Home is not a healthy place for thousands of low-income children and adults who live in substandard apartments in Fresno.
Instead of being a sanctuary from day-to-day struggles, their apartments make their lives more stressful and toxic because they have to deal with cockroach and rodent infestations, mold, faulty electrical wiring and windows without screens.
Scientific research increasingly points to an association between poor housing and physical illnesses, and it also may contribute to psychological and behavioral conditions.
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“Ultimately, you have no safe place, mentally or physically,” said Dvera Saxton, an assistant professor of anthropology at Fresno State who has done social science research with farmworkers and low-income agricultural communities.
Dr. J. Luis Bautista, who runs a clinic in downtown Fresno, sees patients who live in apartments without heat and with poor air circulation, mold and pests.
“The most common diseases you will see are asthma, persistent cough, ear infections and bronchitis,” he said.
Last fall, residents of Summerset Village Apartments, a 220-unit complex in central Fresno, were without heat for a month. One of the residents, Tong Cha, believes the chilly conditions led to her husband’s death from respiratory failure caused by pneumonia. Her Xa Lor, 78, died Jan. 2 at Saint Agnes Medical Center.
Gas to run wall furnaces was turned off Nov. 12. Cha said they wore coats and wrapped themselves in blankets, huddling together on the couch for warmth.
Ultimately, you have no safe place, mentally or physically.
Dvera Saxton, Fresno State assistant professor of anthropology
Over the next month Lor grew increasingly weak, Cha said.
“My husband, he just started to shrink and shrink,” she said in Hmong.
By Dec. 14, when gas lines had been repaired and heat restored at Summerset, Cha said her husband had no energy to eat. A walk from his bed to the couch left him breathless. Other family members also became sick, Cha said. A grandson, 18, was ill when Lor died, she said. Cha and other tenants are suing Summerset owner Chris Henry.
Most Summerset tenants are Southeast Asian, many are Hmong refugees, and almost all are low-income. Poor ethnic minorities are most likely to be living in the worst housing conditions, according to health research.
A two-year Slumlord Criminalization and Health Impact Project in Downtown and South Los Angeles looked at substandard housing inhabited by low-income residents. The findings of the 2010 report of 140 tenants included:
▪ 75 percent reported cockroaches, 45 percent mold, and 40 percent rats or mice.
▪ 39 percent reported leaky pipes, 15 percent exposed wiring.
▪ Nearly 50 percent said they had chronic allergic symptoms.
▪ 15 percent reported family members had suffered lead toxicity.
The Los Angeles study showed the depth of substandard housing and the extent of tenants’ poor health, said Jim Mangia, president and chief executive officer at St. John’s Well Child and Family Center in South Los Angeles. The health center was part of a collaborative that undertook the study and published the paper, “Shame of the City – The Sequel; Slum Housing: LA’s Hidden Health Crisis.”
Mangia said children are especially affected by housing conditions. For example, he said: “We see kids every week with cockroaches lodged in their ears.” Cockroaches crawl inside the ear canal but can’t crawl backward to get out, he explained.
Among children and adults, there are asthma attacks, sinus infections, rat bites on legs, skin rashes, slips and falls, and electrical shocks, he said. Plus, there are mental-health symptoms from stress: chronic headaches, depression, anxiety and children with disruptive behaviors.
“Those are all the things we believe are directly related to these kinds of housing conditions,” Mangia said.
A systematic approach to battle substandard housing worked in South Los Angeles, he said. It included targeting slum owners, initiating legal action against them, organizing tenants, educating public health inspectors and involving doctors who treat low-income patients.
The collaborative effort improved health, he said. There was a 95 percent reduction in blood lead levels and a 100 percent reduction in asthma hospitalizations for children older than 18 months in 2012-14.
Children in substandard public housing were nearly 40 percent more likely to have repeat ER visits than children in redeveloped public housing.
Health costs associated with substandard housing are difficult to assess, but researchers at the University of California, San Francisco, and UC Berkeley found children in substandard public housing were nearly 40 percent more likely to have repeat visits to emergency rooms than children in redeveloped public housing.
And emergency room visits, said Nancy Adler, senior author of the study, “are an inefficient way to provide care, especially for kids who are in poverty.” The study was limited to children on Medi-Cal, the state-federal insurance for people with low incomes.
“We’re all paying the cost for that,” Adler said.
Another study suggests substandard housing can affect children’s psychological health. The study looked at 2,400 low-income children, teens and young adults in Boston, Chicago and San Antonio. Researchers found children in poor housing were more likely to have heightened levels of emotional and behavioral problems, and teens had lower reading and math skills.
Some of the effects appeared to be linked to what parents were experiencing, said Rebekah Levine Coley, a professor at Boston College and researcher of the 2013 study.
A lack of a sense of well-being for families who live in substandard housing concerns Dr. Kenneth Bird, Fresno County’s health officer.
“There is a level of stress I would think that could contribute to mental health and physical health consequences later,” he said.
The county’s public health department does not get involved in housing conditions within the city limits of Fresno unless city officials request help. The department was called to respond to the Summerset crisis, providing health assessments of physically fragile residents and translators to help communicate information to tenants.
Outside city limits, it is the county’s responsibility to respond to substandard housing complaints such as a lack of heat, a lack of running or hot water, and leaking roofs.
Bird winces at a description of toilet sewage that floods a family’s apartment in central Fresno every month or two. Contaminated water can carry a host of diseases, he said.
“Some of those viruses and some of those bacteria can stay around awhile if you don’t do a very thorough cleanup,” he said.
Something as simple as a missing window screen, which is commonplace at substandard apartment complexes in Fresno, is worrisome to Bird. A missing or torn screen that allows too many bugs to enter is a code violation in the city and county, he said: “If you spend a lot of time with screenless windows open here, you run a risk of West Nile virus.”
West Nile, which can cause severe neurological problems and be fatal, is well-established in the central San Joaquin Valley. Bird said other mosquito-borne diseases also could be transmitted, including the Zika virus, which has been linked to a serious birth defect of the brain called microcephaly in babies of mothers who had the virus while pregnant.
Substandard housing clearly has long-lasting and detrimental health effects, Bird said.
“The toll of these health effects on each individual and family, and its resultant stress on our health care system … impacts our public health profoundly.”