Search This Blog

Thursday, November 9, 2023

Environmental psychology

From Wikipedia, the free encyclopedia
 
Environmental psychology is a branch of psychology that explores the relationship between humans and the external world. It examines the way in which the natural environment and our built environments shape us as individuals. Environmental psychology emphasizes how humans change the environment and how the environment changes humans' experiences and behaviors. The field defines the term environment broadly, encompassing natural environments, social settings, built environments, learning environments, and informational environments. According to an article on APA Psychnet, environmental psychology is when a person thinks of a plan, travels to a certain place, and follows through with the plan throughout their behavior.

Environmental psychology was not fully recognized as its own field until the late 1960s when scientists began to question the tie between human behavior and our natural and built environments. Since its conception, the field has been committed to the development of a discipline that is both value oriented and problem oriented, prioritizing research aimed at solving complex environmental problems in the pursuit of individual well-being within a larger society. When solving problems involving human-environment interactions, whether global or local, one must have a model of human nature that predicts the environmental conditions under which humans will respond well. This model can help design, manage, protect and/or restore environments that enhance reasonable behavior, predict the likely outcomes when these conditions are not met, and diagnose problem situations. The field develops such a model of human nature while retaining a broad and inherently multidisciplinary focus. It explores such dissimilar issues as common property resource management, wayfinding in complex settings, the effect of environmental stress on human performance, the characteristics of restorative environments, human information processing, and the promotion of durable conservation behavior. Lately, alongside the increased focus on climate change in society and the social sciences and the re-emergence of limits-to-growth concerns, there has been an increased focus on environmental sustainability issues within the field.

This multidisciplinary paradigm has not only characterized the dynamic for which environmental psychology is expected to develop, but it has also been the catalyst in attracting other schools of knowledge in its pursuit, aside from research psychologists. Geographers, economists, landscape architects, policy-makers, sociologists, anthropologists, educators, and product developers all have discovered and participated in this field.

Although "environmental psychology" is arguably the best-known and most comprehensive description of the field, it is also known as human factors science, cognitive ergonomics, ecological psychology, ecopsychology, environment–behavior studies, and person–environment studies. Closely related fields include architectural psychology, socio-architecture, behavioral geography, environmental sociology, social ecology, and environmental design research.

History

The origins of the field can be traced to the Romantic poets, such as Wordsworth and Coleridge who drew attention to the power of nature and the significance of human interaction with it. Darwin pointed to the role of the environment in shaping evolution. This idea was quickly applied to human interactions with the surroundings. An extreme Victorian acceptance of this were 'environmental determinists' who insisted the physical environment and climate influenced the evolution of racial characteristics. Willy Hellpach is said to be the first to mention "environmental psychology". One of his books, Geopsyche, discusses topics such as how the sun and the moon affect human activity, the impact of extreme environments, and the effects of color and form (Pol, E., 2006, Blueprints for a history of environmental psychology (I): From first birth to American transition. "Medio Ambiente y Comportamiento Humano", 7(2), 95-113). Among the other major scholars at the roots of environmental psychology were Jakob von Uexküll, Kurt Lewin, Egon Brunswik, and later Gerhard Kaminski and Carl Friedrich Graumann.

The end of World War II brought about a demand for guidance on the urgent building programme after the destruction of war. To provide government planning requirements many countries set up research centres that studied how people used space. In the U.K. the Building Research Centre studied space use in houses and later noise levels, heating and lighting requirements. The glass maker Pilkingtons set up a daylight research unit, led by Thomas Markus to provide information on the influence of natural lighting in buildings and guidelines on daylight requirements. Peter Manning developed this further at the Pilkington Research Unit at the University of Liverpool in the 1960s. He studied offices, employing one of the first people to obtain a Ph.D in environmental psychology, Brian Wells. Markus went on to set up the Building Performance Research Unit at the University of Strathclyde in 1968 employing the psychologist David Canter who had been supervised by Wells and Manning for his Ph.D with the Pilkington Research Unit. Canter then went on to the University of Surrey to set up Environmental Psychology programme there in 1971 with the Department of Psychology. The head of that department was Terence Lee who had conducted his PhD on the concept of neighbourhood under the supervision of Sir Frederick Bartlett at the University of Cambridge.

In parallel with these developments people in the US had begun to consider the issues in environmental design. One of the first areas was the consideration of psychiatric hospitals. Psychiatrists worked with architects to take account of the experience of patients who were mentally ill. Robert Sommer wrote his book on 'Personal Space' and Edward T Hall commented as an anthropologist on how people related to each other spatially. Amos Rapoport caused considerable interest amongst architects with his book 'House Form and Culture', showing that the form of buildings was not solely functional but had all sorts of cultural influences. This contributed to the emergence in architecture of 'post-modernism' which took the symbolic qualities of architecture very seriously. These early developments in the 1960s and 1970s were often seen as part of 'architectural psychology'. It was when Harold Proshansky and William Ittelson set up the Environmental Psychology program at the City University of New York Graduate Center that the term Environmental Psychology replaces Architectural Psychology as the widely used term for the study of the ways in which people made sense of and interacted with their surroundings. This was institutionalised when Canter established The Journal of Environmental Psychology in 1980 with Kenneth Craik a personality psychologist at the University of California at Berkeley. President Nixon's campaign to deal with depredations of the environment gave impetus to a change of direction in the field from aspects of buildings and making sense of cities to the broader issues of climate change and the impact of people in the global environment.

Environmental psychologist

Environmental psychologists are the ones who study the relationship between human behavior and the environment that surrounds them. These psychologist study any type of environment, even the ones who are "built" such as peoples homes. They study how we as humans behave and interact in the world. As of May of 2020, the annual salary of an environmental psychologist is $82,180. The two sub-disciplines are conservation psychology and ecopsychology. Conservation Psychology is the study of the development of attitudes in the environment. Ecopsychology is close to the same as conservation psychology, but it focuses on the ties of environmental and societal degradation.

Orientations

Problem oriented

Environmental psychology is a direct study of the relationship between an environment and how that environment affects its inhabitants. Specific aspects of this field work by identifying a problem and through the identification of the said problem, discovering a solution. Therefore, it is necessary for environmental psychology to be problem-oriented.

One important aspect of a problem-oriented field is that by identifying problems, solutions arise from the research acquired. The solutions can aid in making society function better as a whole and create a wealth of knowledge about the inner workings of societies. Environmental psychologist Harold Proshansky discusses how the field is also "value-oriented" because of the field's commitment to bettering society through problem identification. Panyang discusses the importance of not only understanding the problem but also the necessity of a solution. Proshansky also points out some of the problems of a problem-oriented approach for environmental psychology. First, the problems being identified must be studied under certain specifications: they must be ongoing and occurring in real life, not in a laboratory. Second, the notions about the problems must derive directly from the source – meaning they must come directly from the specific environment where the problem is occurring. The solutions and understanding of the problems cannot come from an environment that has been constructed and modeled to look like real life. Environmental psychology needs to reflect the actual society, not a society built in a laboratory setting. The difficult task of the environmental psychologist is to study problems as they are occurring in everyday life. It is hard to reject all laboratory research because laboratory experiments are where theories may be tested without damaging the actual environment or can serve as models when testing solutions. Proshansky makes this point as well, discussing the difficulty in the overall problem oriented approach. He states that it is important, however, for the environmental psychologist to utilize all aspects of research and analysis of the findings and to take into account both the general and individualized aspects of the problems.

