In the United States, where chronic illnesses like diabetes already strain millions of families, the greatest risk to managing the disease might not be sugar, but shelter. Diabetes is mainly treated as a problem of personal responsibility that is solved with medication, diet, and exercise. For afflicted people, the greatest threat to managing their diabetes and health is rooted in unstable housing. Research found that adults with type 2 diabetes who experienced housing instability had higher hemoglobin A1c levels and modestly worse blood pressure outcomes compared with those in stable housing, highlighting that unstable housing directly worsens diabetes management. Housing instability is described as frequent moves, overcrowding, eviction threats, and homelessness which creates both psychological and physiological harm impacting diabetes management. This health disparity lies in America’s failure to recognize housing as healthcare. Healthcare providers cannot expect people to stabilize their blood sugar when they can’t stabilize their living situation. For racially marginalized communities, unstable housing exacerbates diabetes, exposing the healthcare system’s neglect of social realities. America continues to treat diabetes as purely a medical issue, ignoring the social realities that shape health outcomes. If stable housing is a basic human need, why isn’t it treated as a form of healthcare?
Managing diabetes requires a consistent routine: access to nutritious food, refrigeration for insulin, and the ability to manage stress. According to the Center for Disease Control and Prevention, over 38 million Americans live with diabetes, and people experiencing housing insecurity are twice as likely to have diabetes compared to those in stable housing. When your nights are spent worrying about where to sleep, managing meals, or storing medication becomes a privilege. Unstable housing also triggers chronic stress that raises cortisol levels, weakening insulin effectiveness and worsening blood sugar control. In other words, while housing instability doesn’t cause diabetes directly, the stress and challenges it creates can exacerbate symptoms and make managing the condition more difficult.
This reality comes to life in the story of Alfonzo, a man living with type 1 diabetes who shared his experience with the American Diabetes Association. “Being poor and having diabetes was not a good combination,” he said. Diagnosed at sixteen, Alfonzo spent much of his adult life trying to survive without stable housing. Most days, he ate whatever he could find, whether from the streets, discarded food, or the generosity of others. Without a kitchen or a refrigerator to store insulin, he relied on whatever food he could find, and his blood sugar spiraled out of control. When an infection in his foot developed into MRSA, doctors had no choice but to amputate his toe. After the surgery, Alfonzo was told he had nowhere to return to and was placed in a nursing home. An isolating, aging facility that felt more like abandonment than recovery.
For Alfonzo, managing diabetes wasn’t just a matter of taking insulin. It was about surviving poverty. His story illustrates what research already confirms: no one can effectively manage diabetes without the stability that housing provides.
Healthcare systems must implement policies that integrate housing prescriptions into standard care for chronic illnesses. This would help push the idea forward that stable housing is a fundamental component of effective treatment. By bridging hospitals and housing agencies and funding long-term housing assistance through public health budgets, the U.S. could flip the script: instead of spending billions treating the consequences of housing insecurity, we could invest in preventing them. Evidence backs this up. A randomized trial found that providing permanent supportive housing to chronically ill homeless adults led to 24% fewer emergency room visits and 29% fewer hospitalizations after 18 months. Stable housing quite literally kept people healthier and out of hospitals.
Stable housing gives people more than four walls; it gives them back their autonomy. With a secure home, they can store food, refrigerate insulin and manage stress. If health is defined as a state of physical and mental well-being, then housing is its foundation. Until we reform the current housing system in America, our healthcare system will keep treating symptoms of a much deeper policy failure.
December 7, 2025