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Addressing Housing and Health

Photograph of a row of town homes with varied facades facing a walk way surrounded by greenery.One of the major factors that influences a person's ability to be healthy is the affordability and quality of their housing.

On July 26, 2017, the National League of Cities partnered with the Urban Institute to host “Addressing Housing and Health: How Cities Are Making a Difference,” an event in which speakers and panelists discussed the need for localities to address the intersection of housing and health. According to the National League of Cities, access to safe, quality, affordable housing is one of the most basic and powerful social determinants of health. The social determinants of health are the living conditions that affect a person’s ability to be healthy. The speakers highlighted successful strategies that communities around the country have employed, describing how cities are improving residents’ health outcomes by advancing affordable housing, addressing housing hazards, and forging partnerships with private and nonprofit entities.

Affordable Housing

The lack of affordable housing imposes cost burdens on families that leave them unable to address other basic health needs such as good nutrition or medical care. When housing becomes too expensive, people can become homeless, which is associated with numerous poor health outcomes. Throughout the two panels and three presentations, speakers discussed city- and neighborhood-level strategies for improving residents’ health by increasing access to affordable housing. Ras Baraka, the mayor of Newark, New Jersey, described Newark’s strategies to improve housing affordability, including an inclusionary zoning ordinance requiring developers of market-rate housing to either build a certain number of affordable units or contribute to an affordable housing fund. Regarding the ways other cities can implement their own plans to improve housing access, Baraka emphasized the need to pursue broad partnerships, from small nonprofits and community development financial institutions to private-sector entities such as hospitals.

Organizations in the private sector are also promoting affordable housing to improve health. Jenny Ismert, vice president of health policy at the UnitedHealth Group, discussed how organizations in the healthcare sector can influence community health by investing in affordable housing. She said that UnitedHealth Group, which oversees service contracts for Medicaid managed care, deals primarily with low- and very low-income patients and has a keen appreciation for the role of social determinants of health such as housing. “While we can clinically manage an individual, we’re not going to be successful in improving their situation without affecting those social determinants,” explained Ismert, describing the health system’s investment in low-income housing tax credit (LIHTC) vehicles and other housing-related projects.

Housing Hazards

Just as the ability to afford housing affects health, so too does the quality of that housing. Healthy housing is free from hazards such as faulty construction, poor ventilation, pest infestation, accessibility barriers, the presence of environmental contaminants, and other factors that induce illness or injury. Several presenters and panelists spoke about strategies that cities and nongovernmental organizations alike have adopted to improve housing safety in their communities.

Jean Stothert, mayor of Omaha, Nebraska, presented on the city’s successful redevelopment of the low-income neighborhood Prospect Village in 2015, in which the city and its partners performed renovations and repairs, improved access to services, and remediated environmental problems such as the presence of lead, mold, and radon. Over the course of the project, workers made 213 emergency repairs, removed 6 accessibility barriers, and undertook 3 lead hazard control projects. Stothert advised cities seeking to replicate Omaha’s redevelopment success to seek out diverse funding sources for their efforts, and she reiterated the need to connect with community partners, especially neighborhood associations.

Speaking from the perspective of a health nonprofit based in an urban area, Dr. Ankoor Y. Shah, the associate medical director of innovation and advocacy at IMPACT DC, discussed how his organization is addressing pediatric asthma by addressing housing quality. Shah describes asthma as a “community-level disparity” strongly associated with poverty and substandard housing. A major component of IMPACT DC’s work, therefore, is partnering with housing organizations and local governments to remediate poor indoor air quality caused by mold and other hazards.

Vital Partnerships

Speakers repeatedly emphasized the central role of partnerships. “Partnerships are key, and allies are everywhere,” said Mary Cunningham, codirector of the Urban Institute’s Metropolitan Housing and Communities Policy Center. Cunningham elaborated on the need to reach out to entities in different sectors, whether it is a city government partnering with a nonprofit or a housing-oriented organization approaching a healthcare provider. Gail Livingston, deputy administrator of the Boston Housing Authority, detailed the authority’s close partnership with the Boston Public Health Commission and made suggestions for cultivating similar relationships. Livingston acknowledged that such partnerships can be challenging but emphasized the need to identify common goals and to remember that “solving the problem makes everyone’s job easier.”

In his discussion about Community Development for All People (CDAP), a nonprofit based in Columbus, Ohio, executive director Reverend John Edgar used CDAP’s partnership with Nationwide Children’s Hospital as an example of how leveraging partnerships in the healthcare sector can advance housing equity. During the eight years of the partnership, the hospital has contributed staff and participated in LIHTC deals, working with CDAP to undertake renovations, new housing construction, and neighborhood beautification. The partnership has been so successful, said Edgar, that his organization has broadened its work to include other social determinants of health, including youth development, neighborhood safety, and family wellness.

Addressing housing as a social determinant of health is vital for improving health outcomes. However, doing so is complex and often challenging, involving many diverse stakeholders and affecting nearly every aspect of community life. Strategies discussed at this event can effectively address community health by improving housing affordability, mitigating hazards, and forging partnerships.