Environmental psychology addresses environmental problems such as density and crowding, noise pollution, sub-standard living, and urban decay. Noise increases environmental stress. Although it has been found that control and predictability are the greatest factors in stressful effects of noise; context, pitch, source and habituation are also important variables [3]. Environmental psychologists have theorized that density and crowding can also have an adverse effect on mood and may cause stress-related illness or behavior. To understand and solve environmental problems, environmental psychologists believe concepts and principles should come directly from the physical settings and problems being looked at. For example, factors that reduce feelings of crowding within buildings include:

  • Windows – particularly ones that can be opened and ones that provide a view as well as light
  • High ceilings
  • Doors to divide spaces (Baum and Davies) and provide access control
  • Room shape – square rooms feel less crowded than rectangular ones (Dresor)
  • Using partitions to create smaller, personalized spaces within an open plan office or larger work space.
  • Providing increases in cognitive control over aspects of the internal environment, such as ventilation, light, privacy, etc.
  • Conducting a cognitive appraisal of an environment and feelings of crowding in different settings. For example, one might be comfortable with crowding at a concert but not in school corridors.
  • Creating a defensible space (Calhoun)

Personal space and territory

Proxemics is known as the study of human space. It also studies the effects that population has on human behavior, communication, and social interaction. Having an area of personal territory in a public space, e.g., at the office, is a key feature of many architectural designs. Having such a 'defensible space' can reduce the negative effects of crowding in urban environments. The term, coined by John B. Calhoun in 1947, is the result of multiple environmental experiments conducted on rats. Originally beginning as an experiment to measure how many rats could be accommodated in a given space, it expanded into determining how rats, given the proper food, shelter and bedding would behave under a confined environment.

Under these circumstances, the males became aggressive, some exclusively homosexual. Others became pansexual and hypersexual, seeking every chance to mount any rat they encountered. As a result, mating behaviors were upset with an increase in infant mortalities. With parents failing to provide proper nests, thoughtlessly ditching their young and even attacking them, infant mortality rose as high as 96% in certain sections. Calhoun published the results as "Population Density and Social Pathology" in a 1962 edition of Scientific American.

"Get out of my personal space"

Creating barriers and customizing the space are ways of creating personal space, e.g., using pictures of one's family in an office setting. This increases cognitive control as one sees oneself as having control over the competitors to the personal space and therefore able to control the level of density and crowding in the space. Personal space can be both good and bad. It is good when it is used as stated above. Creating "personal space" in an office or work setting can make one feel more comfortable about being at work. Personal space can be bad when someone is in your personal space. In the image to the right, one person is mad at the other person because she is invading her personal space by laying on her.

Systems oriented

The systems-oriented approach to experimenting is applied to individuals or people that are a part of communities, groups, and organizations. These communities, groups, and organizations are systems in homeostasis. Homeostasis is known as the "state of steady conditions within a system." This approach particularly examines group interaction, as opposed to an individual's interaction and it emphasizes on factors of social integration. In the laboratory, experiments focus on cause and effect processes within human nature.

Interdisciplinary oriented

Environmental psychology relies on interaction with other disciplines in order to approach problems with multiple perspectives. The first discipline is the category of behavioral sciences, which include: sociology, political science, anthropology, and economics. Environmental psychology also interacts with the interspecializations of the field of psychology, which include: developmental psychology, cognitive science, industrial and organizational psychology, psychobiology, psychoanalysis, and social neuroscience. In addition to the more scientific fields of study, environmental psychology also works with the design field which includes: the studies of architecture, interior design, urban planning, industrial and object design, landscape architecture, and preservation.

Space-over-time orientation

Space over time orientation highlights the importance of the past. Examining problems with the past in mind creates a better understanding of how past forces, such as social, political, and economic forces, may be of relevance to present and future problems. Time and place are also important to consider. It's important to look at time over extended periods. Physical settings change over time; they change with respect to physical properties and they change because individuals using the space change over time. Looking at these spaces over time will help monitor the changes and possibly predict future problems.

Concepts

Nature restoration

Environmental health shows the effects people have on the environment as well as the effects the environment has on people. From early studies showing that patients with a view of nature from their hospital recovered faster than patients with a window view of a brick wall, how, why, and to which extent nature has mental and physical restorative properties has been a central branch of the field. Although the positive effects of nature have been established, the theoretical underpinning of why it is restorative is still discussed. The most cited theory is the Attention Restoration Theory, which claims nature is a “soft fascination” which restores the ability to direct attention. It is said that being in nature can reduce stress. Studies show that it can reduce anger, improve mood, and even lower one's blood pressure. Secondly, Stress reduction theory claims that because humans have evolved in nature, this type of environment is relaxing, and more adjusted to the senses. Newer theoretical work includes the Conditioned Restoration Theory, which suggests a two-step process. The first step involves associating nature with relaxation, and the second step involves retrieving the same relaxation when presented with an associated stimulus.

Place identity

For many years Harold Proshansky and his colleagues at the Graduate School and University Center of the City University of New York, explored the concept of place identity. Place identity has been traditionally defined as a 'sub-structure of the self-identity of the person consisting of broadly conceived cognitions about the physical world in which the individual lives'. These cognitions define the daily experiences of every human being. Through one's attitudes, feelings, ideas, memories, personal values and preferences toward the range and type of physical settings, they can then understand the environment they live in and their overall experience.

As a person interacts with various places and spaces, they are able to evaluate which properties in different environments fulfill his/her various needs. When a place contains components that satisfy a person biologically, socially, psychologically and/or culturally, it creates the environmental past of a person. Through 'good' or 'bad' experiences with a place, a person is then able to reflect and define their personal values, attitudes, feelings and beliefs about the physical world.

Place identity has been described as the individual's incorporation of place into the larger concept of self; a "potpourri of memories, conceptions, interpretations, ideas, and related feelings about specific physical settings, as well as types of settings". Other theorists have been instrumental in the creation of the idea of place identity. Three humanistic geographers, Tuan (1980), Relph (1976) and Buttimer (1980), share a couple of basic assumptions. As a person lives and creates memories within a place, attachment is built and it is through one's personal connection to a place, that they gain a sense of belonging and purpose, which then gives significance and meaning to their life.

Five central functions of place-identity have been depicted: recognition, meaning, expressive-requirement, mediating change, and anxiety and defense function. Place identity becomes a cognitive "database" against which every physical setting is experienced. The activities of a person often overlap with physical settings, which then create a background for the rest of life's interactions and events. The individual is frequently unaware of the array of feelings, values or memories of a singular place and simply becomes more comfortable or uncomfortable with certain broad kinds of physical settings, or prefers specific spaces to others. In the time since the term "place identity" was introduced, the theory has been the model for identity that has dominated environmental psychology.

Place attachment

According to the book, "Place Attachment", place attachment is a "complex phenomenon that incorporates people-place bonding"  Many different perceptions of the bond between people and places have been hypothesized and studied. The most widespread terms include place attachment and sense of place. One consistent thread woven throughout most recent research on place attachment deals with the importance of the amount of time spent at a certain place (the length of association with a place). While both researchers and writers have made the case that time and experience in a place are important for deepening the meanings and emotional ties central to the person-place relationship, little in-depth research has studied these factors and their role in forging this connection.

