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Tax season is fully upon us, so it’s only natural for people to grumble about the Internal Revenue Service. But here’s one undeniably good thing for which the taxman can take credit: because of an IRS rule dating back more than a decade, tax-exempt hospitals are required to periodically assess the health needs of the communities they serve. That’s the good news. The bad news, for anyone reading Augusta Health’s report card from last year, is that our health in some key areas has declined steadily since 2016, and a significant reason for that decline is housing affordability issues that weren’t even on the radar a decade ago.
Indeed, the most recent Community Health Needs Assessment (CHNA) provides a sharp contrast to the first in a series dating back to 2013. That freshman effort took a notably upbeat approach by noting that Augusta was the 31st most healthy county in the 20th healthiest state in the country. “Augusta County is living up to its motto ‘Let the ages return to the first golden period,’ referring to a period of simplicity and happiness,” it rhapsodized, in less than scientifically detached fashion. “In general, the Augusta County, Staunton, Waynesboro area outperforms the state averages for health status. Where local results fall at or below those levels, we see an opportunity for combined actions that result in improved community ratings.”
But then, in a prescient turn of phrase, it added: “There are several lifestyle gaps that need to be closed to move Augusta County toward greater overall health.”
Fast forward a dozen years, and last year’s CHNA indicates that those gaps not only were not closed, but that some grew into chasms. While the 2012-13 assessment ranked chronic disease management, as well as health behaviors (“particularly related to obesity and physical activity”) as its top two health priorities, the 2025 ranking vaults mental health to the top spot. And although physical activity and weight retain their number two ranking, right on their heels as number three is housing, which scarcely registered in the earlier assessment. Meanwhile, chronic diseases, led by diabetes, trail behind in importance.
To be sure, the 2013 assessment was significantly more superficial than the reports that started coming out in 2016, when the grunt work was handed over to Professional Research Consultants and a 28-page report metastasized into a document nearly nine times as long. Moreover, the greater detail was complemented by a consistency of format, enabling comparisons across the three-year intervals that followed. The problem is that this consistency also highlights just how much backsliding has occurred.
AMONG THE ASSESSMENT’S housing-related findings for Staunton (anyone wanting to focus more on Waynesboro or Augusta County can peruse the complete assessment here), nearly a third (32.1%) of residents worried or stressed over their rent or mortgage payments in the previous year—apparently with good reason, as 12.3% reported they had been displaced from their housing within the past two years, and 9.9% said they’d been homeless in that same time period. Another 11.2 % said they were living in unhealthy or unsafe conditions.
For the SAW region as a whole, the incidence of unhealthy or unsafe living conditions jumped significantly from 2019 to 2025, from 9.9% to 14%—but even more sharply for renters, to 19.5%, compared to 10.5% of homeowners. An even wider disparity between renters and homeowners was found in response to the question of housing instability, with 17.8% of renters in the SAW region saying they had to find emergency housing in the previous two years, compared to 4.8% of homeowners. Meanwhile, the overall incidence of housing instability in the SAW region doubled, from 5% in 2016 to 10.2% in 2025.
Homelessness in the SAW region—defined as adults reporting “a time in the past two years when they lived on the street, in a car, or in a temporary shelter”—was zero in 2016, then climbed steadily through each reporting period, to 6.8% in 2025.
The health consequences of being homeless or of living in unsafe housing can be intuited by most people, but less immediately obvious is the toll on mental health taken by persistent anxiety over losing the home one already has. And while there are numerous reasons for depression or suicidal ideation, the parallel growth of deteriorating mental health and of insufficient affordable housing strongly suggests a link. Indeed, as housing stress has grown significantly over the past decade, the area’s mental health has taken a dive:
- Asked to rate their overall mental health, 21.9% of SAW adults believe it is only “fair” or “poor,” a 150% increase since 2016. Staunton leads the way on that metric, with 27.8% reporting fair or poor mental health.
- A total of 41.7% of SAW adults (and 50.4% of Stauntonians) say they have had two or more years in their lives when they felt depressed or sad most days. The open-ended nature of that measurement would dilute its significance, were it not for the fact that it is nearly double the 21.8% reading in 2016.
- More than a third (35.5%) of SAW adults say they have been professionally diagnosed as having a depressive disorder, a 138% increase from the 14.9% reported in 2016. Moreover, that incidence jumps to a whopping 47.1% of Staunton’s adults, which is more than twice the 20.4% incidence for Virginia overall.
- Local residents aren’t just depressed; 17.2% of SAW adults say they feel that most days are “very” or “extremely” stressful—a percentage also up significantly from the 10.5% recorded in 2016. Staunton leads the pack on this metric as well, with 22.1% reporting they feel stressed out.
Such ailments, alas, afflict some demographic groups far more severely than others, with low income and LGBTQ+ respondents greatly over-represented in all negative ratings—demographic groups that also have less visibility within the larger community, and less political clout with which to address the issues that are making them sick. Nor, once they do get sick, are there adequate mental health and related services to provide the care that’s needed.
The CHNA includes literally scores of comments from local doctors, social services providers, community leaders and others, detailing what they believe are the reasons for this intractable morass. To be blunt, there isn’t much that’s revelatory, although some of the anecdotes—a 35-year-old father, working two jobs to house his family in a motel room, dying from a stress-induced heart attack—get at the human cost of the illness permeating our body politic. And then there’s the occasional assessment item that further drives the point home, such as the finding that 19.3% of local adults acknowledge they have been “hit, slapped, pushed, kicked or otherwise hurt by an intimate partner.” That rate, too, has doubled since the 9.7% reported in 2016.
The problem with health exams, as all too many physicians know, is that patients will yes them to death—exercise, stop smoking, eat more nutritionally, cut down on the booze, yadda-yadda—and then go blithely on as though no red flags had been raised. So it seems with the 2025 CHNA’s section marked “evaluation of past activities.” Number two on its list of previous strategies was meeting the health care needs of the homeless through a four-pronged approach, all of which were implemented in 2023—and all but one, and then only minimally, going unaddressed in 2024, due to a vacant RN Health Educator position.
Vacant since November 2023, that is, or almost two years prior to the 2025 CHNA’s release.
It’s a near certainty that Augusta Health’s unfilled position is a result of budget constraints, but as with all such cuts, choices reflect priorities. Short-term rewards have a way of biting us in the ass down the road, and a high-salt, high-cholesterol diet almost invariably morphs into diabetes and obesity. But what are you going to do when it’s your doc who’s ignoring sound medical advice?
Meanwhile, when are Staunton’s decision-makers going to move beyond merely economic or policy discussions about affordable housing and the homeless, and recognize that we’re facing a much broader health crisis as well? One just as insidious as lead poisoning, in that it seeps into the populace largely unseen and unremarked, the body rotting from within until it explodes in seemingly inexplicable violence, depression and apathy. The 2025 CHNA has waved the red flags. How many more such studies will we need to convince us that there’s something definitely happening, and it’s not good?
Looking askance 