by not inviting people into their home for the fear of negative judgment (Hochstenbach, 2023). Others may perceive parental co-residence as a personal failure to live up to societal norms and expectations, particularly in those contexts where early home leaving has long been the norm (Worth, 2021). Most extremely, people experiencing homelessness face severe stigmatization, further contributing to isolation, exclusion and loneliness (Reilly et al., 2022). These various residential situations may all negatively impact health and wellbeing via blemished social status, albeit in different ways and to different extents. Crucially, a political economy of housing and health moves beyond individualized experiences to connect these to macro-political conditions.

2 Methodological approaches for future research

Having outlined these conceptual mechanisms through which housing politics and structures can generate health inequalities, this section finally sketches three methodological approaches that may inspire future research.

A first approach draws inspiration from comparative housing research. This strand of literature focuses on how the production, distribution and consumption of housing are organized across societies, and delineates the different roles and relative importance of the state, market and family therein (e.g., Blackwell and Kohl, 2019; Kemeny, 2006; Schwartz and Seabrooke, 2008; Stephens, 2020). These efforts have led to a wide range of ideal types of housing systems, housing regimes and varieties of residential capitalism that can be mapped onto groups of countries, based on indicators such as tenure distributions, rental regulations and homeownership financing (it is beyond this paper’s focus to zoom in on these typologies, but see Flynn and Montalbano (2024) for a recent overview).

Importantly, these typologies are assumed to result in different types and degrees of housing inequalities, which in turn may feed into wider social inequalities. Studies, for example, find that more commodified housing systems are associated with stronger inequalities, although associations are not straightforward (Dewilde, 2017; Dewilde and De Decker, 2016; Filandri and Olagnero, 2014). So far, however, these have not been linked to health inequalities, an important lacuna since “ultimately a housing system is to be judged by the outcomes it produces” (Stephens, 2016: 26). A comparative political economy of housing and health addresses this omission by charting the prevalence of housing-based health inequalities across countries with different housing systems. A key challenge here is not to treat housing-system typologies as a given, or a black box, but to unpack these systems to understand which features shape health outcomes, and how they do so. Furthermore, housing characteristics may be of more importance for health in some housing systems than in others. To give an example, the influence of tenure, will depend on degrees of homeownership idealization and subsidization, as well as tenant protections. Where the political economy of health literatures dedicates much attention to the importance of the welfare state, a political economy of housing and health can zoom in on housing systems to understand how these shape health inequalities through distributing resources, compressing extremes, mediating associations, and via overlaps with other policy domains (see Beckfield et al., 2015).

A second methodological approach, building on recent advances in health geography (Campbell et al., 2021; Prior et al., 2019) and human geography more broadly (Coulter et al., 2016), champions a longitudinal approach. For one, such a longitudinal approach would address the criticism that comparative housing research focuses too much on static housing systems rather than changing ones (Blackwell and Kohl, 2019). These may pertain to shifting state-market relations, policy reforms such as those weakening or strengthening rent regulations, shifting housing ideologies and political narratives, and the rise of new types of housing investors. They may also concern the emergence of new technologies such as digital platforms and new housing typologies such as co-living, facilitating new forms of rent extraction and precarious living (Maalsen et al., 2024; Nethercote, 2023; Ronald et al., 2024).

Longitudinal approaches offer the opportunity to trace housing-based health inequalities both before and after the onset of transformations. In some cases, there may be clear cut-off points, such as in the case of policy implementation. In other cases, these developments gradually unfold, such as in the case of new investors entering the scene. These can be studied through (quasi-)experimental approaches, comparing “treated” and “untreated” populations, that is, comparing populations that are directly affected by these developments to those that aren’t. Such a longitudinal approach enables analysis of the different political and economic mechanisms generating housing-based health disparities (Jones et al., 2019).

A third methodological approach studies how the housing-health nexus is crucially shaped by ideology, capital and class. Doing so requires “populating” housing systems with real actors such as policymakers, real-estate developers, public-housing providers, resident organizations, and social movements. These are not neutral actors, but come with clear interests, socialized dispositions, class positions and internalized housing ideologies. For example, in their study of middle-class urban and housing politics in Amsterdam, the Netherlands, Boterman and Van Gent (2023) argue these cannot be separated from the specific class trajectories of key urban planners working for the municipality. Similarly, such positions and dispositions will likely shape how key actors perceive housing-based health effects, and how this subsequently translates into their practices: who do they see as responsible for health effects rooted in housing? How do they seek to mitigate potential negative effects (if at all)? How do they balance health concerns with other interests? The goal of this approach is to understand how health inequalities are not merely an outcome of housing conditions, but are—in both intended and unintended ways—actively produced, exacerbated or alternatively mitigated through housing systems and key stakeholders operating within them.