Place attachment is defined as one's emotional or affective ties to a place, and is generally thought to be the result of a long-term connection with a certain environment. This is different from a simple aesthetic response such as saying a certain place is special because it is beautiful. For example, one can have an emotional response to a beautiful (or ugly) landscape or place, but this response may sometimes be shallow and fleeting. This distinction is one that Schroeder labeled "meaning versus preference". According to Schroeder the definition of "meaning" is "the thoughts, feelings, memories and interpretations evoked by a landscape"; whereas "preference" is "the degree of liking for one landscape compared to another". For a deeper and lasting emotional attachment to develop (Or in Schroeder's terms, for it to have meaning) an enduring relationship with a place is usually a critical factor. Chigbu carried out a rural study of place-attachment using a qualitative approach to check its impact on a community, Uturu (in Nigeria), and found that it has a direct relationship to the level of community development.

Environmental consciousness

Leanne Rivlin theorized that one way to examine an individual's environmental consciousness is to recognize how the physical place is significant, and look at the people/place relationship.

Environmental cognition (involved in human cognition) plays a crucial role in environmental perception. All different areas of the brain engage with environmentally relevant information. Some believe that the orbitofrontal cortex integrates environmentally relevant information from many distributed areas of the brain. Due to its anterior location within the frontal cortex, the orbitofrontal cortex may make judgments about the environment, and refine the organism's "understanding" through error analysis, and other processes specific to the prefrontal cortex. But to be certain, there is no single brain area dedicated to the organism's interactions with its environment. Rather, all brain areas are dedicated to this task. One area (probably the orbitofrontal cortex) may collate the various pieces of the informational puzzle in order to develop a long term strategy of engagement with the ever-changing "environment". Moreover, the orbitofrontal cortex may show the greatest change in blood oxygenation (BOLD level) when an organism thinks of the broad, and amorphous category referred to as "the environment". Research in this area is showing an increase in climate change related emotional experiences that are seen to be inherently adaptive. Engagement with these emotional experiences leads to a greater sense of connection with others and increased capacity to tolerate and reflect on emotions.

Because of the recent concern with the environment, environmental consciousness or awareness has come to be related to the growth and development of understanding and consciousness toward the biophysical environment and its problems.

Behavior settings

The earliest noteworthy discoveries in the field of environmental psychology can be dated back to Roger Barker who created the field of ecological psychology. Founding his research station in Oskaloosa, Kansas in 1947, his field observations expanded into the theory that social settings influence behavior. Empirical data gathered in Oskaloosa from 1947 to 1972 helped him develop the concept of the "behavior setting" to help explain the relationship between the individual and the immediate environment. This was further explored in his work with Paul Gump in the book Big School, Small School: High School Size and Student Behavior. One of the first insightful explanations on why groups tend to be less satisfying for their members as they increase in size, their studies illustrated that large schools had a similar number of behavior settings to that of small schools. This resulted in the students' ability to presume many different roles in small schools (e.g. be in the school band and the school football team) but in larger schools, there was a propensity to deliberate over their social choices.

In his book Ecological Psychology (1968), Barker stresses the importance of the town's behavior and environment as the residents' most ordinary instrument of describing their environment. "The hybrid, eco-behavioral character of behavior settings appear to present Midwest's inhabitants with no difficulty; nouns that combine milieu and standing behavior are common, e.g. oyster supper, basketball game, turkey dinner, golden gavel ceremony, cake walk, back surgery, gift exchange, livestock auction, auto repair."

Barker argued that his students should implement T-methods (psychologist as 'transducer': i.e. methods in which they studied the man in his 'natural environment') rather than O-methods (psychologist as "operators" i.e. experimental methods). Basically, Barker preferred fieldwork and direct observation rather than controlled experiments. Some of the minute-by-minute observations of Kansan children from morning to night, jotted down by young and maternal graduate students, may be the most intimate and poignant documents in social science. Barker spent his career expanding on what he called ecological psychology, identifying these behavior settings, and publishing accounts such as One Boy's Day (1952) and Midwest and Its Children (1955).

Natural environment research findings

Environmental psychology research has observed various concepts relating to humans' innate connection to natural environments which begins in early childhood. One study shows that fostering children's connectedness to nature will, in turn, create habitual pro-ecological behaviors in time. Exposure to natural environment may lead to a positive psychological well-being and form positive attitudes and behavior towards nature.  Connectedness to nature has shown to be a huge contributor to predicting people's general pro-ecological and pro-social behaviors. Connectedness to nature has also been shown to benefit well-being, happiness, and general satisfaction. "Nature-deficit disorder" has recently been coined to explain the lack of connectedness to nature due to a lack of consciousness identification and nature disconnect. Further research is required to make definitive claims about the effects of connectedness to nature.

Applications

Impact on the built environment

Environmental psychologists rejected the laboratory-experimental paradigm because of its simplification and skewed view of the cause-and-effect relationships of human behaviors and experiences. Environmental psychologists examine how one or more parameters produce an effect while other measures are controlled. It is impossible to manipulate real-world settings in a laboratory.

Environmental psychology is oriented towards influencing the work of design professionals (architects, engineers, interior designers, urban planners, etc.) and thereby improving the human environment.

On a civic scale, efforts toward improving pedestrian landscapes have paid off, to some extent, from the involvement of figures like Jane Jacobs and Copenhagen's Jan Gehl. One prime figure here is the late writer and researcher William H. Whyte. His still-refreshing and perceptive "City", based on his accumulated observations of skilled Manhattan pedestrians, provides steps and patterns of use in urban plazas.

The role and impact of architecture on human behavior is debated within the architectural profession. Views range from: supposing that people will adapt to new architectures and city forms; believing that architects cannot predict the impact of buildings on humans and therefore should base decisions on other factors; to those who undertake detailed precedent studies of local building types and how they are used by that society.

Environmental psychology has conquered the whole architectural genre which is concerned with retail stores and any other commercial venues that have the power to manipulate the mood and behavior of customers (e.g. stadiums, casinos, malls, and now airports). From Philip Kotler's landmark paper on Atmospherics and Alan Hirsch's "Effects of Ambient Odors on Slot-Machine Usage in a Las Vegas Casino", through the creation and management of the Gruen transfer, retail relies heavily on psychology, original research, focus groups, and direct observation. One of William Whyte's students, Paco Underhill, makes a living as a "shopping anthropologist". Most of this advanced research remains a trade secret and proprietary.

Environmental psychology is consulted thoroughly when discussing future city design. Eco-cities and eco-towns have been studied to determine the societal benefits of creating more sustainable and ecological designs. Eco-cities allow for humans to live in synch with nature and develop sustainable living techniques. The development of eco-cities requires knowledge in the interactions between "environmental, economic, political, and socio-cultural factors based on ecological principles".

Organizations

  • Project for Public Spaces (PPS) is a nonprofit organization that works to improve public spaces, particularly parks, civic centers, public markets, downtowns, and campuses. The staff of PPS is made up of individuals trained in environmental design, architecture, urban planning, urban geography, urban design, environmental psychology, landscape architecture, arts administration and information management. The organization has collaborated with many major institutions to improve the appearance and functionality of public spaces throughout the United States. In 2005, PPS co-founded The New York City Streets Renaissance, a campaign that worked to develop a new campaign model for transportation reform. This initiative implemented the transformation of excess sidewalk space in the Meatpacking District of Manhattan into public space. Also, by 2008, New York City reclaimed 49 acres (200,000 m2) of traffic lanes and parking spots away from cars and gave it back to the public as bike lanes and public plazas.
  • The Center for Human Environments at the CUNY Graduate Center is a research organization that examines the relationship between people and their physical settings. CHE has five subgroups that specialize in aiding specific populations: The Children's Environments Research Group, the Health and Society Research Group, the Housing Environments Research Group, the Public Space Research Group, and the Youth Studies Research Group.
  • The most relevant scientific groups are the International Association of People-Environment Studies (IAPS) and the Environmental Design Research Association (EDRA).
  • Urban Ecology , The Urban Ecologist, and the International Eco-City Conference were some of the first collectives to establish the idea of eco-cities and townships.

