Pet-inclusive housing as a social determinant of health: a multi-stakeholder qualitative study of rental policy and health equity

Housing is a well-established social determinant of health, but the pet-related rental policies that shape it have received little attention. Most U.S. households include a companion animal, yet fewer than 10% of rental properties are truly pet-inclusive (i.e., free of breed, size, and number restrictions and of substantial pet fees), creating systemic barriers that disproportionately affect low-income and marginalized renters. Guided by the World Health Organization’s Social Determinants of Health (SDOH) framework, this multi-stakeholder qualitative study examined how upstream housing policy and rental market environments produce downstream health inequities among pet-owning households and identified actionable points for cross-sector reform. Forty participants in one North Central Florida community took part in four focus groups and 13 in-depth, semi-structured interviews across five stakeholder groups: tenants with pets ( n = 15), housing providers ( n = 8), government officials ( n = 6), animal welfare professionals ( n = 5), and tenants’ rights advocates ( n = 6). Data were analyzed by two coders using inductive thematic analysis within stakeholder groups, followed by deductive mapping to structural and intermediary SDOH domains. Structural determinants, including state preemption laws, insurance underwriting, and corporate portfolio management, shaped the availability, affordability, and transparency of pet-inclusive housing. These upstream forces produced intermediary conditions such as unit scarcity, stacked move-in costs and recurring fees, policy opacity, stigma, and fragmented assistance ecosystems; advocates further linked breed restrictions to racial discrimination. Tenants responded through concealment, negotiation, and emotional-support-animal workarounds, while providers escalated surveillance and fee-based enforcement. Downstream consequences included emotional distress, housing instability, family separation from pets, increased shelter intakes, and community safety concerns, collectively straining a human-animal bond that many described as a source of psychosocial support. These exploratory findings suggest that pet-inclusive housing may be an overlooked structural determinant of health. Transparent policy disclosures, behavior-based insurance and pet-fee reform, and co-sheltering and veterinary supports could reduce inequities, relieve pressure on animal-services systems, and protect the human-animal bond. Integrating pet-inclusive housing into public health and housing planning offers a feasible avenue to advance health equity.