Bringing life course home: Boston's healthy start in housing program

Healthy Start in Housing (HSiH) is a unique collaboration between the Boston Public Health Commission (BPHC) and Boston Housing Authority (BHA) that attempts to address racial disparities in birth outcomes by focusing on housing, a known social determinant of health. The program provides priority access to housing and intensive case management to pregnant women who are at risk of adverse birth outcomes and homelessness. It aims to reduce housing stress, which is associated with poor physical and mental health among pregnant women, and lower birth weight, prematurity, and developmental delays among their children. Life course perspective (LCP) is the framework that underlies HSiH. Specifically, LCP provides the theoretical framework to describe an explanatory pathway, from housing insecurity to psychological stress, psychological stress to physiological stress, and physiological stress to adverse birth outcomes and developmental delays among children. LCP has become the leading framework underlying national and state-level maternal and child health programs. However, its application to housing policy and understanding housing impacts is novel. In this first of three abstracts, we will use case study methodology to document, describe, and analyze the effort, effects, and context that brought HSiH to fruition. Through review of archival documents, program data, and interviews with key stakeholders from BPHC and BHA, we will identify key events and progress markers and analyze how the LCP has motivated Healthy Start in Housing program design and evaluation. HSiH represents both a successful multi-sectoral collaboration and a unique application of LCP to public health practice.