Challenges

The field saw significant research findings and a fair surge of interest in the late 1970s and early 1980s, but has seen challenges of nomenclature, obtaining objective and repeatable results, scope, and the fact that some research rests on underlying assumptions about human perception, which is not fully understood. Being an interdisciplinary field is difficult because it lacks a solid definition and purpose. It is hard for the field to fit into organizational structures. In the words of Guido Francescato, speaking in 2000, environmental psychology encompasses a "somewhat bewildering array of disparate methodologies, conceptual orientations, and interpretations... making it difficult to delineate, with any degree of precision, just what the field is all about and what might it contribute to the construction of society and the unfolding of history."

A grand challenge in the field of environmental psychology today is to understand the impact of human behavior on the climate and climate change. Understanding why some people engage in pro-environment behaviors can help predict the necessary requirements to engage others in making sustainable change.

Environmental psychology has not received nearly enough supporters to be considered an interdisciplinary field within psychology. Harold M. Proshanksy was one of the founders of environmental psychology and was quoted as saying "As I look at the field of environmental psychology today, I am concerned about its future. It has not, since its emergence in the early 1960s grown to the point where it can match the fields of social, personality, learning or cognitive psychology. To be sure, it has increased in membership, in the number of journals devoted to it, and even in the amount of professional organizational support it enjoys, but not enough so that one could look at any major university and find it to be a field of specialization in a department of psychology, or, more importantly, in an interdisciplinary center or institute".

University courses

  • University of Groningen offers a graduate program in environmental psychology focusing on the interactions between people and their environment. The program is taught by the world-leading Environmental Psychology group at the University of Groningen.
  • University of Victoria offers general and advanced undergraduate courses in environmental psychology, and graduate courses in Psychology and Nature, as well as Environmental Psychology of the Built Environment. The psychology graduate department also offers individualized master's and PhD programs in Environmental Psychology under the supervision of Dr. Robert Gifford.
  • Antioch University New England Graduate School offers graduate programs involving environmental education through a planning approach. With environmental psychology being such a diverse field with many different approaches, students have a variety of programs to choose from.
  • Arizona State University offers a master's in Environmental Resources, which takes more of a planning approach to the field.
  • The Environmental Psychology Ph.D program at the CUNY Graduate Center takes a multidisciplinary approach to examining and changing "the serious problems associated with the urban environment with a view towards affecting public policy" using social science theory and research methods. The GC-CUNY was the first academic institution in the U.S. to grant a Ph.D. in Environmental Psychology. As discussed in detail on the program website, "recent research has addressed the experiences of recently housed homeless people, the privatization of public space, socio-spatial conflicts, children's safety in the public environment, relocation, community based approaches to housing, the design of specialized environments such as museums, zoos, gardens and hospitals, the changing relationships between home, family and work, the environmental experiences of gay men and lesbians, and access to parks and other urban 'green spaces'." See also The Center for Human Environments.
  • Cornell University's department of Design and Environmental Analysis offers undergraduate and graduate (Master of Science in Human Environment Relations, Master of Arts in Design, and Ph.D in Human Behavior and Design) studies in environmental psychology, interior design, sustainable design studies, human factors and ergonomics, and facility planning and management.
  • Drexel University offers a Master of Science degree in Design Research. Of two degree paths, the Environmental Design and Health path includes study with community practitioners and researchers in design and related fields, including health, community design, and public policy. Research typically includes data collection and engaged research practices of design thinking and participatory design. This area of investigation has the potential to create innovative health and educational partnerships, economic opportunities and neighborhood initiatives and relates to the strategic mission of the university to be highly engaged in civic sustainability.
  • Inland Norway University of Applied Sciences offers a Masters in Environmental psychology. The focus is on how people are affected by both physical and virtual environments, as well as how people affect nature. The program offers courses on environmental behaviour, environment and neuroscience, human factors, virtual environments and cognitive design, change management and greening organizations and architecture and aesthetics.
  • The Ohio State University City & Regional Planning Program, in the School of Architecture, offers a specialization in environmental psychology (urban design/physical planning and behavior) at both the master's and PhD level. Dissertations have examined such topics as environmental aesthetics, spatial cognition, ethnic enclaves, neighborhood decline, neighborhood satisfaction, restorative and livable places, and behavior change.
  • Prescott College offers a master's program that incorporates a number of the foundations of environmental psychology as well. The sub-fields in which the program provides includes environmental education, environmental studies, ecology, botany, resource policy, and planning.
  • University of California, Irvine offers a doctoral specialization in Design & Behavior Research within the Department of Planning, Policy, and Design in the School of Social Ecology, and undergraduate coursework in Environmental Psychology offered jointly by the Departments of Psychology and Social Behavior, Planning, Policy, and Design, and the Program in Public Health.
  • The University of Michigan offers Master of Science and Master of Arts degrees in its new School for Sustainability and Environment (SEAS). The focus is on how people affect and are affected by environments, and includes a pragmatic approach to promoting environmental stewardship behavior, as well as a focus on how "nearby nature" affects people's mental vitality, physical health and well-being. An emerging theme is helping people to remain optimistic while learning to respond well to increasingly difficult biophysical circumstances.
  • Another strain of environmental psychology developed out of ergonomics in the 1960s. The beginning of this movement can be traced back to David Canter's work and the founding of the "Performance Research Unit" at the University of Strathclyde in Glasgow, Scotland, in 1966, which expanded traditional ergonomics to study broader issues relating to the environment and the extent to which human beings were "situated" within it (cf situated cognition). Canter led the field in the UK for years and was the editor of the Journal of Environmental Psychology for over 20 years, but has recently turned his attention to criminology.
  • The University of Surrey was the first institution that offered an architectural psychology course in the UK starting in 1973. Since then, there have been over 250 graduates from over 25 countries. The Environmental Psychology Research Group (EPRG) within the University of Surrey, of which students on the M.Sc in Environmental Psychology are automatically members, has been undertaking research for more than thirty years. EPRG's mission is to gain a better understanding of the environmental and psychological effects of space, no matter the size, with help from social sciences, psychology, and methodologies. There are four categories under which the research projects fall: sustainable development, environmental risk, architectural assessment and environmental design, and environmental education and interpretation. Other universities in the UK now offer courses on the subject, which is an expanding field.

See the APA's list of additional environmental psychology graduate programs here: http://www.apadivisions.org/division-34/about/resources/graduate-programs.aspx

Homelessness and mental health

From Wikipedia, the free encyclopedia

In a study in Western societies, homeless people have a higher prevalence of mental illness when compared to the general population. They also are more likely to suffer from alcoholism and drug dependency. It is estimated that 20–25% of homeless people, compared with 6% of the non-homeless, have severe mental illness. Others estimate that up to one-third of the homeless have a mental illness. In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the United States. Depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless—140,000 individuals—were seriously mentally ill at any given point in time. 45% percent of the homeless—250,000 individuals—had any mental illness. More would be labeled homeless if these were annual counts rather than point-in-time counts. Being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalization within the criminal justice system. Majority of the homeless population do not have a mental illness. Although there is no correlation between homelessness and mental health, those who are dealing with homelessness are struggling with psychological and emotional distress. The Substance Abuse and Mental Health Services Administration conducted a study and found that in 2010, 26.2 percent of sheltered homeless people had a severe mental illness.

