SPATIAL INEQUALITY, HOUSING AFFORDABILITY, AND URBAN HEALTH IN THE UNITED STATES: AN INTEGRATIVE REVIEW

Housing is one of the most consequential yet unevenly distributed determinants of health in the United States, and the geography of who can afford safe, stable housing increasingly determines who experiences chronic disease, psychological distress, and premature mortality. Contemporary housing disparities are not incidental; they are rooted in decades of racialized zoning, mortgage redlining, and exclusionary land-use policy that continue to shape neighborhood conditions long after their formal repeal. Despite a growing body of research connecting housing conditions to health, the literature remains fragmented across disciplines: urban economists conduct studies on spatial inequality in housing markets. Public health scholars study housing instability and disease outcomes, and health equity researchers study gentrification and displacement. Only few works integrating these strands into a single account of how spatial inequality, housing affordability, and urban health interact. This integrative review synthesizes peer-reviewed and institutional literature published primarily between 2019 and 2026, organized around four thematic domains: the structural and historical drivers of spatial inequality; housing affordability, cost burden, and financial precarity; housing instability, eviction, and health outcomes; and neighborhood change, gentrification, and health care access. The review finds that housing-related health harms are cumulative and mutually reinforcing across these domains, and that interventions addressing any single dimension in isolation, such as affordability subsidies without zoning reform, or technical hardening of housing stock without attention to displacement, produce limited and unstable gains.