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Health Equity through Analytics (HExA): Infrastructure

Analyzing effects of infrastructure on health outcomes

Explore the foundational role of physical infrastructure—housing, commute, and technology—in shaping health outcomes. Our in-depth analysis explores how these important environmental elements intersect with other direct factors, offering actionable solutions to enhance health equity and drive meaningful change in community well-being.

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How can infrastructure affect health outcomes?

Infrastructure plays an important role in community health, influencing outcomes through various direct and indirect pathways. Key takeaways from the report include:

  • Homeownership: A significant milestone that can also introduce stress, particularly when debt-to-income ratios are high, potentially contributing to poorer health outcomes.
  • Dense housing: While dense urban areas may face challenges, they often provide better access to services and foster social connectedness, which can enhance community health.
  • Remote work: Offers health benefits by reducing commute times and can differently impact various income groups, highlighting the need for community-specific solutions.
  • Digital access: Broadband and technology significantly support community health, but benefits can vary based on county income and other socioeconomic factors.
  • Infrastructure overall involves additional contextualization from other more direct drivers of health for comprehensive solutioning.

This brief overview frames the depth of our analysis, emphasizing the nuanced interplay between infrastructure and health. Download the complete report for a deeper dive into the data.

About the HExA series

The Health Equity through Analytics (HExA) series explores relationships between drivers of health—all the social, environmental, and economic factors that influence health—and health outcomes, identifying actionable trends through a quantitative lens. The main goals of the HExA series are to deepen our knowledge on drivers of health, detangle and segment analyses, and share knowledge broadly in order to inspire conversation and catalyze collaborations that ultimately address root causes.

We recognize that real-world health care issues are highly nuanced, complex, and multifactorial. Therefore, additional real-world research is important to keep building the evidence base—and this series is just the first step.

Housing can significantly affect health across physical, mental, and social dimensions. Quality, affordability, and location of housing can all become factors in health outcomes.1 Additionally, our analysis shows that the associations of homeownership and housing density to county-level health outcomes becomes more apparent when stratifying for the county income and considering the debt burden.

Unpacking the data: Key findings
  • Increased homeownership in a community correlates with poorer physical health outcomes. This may be due to the stress of homeownership, particularly as the cost burden of housing becomes more than 30% of a household’s income and especially in middle-income counties.
  • As the proportion of denser housing increases in a county, the prevalence of community-level chronic conditions decreases. This could be due to several factors, which include differences between urban and rural housing, the creation of a community and social connectedness in more densely populated counties, and the availability of more proximate health resources in densely populated areas.

The intricate relationship between transportation, commuting, and health is a multifaceted issue that extends beyond mere convenience and efficiency. If urbanization accelerates and metropolitan areas expand, the daily commute may consume significant portions of the day. This routine activity can have profound implications for public health, influencing physical, mental, and social well-being. However, a working culture shift around the COVID-19 pandemic opened the opportunity for working from home to a greater proportion of the population.2

Unpacking the data: Key findings
  • There appears to be a community-level increase in self-reported physical activity, physical health, and mental health as the proportion of the population that works from home increases. However, the benefits are not evenly distributed when considering average county income.
  • Working from home may confer different benefits to different groups due to their other daily needs. The association with working from home and increased physical health and activity was mainly seen in higher-income counties. Meanwhile the benefits of better mental health were seen in middle-income counties.

Broadband connectivity—and the technology to utilize it—may be a key infrastructure that can support the health of communities. As other established drivers, such as education, employment opportunities, and job training, are increasingly premised on the availability of connectivity, broadband may be a gateway to the other determinants.3 In our analysis, we also find that county average income appears to modify the relationship between access to technology and communications, and the lifestyle and wellness benefits it may support.

Unpacking the data: Key findings
  • Overall, there appears to be a marked community-level decrease in chronic conditions and self-reported poor physical health with increased broadband access and the technology to utilize it.
  • However, when stratified for county income, the association with broadband access and increased physical health and decreased chronic condition prevalence was diminished, particularly as it relates to mental health. Income appears to modify the relationship between the access to technology and communications, and the lifestyle and wellness benefits it may support.

Dive deeper into the HExA data

From housing affordability to the digital divide, our comprehensive report examines the intricate ways in which infrastructure can affect health outcomes.

Download the report

Implications for action

We may see the greatest opportunity for impact on health outcomes by considering structural and indirect drivers of health (e.g., infrastructure) in combination with more direct and individual drivers of health (e.g., social connectedness), rather than as stand-alone contributors. Findings from our analysis suggest the following:

  1. More nuance should be involved when considering infrastructure as a driver of health. Local infrastructure may be out of the control of the individual, thus variables like income, access, and affordability should be considered when contextualizing the relationship between infrastructure and health outcomes.
  2. While homeownership may be a major milestone and pathway to financial stability, it may also be very stressful when the debt-to-income ratio is high, thus leading to poorer health outcomes.
  3. Dense housing and urban crowding may have disadvantages, but they may also provide better local access to services and support a social community that fosters social connectedness.
  4. Working from home, instead of spending portions of the day commuting, may provide health benefits to the community overall. However, access and availability of these opportunities may not be evenly distributed across income groups. Additionally, different income groups may benefit differently from these opportunities (e.g., middle-income counties experience mental health benefits, while upper-income counties experience better physical health).
  5. Access to broadband and the technology to use it seems to support improved community health; however, county income appears to modify this relationship unevenly. There may be other individual-level factors also associated with income that may be modifying technology’s relationship to better health outcomes (e.g., literacy).

How stakeholders can lean in

Community leaders and policymakers
Infrastructure decisions often lie with local governments and policymakers. It’s important to understand the complex interplay between infrastructural and individual health drivers to craft tailored, effective health policies.

Additionally, there should be continued consideration beyond simply the access to the systems.

  • For example, medical technology providers and community stakeholders can work together to understand how the community may best benefit from the availability of the technology through other more individual and community-specific programs. These may include education and training components that allow the systems to be used to their greatest potential.

Health care providers
Health professionals can collaborate with community leaders to align structural and individual health initiatives, leveraging infrastructure improvements for broader community health benefits.

  • Providers may also consider collecting additional data on the drivers of health to support targeted and evidence-based infrastructural changes within the community.

Endpoints

1Alessa Riva et al., “Can homes affect well-being? A scoping review among housing conditions, indoor environmental quality, and mental health outcomes,” International Journal of Environmental Research and Public Health 19, no. 23 (November 2022): 15975; Amy Clair and Amanda Hughes, “How renting could affect your health,” World Economic Forum, February 11, 2019; Meridith Sones, “How social connectedness between neighbors supports health and well-being,” Hey Neighbor Collective, June 3, 2022.

2Kiron Chatterjee et al., The commuting and wellbeing study: Understanding the impact of commuting on people’s lives (Bristol, UK: University of the West of England) October 23, 2017; Jaana I. Halonen et al., “Commuting time to work and behaviour-related health: A fixed-effect analysis,” Occupational and Environmental Medicine 77, no. 2 (2020); pp. 77–83; Kathryn Vasel, “Two years later, remote work has changed millions of careers,” CNN Business, March 18, 2022.

3Federal Communications Commission (FCC), “Studies and data analytics on broadband and health,” January 26, 2024.

If you’d like to talk more about infrastructure as a driver of health, or the emerging opportunities our strategies can present for your organization, let’s have a conversation.

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