Nikes and Homeless

Studies have found that there is a correlation between homelessness and incarceration. Those with mental illness or substance abuse problems were found to be incarcerated at a higher frequency than the general population. Fischer and Breakey have identified the chronically mentally ill as one of the four main subtypes of homeless persons; the others being the street people, chronic alcoholics, and the situationally distressed.

The first documented case of a psychiatrist addressing the issue of homelessness and mental health was in 1906 by Karl Wilmanns.

Historical context

United States

In the United States, there are broad patterns of reform within the history of psychiatric care for persons with mental illness. These patterns are currently categorized into three major cycles of reform. The first recognized cycle was the emergence of moral treatment and asylums, the second consists of the mental hygiene movement and the psychopathic (state) hospital, and most recent cycle includes deinstitutionalization and community mental health. In an article addressing the historical developments and reforms of treatment for the mentally ill, Joseph Morrissey and Howard Goldman acknowledge the current regression of public social welfare for mentally ill populations. They specifically state that the "historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies".

Asylums

Within the context of transforming schemas of moral treatment during the early nineteenth century, the humanitarian focus of public intervention was linked with the establishment of asylums or snake pits for treatment of the mentally ill. The ideology that emerged in Europe disseminated to America, in the form of a social reformation based on the belief that new cases of insanity could be treated by isolating the ill into "small, pastoral asylums" for humane treatment. These asylums were meant to combine medical attention, occupational therapy, socialization activities and religious support, all in a warm environment.

In America, Friends Asylum (1817) and the Hartford Retreat (1824) were among the first asylums within the private sector, yet public asylums were soon encouraged, with Dorothea Dix as one of its key lobbyists. The effectiveness of asylums was dependent on a collection of structural and external conditions, conditions that proponents began to recognize were unfeasible to maintain around the mid-nineteenth century. For example, with the proliferation of immigrants throughout industrialization, the original purpose of asylums as small facilities transformed into their actualized use as "large, custodial institutions" throughout the late 1840s. Overcrowding severely inhibited the therapeutic capacity, inciting a political reassessment period about alternatives to asylums around the 1870s. The legislative purpose of state asylums soon met the role society had funneled them toward; they primarily became institutions for community protection, with treatment secondary.

Deinstitutionalization

Toward the end of World War II, the influx of soldiers diagnosed with "war neurosis" incited a new public interest in community care. In addition to this, the view that asylums and state hospitals exacerbated symptoms of mental illness by being "inherently dehumanizing and antitherapeutic" spread through the public consciousness. When psychiatric drugs like neuroleptics stabilized behavior and milieu therapy proved effective, state hospitals began discharging patients, with hope that federal programs and community support would counterbalance the effects of institutionalization. Furthermore, economic responsibility for disabled people began to shift, as religious and non-profit organization assumed the role of supplying basic needs. The modern results of deinstitutionalization show the dissonance between policy expectations and the actualized reality.

Community mental health centers

In response to the flaws of deinstitutionalization, a reform movement reframed the context of the chronically mentally ill within the lens of public health and social welfare problems. Policy makers intentionally circumvented state mental hospitals by allocating federal funds directly to local agencies. For example, the Community Mental Health Centers (CMHC) Act of 1963 became law, "which funded the construction and staffing of hundreds of federal centers to provide a range of services including partial hospitalization, emergency care, consultation, and treatment." Despite efforts, newly founded community centers "failed to meet the needs of acute and chronic patients discharged in increasing numbers from public hospitals". With decreased state collaboration and federal funding for social welfare, community centers essentially proved unable "to provide many essential programs and benefits", resulting in a growth of homelessness and indigency, or lack of access to basic necessities. It is argued that an over reliance on community health has "left thousands of former patients homeless or living in substandard housing, often without treatment, supervision or social support."

State mental hospitals

As debates regarding the deteriorating role of American asylums and psychiatry amplified around the turn of the century, new reformation arose. With the founding of the National Committee for Mental Hygiene, acute treatment centers like psychopathic hospitals, psychiatric dispensaries and child guidance clinics were created. Beginning with the State Care Act in New York, states began assuming full financial control for the mentally ill, in an effort to compensate for the deprivations of asylums. Between 1903 and 1950, the number of patients in state mental hospitals went from 150,000 to 512,000. Morrissey recognizes that despite persistent problem of chronic mental illness, these state mental hospitals were able to provide a minimal level of care. United States president John F. Kennedy signed the Community Mental Health Act that was put in place to give funding for community-based facilities rather than having patients going to state hospitals. Decades later, once the Community Mental Health Act was implemented a lot of state hospitals suffered and were on the verge of forced to close which pushed patients to the community-based facilities. The closures of the state hospitals lead to an overcrowding in the community facilities and there was a lack of support, which lead to patients not having access to the medical help they needed.

Personal factors

Neurobiological determinants

The mental health of homeless populations is significantly worse than the general population, with the prevalence of mental disorders up to four times higher in the former. It is also found that psychopathology and substance abuse often exist before the onset of homelessness, supporting the finding that mental disorders are a strong risk factor for homelessness. Ongoing issues with mental disorders such as affective and anxiety disorders, substance abuse and schizophrenia are elevated for the homeless. One explanation for homelessness states that "mental illness or alcohol and drug abuse render individuals unable to maintain permanent housing." One study further states that 10–20 percent of homeless populations have a dual diagnoses, or the co-existence of substance abuse and of another severe mental disorder. For example, in Germany there is a link between alcohol dependence and schizophrenia with homeless populations.

Trauma

There are patterns of biographical experience that are linked with subsequent mental health problems and pathways into homelessness. Martens states that reported childhood experiences, described as "feeling unloved in childhood, adverse childhood experiences, and general unhappiness in childhood" seem to become "powerful risk factors" for adult homelessness. For example, Martens emphasizes the salient dimension of familial and residential instability, as he describes the prevalence of foster-care or group home placement for homeless adolescents. He notes that "58 percent of homeless adolescents had experienced some kind of out-of-home placement, running away, or early departure from home." Moreover, up to 50 percent of homeless adolescents report experience with physical abuse, and almost one-third report sexual abuse. In addition to family conflict and abuse, early exposure to factors like poverty, housing instability, and alcohol and drug use all increase one's vulnerability to homelessness. Once impoverished, the social dimension of homelessness manifests from "long exposure to demoralizing relationships and unequal opportunities."

Trauma and homeless youth

Youth experiencing homelessness are more susceptible to developing post-traumatic stress disorder (PTSD). Common psychological traumas experienced by homeless youth include, sexual victimization, neglect, experiences of violence, and abuse. In an article published by Homeless Policy Research Institute it notes that homeless youth are subjected to many different forms of trauma. A study was done and found that 80% of youth that experienced homelessness in Los Angeles suffered at least one traumatic experience. Another study was conducted in Canada that showed a more severe statistic that Canadian homeless youth have been through 11 to 12 traumatic experiences. While trauma is prevalent in homeless youth, it is not uncommon for an adolescent to experience an increase of trauma after they experience homelessness. The LGBTQ community represents 20% of the homeless youth population. The reason for this high percentage is due to the issues and/or rejection from their family due to the sexual orientation.

Societal factors

Draine et al. emphasize the role of social disadvantage with manifestations of mental illness. He states that "research on mental illness in relation to social problems such as crime, unemployment, and homelessness often ignores the broader social context in which mental illness is embedded."

