Published on May 4, 2021
“Our house is a very, very, very fine house— Crosby, Stills & Nash
With two cats in the yard
Life used to be so hard
Now everything is easy ’cause of you”
“I’m moving back in with my parents.”
For some, that’s a scary thing to say or hear. For others, it’s a solution to life’s challenges. Regardless, multigenerational households are increasingly common in American communities. While most of the twentieth century was marked by a movement toward single-family dwellings, the past 40 years has seen a rising percentage of people remaining with larger families or returning to the fold.
Multi-generational households, defined as homes with two or more adults at least 18 years apart that live together, now account for nearly 29 million households, or 17% percent of the U.S. total.
How is this trend impacting health? To answer this question, we used our Carrot Social Risk Grouper (SRG) framework to analyze whether social determinants of health (e.g., loneliness, financial insecurity, discord at home) are affected by multigenerational housing.
The results were surprising.
The History of Housing in America
Housing patterns, influenced by demographic, socioeconomic, and cultural forces, are especially complex in a large, diverse nation like the United States.
The movement toward single-family housing started in the early 1900s with the decline of family farms and businesses. It accelerated post-World War II with economic expansion, the rise of the suburbs, the increased ease of mobility (highways, air travel), decrease in family size, and the emergence of Medicare.
Single-family housing became associated with prosperity and the mainstream while multi-generational living was linked to minority and immigrant populations. Municipal and state regulations banning or discouraging multi-family housing have their roots in systemic racism. Historically, some local governments used zoning regulations to block multi-family housing and minority-owned businesses from certain neighborhoods. In 2020, California Senate Bill 50 (SB 50) attempted to overturn local zoning laws prohibiting multi-unit housing near public transportation hubs and job centers. With strong opposition from voters, SB 50 failed to pass.
The trend toward single family homes began to turn in 1980 and picked up speed with the global recession in 2008 as Millennials, hit hard by the economic downturn, moved back home. In the decade since, financial and time pressures have made caregiving harder, and soaring housing prices have led many to decide that living together under one roof could help address these various challenges. COVID accelerated this shift for isolated seniors and unemployed younger adults.
This impact on social determinants of health has been striking.
The Silver Lining to a Full House
At a high level, multigenerational households show significantly less (-27%) SDoH risk than other households. Perhaps least surprising, the reduced risk of loneliness (-40%) is the biggest benefit. Next up are the benefits (i.e., lower risks) of being uninsured (-37%) and of experiencing food insecurity (-23%) and housing instability (-25%).
Interestingly, significant variations show up at the state, county, and municipal levels. To illustrate this, consider the following comparison between Youngstown-Warren-Boardman (a metropolitan area with one of the nation’s highest rates of multigenerational housing) with Durham-Chapel Hill (one of the lowest).
The overall SRG score for both regions is roughly the same. But residents of Youngstown-Warren-Boardman have much less risk of being uninsured and less risk of both financial insecurity and housing instability. Durham-Chapel Hill residents have notably higher socio-economic status and less risk of food insecurity.
Who Drank All the Milk?
For many, moving back home, taking in parents, or living with extended family is an unpleasant prospect. A crowded house, lack of privacy, shared facilities and empty cereal boxes are frustrations to avoid.
For others, grandparents, adult children, teenagers, and toddlers living together under one roof means community, financial security, compassionate care, and mutual support.
Regardless of personal preference, it’s clear that multigenerational housing has strong social risk and health benefits that communities, governments, and care providers should appreciate and understand. These insights can challenge assumptions, help families and communities make better decisions, and inform policies and strategies that address social determinants of health.
When it comes to social determinants, Sesame Street put it best: It’s all about the people in your neighborhood.