This approach charts overlaps and interactions between health and housing goals (Beckfield et al., 2015), for example, by studying how health considerations influence the formulation of housing policies (also known as policy mainstreaming, see Siri and Geddes, 2022). Although this question is rarely studied, there are some exceptions. Notably, in evaluating housing-based approaches to address homelessness, central consideration is given to presumed health benefits to individuals experiencing homelessness (Baxter et al., 2019) as well as reducing burdens on health-care systems and costs. The same may be said of studies into evictions (Desmond and Kimbro, 2015; Vásquez-Vera et al., 2017). In such cases, health effects play an important role in advocating for certain types of policies such as Housing First approaches to homelessness, or imposing bans on no-fault evictions.

VI Conclusion

Starting from the observation that housing is recognized as an important social determinant of both physical and mental health, this paper has problematized the predominant analytical focus on the dwelling level, routinely ignoring contextual higher-order structures. If context is taken into account at all, it is typically restricted to snapshots of the immediate neighborhood (Cummins et al., 2007). Too little attention is paid to wider contexts, for example, those pertaining to housing policies and vested interests shaping housing systems. This paper has identified and problematized this important research gap, concretizing calls to scale up analyses to consider how political structures produce health outcomes and systemic inequalities therein (e.g., Bambra et al., 2019; McCartney et al., 2019). It therefore proposes a research focus on what can be broadly delineated as the political economy of housing and health, which studies wider housing-political structures and how these (re)produce housing as a potential health hazard and generate housing-based health inequalities across populations. In doing so, it also enriches the burgeoning housing literature which studies how housing not only reflects but also drives inequalities (Adkins et al., 2021 ; DeLuca and Rosen, 2022; Desmond, 2018; Zavisca and Gerber, 2016).

To develop this research agenda, this paper has brought three disparate literatures in close conversation. First, the geographical literature on housing and health is strong in showing how a score of dwelling and contextual characteristics can impact different aspects of health, but pays little attention to systemic features. Second, the political economy of health literature is crucial in showcasing how political structures and welfare regimes produce health inequalities (e.g., Beckfield et al., 2015; Schrecker and Bambra, 2015), but causal pathways require further concretizing (Lynch, 2023). Third, the political economy of housing literature unravels how macro-structures, such as those pertaining to capital, class and ideology (Aalbers and Christophers, 2014; Jacobs et al., 2024), create housing-based inequalities but they typically ignore health outcomes and disparities. Bringing these literatures together, this paper argues, is fruitful in bringing out the fundamental causes of housing-based health inequalities.

Combining these literatures, the paper has proposed three causal mechanisms to address the challenge of linking system-level housing politics to individual-level health outcomes. First, material investments shape the availability and physical quality of dwellings, but do so unevenly creating and maintaining social and spatial inequalities. Second, regulatory dynamics crucially inform key dwelling dimensions such as affordability, security of tenure and control. Third, symbolic politics determines the valuation and hierarchization of different housing types, notably tenures, which leave a profound impact on lived experiences and emotions related to housing and home, and can legitimize the wider differential treatment of dwellings.

The paper also outlined three fruitful methodological approaches to subsequently study the political economy of housing and health. The methodological approaches pertain to a comparative focus centering housing systems, a longitudinal focus on transformations, and an actor-oriented approach zooming in on how housing actors navigate the housing-health nexus. These represent novel methodological perspectives to approach the topic of housing and health, adding a crucial multi-scalar dimension. Taken together, these causal pathways and methodological approaches, while certainly non-exhaustive, provide a framework to begin understanding the political economy of housing and health.

Footnotes

Acknowledgments

The author thanks all colleagues that generously helped develop and concretize the ideas presented here: Rivke Jaffe, Justus Uitermark, Sarah de Lange, Thijs Bol, Jens van ’t Klooster, Femke Roosma, Federico Savini, Willem Boterman, Robbin Jan van Duijne, and Emil Holland. A research seminar at the Vrije Universiteit Brussel helped me formulate initial ideas, thanks to Reijer Hendrikse and David Bassens for the invitation and other participants for their feedback. Thanks also to two anonymous reviewers, and the editors of Progress in Human Geography.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author acknowledges the financial support from an Open Call grant (“Housing deprivation beyond affordability,” 406.XS.01.084) from NWO, the Dutch Research Council.

ORCID iD

Cody Hochstenbach

Author Biography

Cody Hochstenbach is an associate professor in urban geography at the University of Amsterdam, the Netherlands. He studies how housing is both an outcome and driver of various inequalities. He also writes literary non-fiction books with Dutch publisher Das Mag.

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For a political economy of housing and health

Abstract

Keywords

I Introduction

II Housing and health

III Political economy of health

IV Critical housing studies

V Studying the political economy of housing and health

1 Conceptual mechanisms

2 Methodological approaches for future research

VI Conclusion

Footnotes

Acknowledgments

Declaration of conflicting interests

Funding

ORCID iD

Author Biography

References