Social barriers

Stigma

Lee argues that societal conceptualizations of homelessness and poverty can be juxtaposed, leading to different manifestations of public stigma. In his work through national and local surveys, respondents tended to deemphasize individual deficits over "structural forces and bad luck" for homeless individuals. In contrast, the respondents tended to associate personal failures more to the impoverished than homeless individuals.

Nonetheless, homeless individuals are "well aware of the negative traits imputed to them – lazy, filthy, irresponsible dangerous – based on the homeless label." In an effort to cope with the emotional threat of stigma, homeless individuals may rely on one another for "non-judgmental socializing". However, his work continues to emphasize that the mentally ill homeless are often deprived of social networks like this.

Social isolation

People who are homeless tend to be socially isolated, which contributes negatively to their mental health. Studies have correlated that those who are homeless and have a strong support group tend to be more physically and mentally healthy. Aside from the stigma received by the homeless population, another aspect that contributes to social isolation is the purposeful avoidance of social opportunity practiced by the homeless community out of shame of revealing their current homeless state. Social isolation ties directly to social stigma in that homeless socialization outside of the homeless community will affect how the homeless are perceived. This is why homeless individuals talking with those who are not homeless is encouraged since it can combat the stigma that is often associated with homelessness.

Racial inequality

One dimension of the American homeless is the skewed proportion of minorities. In a sample taken from Los Angeles, 68 percent of the homeless men were African American. In contrast, the Netherlands sample had 42 percent Dutch, with 58 percent of the homeless population from other nationalities. Furthermore, Lee notes that minorities have a heightened risk of the "repeated exit-and-entry pattern"

Institutional barriers

Shinn and Gillespie (1994) argued that although substance abuse and mental illness is a contributing factor to homelessness, the primary cause is the lack of low-income housing. Elliot and Krivo emphasize the structural conditions that increase vulnerability to homelessness. Within their study, these factors are specifically categorized into "unavailable low-cost housing, high poverty, poor economic conditions, and insufficient community and institutional support for the mentally ill." Through their correlational analysis, they reinforce the finding that areas with more spending on mental health care have "notably lower levels of homelessness." Furthermore, their findings emphasize that among the analyzed correlates, "per capita expenditures on mental health care, and the supply of low-rent housing are by far the strongest predictors of homelessness rates." Along with economic hardship, patterns of academic underachievement also undermine an individual's opportunity for reintegration into general society, which heightens their risk for homelessness.

On a psychological level, Lee notes that the "stressful nature of hard times (high unemployment, a tight housing market, etc.) helps generate personal vulnerabilities and magnifies their consequences." For example, poverty is a key determinant of the relationship between debilitating mental illness and social maladjustment; it is associated with decreased self-efficacy and coping. Moreover, poverty is an important predictor of life outcomes, such as "quality of life, social and occupational functioning, general health and psychiatric symptoms", all relevant aspects of societal stability. Thus, systemic factors tend to compound mental instability for the homeless. Tackling homelessness involves focusing on the risk factors that contribute to homelessness as well as advocating for structural change.

Consequences

Incarceration

It is argued that persons with mental illness are more likely to be arrested, simply from a higher risk of other associated factors with incarceration, such as substance abuse, unemployment, and lack of formal education. Furthermore, when correctional facilities lack adequate coordination with community resources upon release, the chances of recidivism increase for persons who are both homeless and have a mental illness. Every state in the United States incarcerates more individuals with severe mental illness than it hospitalizes. Incarcerations are due to lack of treatments such as psychiatric hospital beds. Overall, according to Raphael and Stoll, over 60 percent of United States jail inmates report mental health problems. Estimates from the Survey of Inmates in State and Federal Correctional Facilities (2004) and the Survey of Inmates in Local Jails (2002) report that the prevalence for severe mental illness (the psychoses and bipolar/manic-depressive disorders) is 3.1–6.5 times the rate observed for the general population. In relation to homelessness, it is found that 17.3 percent of inmates with severe mental illness experienced a homeless state before their incarceration, compared to 6.5 percent of undiagnosed inmates. The authors argue that a significant portion of deinstitutionalized mentally ill were transitioned into correctional facilities, by specifically stating that "transinstitutional effect estimates suggest that deinstitutionalization has played a relatively minor role in explaining the phenomenal growth in U.S. incarceration levels."

Responses

Responses to mental health and homelessness include measures focused on housing and mental health services. Providers face challenges in the form of community adversity.

Housing

Modern efforts to reduce homelessness include "housing-first models", where individuals and families are placed in permanent homes with optional wrap-around services. This effort is less expensive than the cost of institutions that serve the complex needs of people experiencing homeless, such as emergency shelters, mental hospitals and jails. The alternative approach of housing first has shown positive outcomes. One study reports an 88 percent housing retention rate for those in Housing First, compared to 47 percent using traditional programs. Additionally, a review of permanent supportive housing and case management on health found that interventions using “housing-first models” can improve health outcomes among chronically homeless individuals, many of whom have substance use disorders and severe mental illness. Improvements include positive changes in self-reported mental health status, substance use, and overall well-being. These models can also help reduce hospital admissions, length of stay in inpatient psychiatric units, and emergency room visits. There is a new intervention called "Permanent Supportive Housing" that was designed help independent living and help with employment and health care. 407,966 individuals were homeless in shelters, transitional housing programs, or on the streets. Those with mental illnesses have difficulty not only with their current housing issues, but have issues with housing if they get evicted. Youth can benefit from permanent housing, increases social activity, and improve mental health. Federally funded rental assistance are in place, but due to the high demand of the funds, the government is unable to keep up.

One study evaluating the efficacy of the Housing First model followed mentally ill homeless individuals with criminal records over a two-year period, and after being placed in the Housing First program only 30% re-offended. Overall results of the study showed a large reduction in re-conviction, increased public safety, and a reduction in crime rates. A significant decline in drug use was also seen with the implementation of the Housing First model. The study showed a 50% increase in housing retention and a 30% increase in methadone treatment retention in program participants.

Mental health services

Uninterrupted assistance greatly increases the chances of living independently and greatly reduces the chances of homelessness and incarceration. Through longitudinal comparisons of sheltered homeless families and impoverished domiciled families, there are a collection of social buffers that slow one's trajectory toward homelessness. A number of these factors include "entitlement income, a housing subsidy, and contact with a social worker." These social buffers can also be effective in supporting individuals exiting homelessness. One study utilizing Maslow's hierarchy of needs in assessing housing experiences of adults with mental illnesses found a complex relationship between basic needs, self-actualization, goal setting, and mental health. Meeting self-actualization needs are vital to mental health and treatment of mental illness. Housing, stable income, and social connectedness are basic needs, and when met can lead to fulfillment of higher needs and improved mental health. Those with a brief history of homelessness and managed disabilities may have better access to housing.

Research calls for evidence based remediation practices that transform mental health care into a recovery oriented system. The following list includes practices currently being utilized to address the mental health needs of homeless individuals:

  • Integrated service system, between and within agencies in policy making, funding, governance and service delivery.
  • Low barrier housing with support services.
  • Building Assertive Community Teams (ACT) and Forensic Assertive Community Teams (FACT).
  • Assisted Community Treatment (ACT).
  • Outreach services that identify and connect homeless to the social service system and help navigate the complex, fragmented web of services.

Challenges

Fear surrounds the introduction of mentally ill homeless housing and treatment centers into neighborhoods, due to existing stereotypes that homeless individuals are often associated with increased drug use and criminal activity. The Housing First Model study, along with other studies, show that this is not necessarily the case. Proponents of the NIMBY (not-in-my-backyard) movement have played an active role in the challenges faced by housing and mental health service interventions for the homeless.

Conclusion

For some individuals, the pathways into homelessness may be upstream. E.g. issues such as housing, income level, or employment status. For others, the pathways may be more personal or individual. E.g. issues such as compromised mental health and well ‐ being, mental illness, and substance abuse. Many of these personal and upstream issues are interconnected.

Poverty and health in the United States

U.S. Poverty Trends

Poverty and health are intertwined in the United States. As of 2019, 10.5% of Americans were considered in poverty, according to the U.S. Government's official poverty measure. People who are beneath and at the poverty line have different health risks than citizens above it, as well as different health outcomes. The impoverished population grapples with a plethora of challenges in physical health, mental health, and access to healthcare. These challenges are often due to the population's geographic location and negative environmental effects. Examining the divergences in health between the impoverished and their non-impoverished counterparts provides insight into the living conditions of those who live in poverty.

A 2023 study published in The Journal of the American Medical Association found that cumulative poverty of 10+ years is the fourth leading risk factor for mortality in the United States, associated with almost 300,000 deaths per year. A single year of poverty was associated with 183,000 deaths in 2019, making it the seventh leading risk factor for mortality that year.

Environment and health

The environment of people in poverty impacts their health in many aspects. High poverty areas experience problems associated with poor air quality, water pollution, hazardous and toxic waste, and noise pollution. According to Unhealthy Cities: Poverty, Race, and Place in America, poor air quality results in higher rates of children with asthma living in these areas, and nearly 2 million children with asthma live in areas that do not meet national ozone standards. These children are also exposed to greater amounts of allergens that trigger their asthma. Water pollution is also present impoverished cities due which results in unsanitary practices due to poor water supply and sanitation. Impoverished communities are prone to be in proximity to hazardous waste facilities which result in toxic waste dumping, chemical runoff, and water pollution within the area. Because many residents of low-income areas are desperate, they tend to not protest against incoming hazardous facilities. Therefore, these facilities tend to seek out these communities to build in, and this results in more health costs for those in the area. Low-income populations are also more exposed to pesticides, and a significantly higher amount of lead was found in African-American children living in inner-city areas. Neglected Tropical Diseases (NTDs) are also more prevalent in areas of high poverty such as the South and inner-city areas though they often get overlooked by physicians for other diseases.

Climate change also affects the health of those living in low-income communities. Climate change can result in a greater frequency of bad allergy days which results in weakened immune systems and increase asthma cases within the community. From air pollution, respiratory and cardiovascular diseases can worsen due to the greater amounts of chemicals in the atmosphere and hotter temperatures. The warmer temperatures also result in warmer surface water bodies which are better environments for tropical diseases to take root and spread. Climate change also results in higher frequency of storms, hurricanes, and floods which can result in greater damage to infrastructure resulting in more financial stress for people in low-income communities.

Spatial

Health outcomes of those in poverty can also be determined by spatial, or geographic, location which is another aspect of the environment. Opportunities for healthcare, goods and services like food, and community are all based on geography. Childhood/early adulthood settings highly influence behavior, education, and careers. Those who are financially unstable can usually only find homes that are lower-priced in neighborhoods that are not invested in and are not managed well. These homes are often lower quality, and the costs are higher than what can be managed. According to The Link between Neighborhood Poverty and Wealth: Context or Composition?, Residents in a high-poverty neighborhood reports poor health 1.63 times more than a person in a low-poverty neighborhood, even when controlling for factors like education, marital status, and labor force status. For those living in rural areas, health services are not as accessible, and impoverished people go to doctors fewer times than their counterparts. The effect of spatial location is seen in both physical and mental health.

Poverty and physical health

Poverty can affect health outcomes throughout a person's entire life. The affect may not always be expressed while an individual is impoverished. Mothers who are in poverty during their pregnancies may experience more health risks during their delivery, and their newborn may experience more health risks and markedly more behavioral problems during their development. Furthermore, children in poverty have worse health outcomes during adulthood. This effect is especially pronounced for specific ailments, such as heart disease and diabetes. The impact persists even if a youth escapes poverty by adulthood, suggesting that the stress of poverty encountered during childhood or adolescence has a lasting effect. Previous research has identified the labor environments of the impoverished as more likely to contain risk factors for illness and disability relative to their non-impoverished counterparts. The implication is that the unique stresses of life within an impoverished community contribute to poorer health outcomes, even if the resident does not engage in any specific behavior detrimental to their health. Early into the COVID-19 pandemic in North America, being impoverished was associated with an increased likelihood of contracting COVID-19, as well as dying from it.

Poor housing results in many health problems. Accidents, respiratory disease, and lead poisoning can be caused by poorly built housing. There can also be a lack of safe drinking water, pests, and dampness in the house, and gonorrhea is associated with deteriorating houses. Mothers who live in poverty areas have lower rates of prenatal care and higher rates of infant mortality and low birth weight. Tuberculosis rates are also higher in high-poverty areas. Obesity is associated with poverty due to lack of infrastructure that supports a healthy lifestyle. Often, poverty-areas do not have places to walk or get healthy food nearby, and they are bombarded with unhealthy promotions like cigarettes, alcohol, and fast food. High-poverty areas also had higher death rates than low-poverty areas.

Cost of housing is a huge detriment to physical health. Housing is what the poor pay the most for on a regular basis, and this results in lack of funds for other basic needs like food and health. In a National Health Interview Survey, it was found that around 10% of American families did not receive needed medical care because of cost. Food insecurity also increases due to being unable to buy food due to cost.

According to a 2023 study published in JAMA, cumulative poverty of a decade or more is the fourth leading risk factor for death in the United States annually, being associated with 295,000 deaths. A single year of poverty was associated with 183,000 deaths in 2019, making it the seventh leading risk factor. Up until the age of 40, poor people's survival rates were essentially comparable to those of more affluent people, according to UCR researchers, but after that point, they died at a rate that was noticeably higher.

Poverty and mental health

Poverty also has a complex relationship with mental health. Being in poverty may itself provoke a condition of elevated emotional stress, known as "poverty distress". Poverty is also a precursor or risk factor for mental illness, particularly mood disorders, such as depression and anxiety. Schizophrenia is also strongly associated with poverty, occurring most frequently in the poorest classes of people all over the world, especially in more unequal countries.  In a sort of reciprocating relationship, having mental illness is a major risk factor for being in poverty.  Having a mental illness may inhibit a person's ability to work or deter employees from hiring them.

A hypothesis known as "drift hypothesis", posits that for people with psychiatric disorders (primarily schizophrenia), they tend to fall further down the socioeconomic ladder as their condition reduces their functionality.  This hypothesis is an effort to establish that people with profoundly limiting psychiatric symptoms are more likely to descend economically, not that the financially challenged are more likely to present severe psychiatric disorders. People experiencing less severe symptoms are less likely to be affected by "drift".  

Receiving treatment has shown positive effects for those struggling with mental illness and poverty.

With those in poverty having greater likelihood of suffering from mental illness, the benefit of access to clinical psychotherapy treatments has been explored. Despite numerous barriers for access to care for low-income individuals, there is evidence that those who do receive care respond with significant improvements. This research supports policy measures for improved outreach and access-to-care measures designed to benefit those with low-incomes and mental health disorders.

Mental health is affected by location as well. Noisy housing impacts reading in children and promotes psychological stress. Many poor families move more often and are residentially instable. This results in children experiencing instability with relationships with peers. They also experience more stressful life events which places strain on their mental state as the events accumulate. As both parents and children try to cope, they may cut themselves off from social interactions and healthy development.

Race and health

Poverty and race both impact the health outcome of a person. Of the residents in poverty-areas, well over half are people of color. When compared to White Americans, all other races have lower outcomes of infant mortality, low birth weight, prenatal care, and deaths in cities. People of Color have an 80% higher mortality rate than White people, and this includes deaths from cancer, accidents/homicides, and disease. Those in severe poverty are more likely to be Black Americans and Latinx. More than one-fourth of the Native American and Alaska Native population lives in poverty. When adjusted for age, the death rate of Native Americans and Alaska Natives is 40% higher than the general population, and 39% of the children are obese or overweight. Mental health is the number one problem in the Native American and Alaska Native population. For Black Americans, racial segregation in neighborhoods are barriers for equitable health opportunities. Most current neighborhoods that are predominantly Black have been institutionally disinvested and have fewer public services and more housing insecurity. With these barriers, many Black Americans do not have the wealth of a family home passed down through generations. Latinx and Asians may also have trouble with home ownership due to cultural and linguistic isolation.

Homelessness and health

Homelessness is a public welfare and health epidemic within the United States. Any period of homelessness is associated with adverse health consequences. These adverse health consequences are associated with poor living conditions and a lack of access to treatment facilities. Due to living in extreme poverty it is unlikely for an individual or a family to have a healthcare plan. These healthcare plans are important in obtaining treatment for illnesses or injury from treatment facilities. Without it, individuals and families are left to deal with their ailments themselves or endure further financial burden by receiving treatments without a health insurance plan. Respiratory infections and outbreaks of tuberculosis and other aerosol transmitted infections have been reported. Homeless intravenous drug users are at an increased risk of contracting HIV, and hepatitis B and C infections.

The close living spaces of areas such as Skid Row in California provide an environment in which infectious diseases can spread easily. These areas with a high concentration of homeless individuals are dirty environments with little resources for personal hygiene. It was estimated in a report to congress that 35% of homeless were in unsheltered locations not suitable for human habitation.

There is a bidirectional relationship between homelessness and poor health. Homelessness exacts a heavy toll on individuals and the longer individuals experience homelessness, the more likely they are to experience poor health and be at higher risk for premature death. Health conditions, such as substance use and mental illness, can increase people's susceptibility to homelessness. Conversely, homelessness can further cause health issues as they come with constant exposure to environmental threat such as hazards of violence and communicable diseases. Homeless people have disproportionately high rates of poly substance use, mental illness, physical health problems and legal issues/barriers in attaining employment.

Large number of homeless people work but few homeless people are able to generate significant earnings from employment alone. Physical health problems also limit work or daily activities which are barriers to employment. Substance use is positively associated with lower work level but is negatively related to higher work level. Those with physical health problems are substantially more likely than those with mental health problems to be in the more generous disability programs. Substance use disorders are also a barrier to participation in disability programs. Rates of participation in government programs are low, and people with major mental disorders have low participation rate in disability programs.

Around the United States, homeless deaths surged 77% from 2016 to 2020. An analysis from The Guardian in February 2022 found that some 18,000 homeless people died on the streets and in encampments and shelters over a five year period, with 5,000 of these deaths occurring in 2020. The non-profit National Health Care for the Homeless Council places homeless deaths at between 17,000 and 40,000 annually, as many are never counted given the federal government does not track homeless deaths nationally. The top direct causes of death among the homeless population include "drug overdoses, violence, traffic deaths and premature lethality of treatable conditions like heart disease." Regarding drug deaths, methamphetamine is a significant killer, as people who are homeless use the stimulant drug to stay awake and alert in order to protect themselves from violence. The report also notes that, outside of direct medical causes of death, a major factor contributing to both the epidemic of homelessness and surge in deaths among the homeless population is the lack of affordable housing throughout much of the country.

Homelessness among the elderly has been increasing. The Los Angeles County Department of Public Health found that homeless persons die at greater rates than the general public from specific causes. They are more likely to die by: 35 times from alcohol or drug overdoses, 16 times from auto accidents, 14 times from murder, 8 times from suicide, and 4 times from heart disease. According to data from HUD in September 2023, the elderly are now the fastest growing demographic of the homeless population.

Judge Milan Smith Jr., an American jurist claimed that homelessness is "presently the defining public health and safety crisis in the western United States." According to the Lahsa data, on average six unhoused people are dying each day. the causes reported of death are Overdoses, heart disease, traffic accidents, homicides, hypothermia, and heat exhaustion.Va Lecia Adams Kellum, Lahsa's CEO, believes "The primary causes of homelessness are economic."

Health care policy

Between 1987 and 2005, the number of people without health insurance in the United States rose from just over 30 million, to 46.6 million. Insurance tends to increase the price of services, and at that time, 8.5% of people belonging to households that made over $75,000 annually were uninsured. For families earning $25,000 or less, that percentage rose to 24.4% uninsured. This figure exhibits how lack of access to care via health insurance disproportionately affects those in poverty.

Graph from U.S. Census Bureau on rates of uninsuredGraph showing

Despite the cost of healthcare being an obstacle for those with relatively low incomes, research suggests that insurance coverage will not dramatically change outcomes related to physical health.  Access to Medicaid for low-income adults aided in diagnosis of metabolic disease, saw a reduction in diagnosis of mental health disorders, and reduced incurrence of "catastrophic medical costs" by patients dramatically. While these positive effects were observed, outcomes for heart disease, diabetes, and other physical health characteristics were not meaningfully improved. It has been posited that one year, the duration of the study, is an insufficient length to fully observe the divergent health outcomes that would be characteristic of an experiment with a lengthier time-table. Also, minorities have an excess amount of deaths due to diseases like cancer and cardiovascular disease compared to whites.

The medical-industrial complex also contributes to the difficulties of patients paying for medications and healthcare costs.

Actions taken by the government

The United States government has passed acts to make healthcare more accessible. Though it does not have universal health coverage, the country has two forms of public insurance, Medicare and Medicaid. Medicare is insurance for those who are over 65 or have long-term disabilities or end-stage renal disease. Medicaid allows for federal funding to match health care services and allow low-income families, low-income pregnant women, low-income children up to 18 years old, the blind, and those with disabilities to have these services. Medicaid is administered by states, so states have the right to set the criteria for eligibility. According to The Commonwealth Fund website, Medicaid now covers 17.9% of Americans. The Children's Health Insurance Program (CHIP) provides insurance to children in low-income families and covers 9.6 million children, according to The Commonwealth Fund. The Affordable Care Act was passed in 2010, and it expanded Medicaid eligibility and provided funding for federally qualified health centers. These centers take patients regardless of ability to pay and provides free vaccines to uninsured and underinsured children. Community mental health services are also funded by the federal government through grants provided to states by the Substance Abuse and Mental Health Services Administration.

Recommendations to further improve

One recommendation to address the inequity of healthcare for the poor is to take community-based action. One example of this is county health councils in Tennessee. These are volunteer groups from the community who assess health inequities within their county and decide what policies to implement. Another idea is to implement community-oriented primary care where physicians consider the environment and culture of the patient to further their health. To improve housing, weatherization programs are recommended to refurbish poor housing to be more health friendly.

Policy wise, it is recommended to continue investing in the health of the poor by creating an amendment or law and increasing affordable housing. The amendment would ensure that adequate housing is a right to be enjoyed by everyone, and if that could not happen, then a law could be passed for a better housing policy. Affordable housing can be increased by increasing subsidies through housing vouchers for households or reduced interest loans for developers.

Butane

From Wikipedia, the free encyclopedia ...