How Housing Matters: Housing As a Platform for Improving Health Outcomes

When we think of improving the health outcomes of Americans, we often think of better medicine, lower health care costs, and smarter prevention strategies. But in many ways, safe, decent affordable housing is just as important.

Perhaps the clearest example is an effort by the federal government that began a decade ago to reduce people’s exposure to lead hazards in their homes. Since that time, these efforts have reduced the number of children with lead poisoning by 75 percent.

That’s just the beginning.  Several studies have demonstrated that “permanent supportive housing” ends homelessness, which is associated with serious health problems.  Providing people with a combination of housing vouchers and supportive health services actually ends up costing less than the revolving door of shelters, emergency rooms, detox centers, prisons, and hospitals.

We also have a growing understanding that the connection between people’s homes and their health doesn’t stop when they walk out their front door. The New England Journal of Medicine recently published the results of “Moving to Opportunity,” a study showing connections between health and housing at the neighborhood scale.

Looking at 4,500 very low-income families living in public housing projects in high-poverty neighborhoods in five major cities, the study found that very low-income women who have the opportunity to move from high- to lower-poverty areas are significantly less likely to be extremely obese or to have diabetes.

What’s significant is that most of these studies have been coming not from journals focused on housing or social policy, but from premiere medical journals. And each study came to the same conclusion: that housing is a powerful public health intervention that actually saves taxpayers money.

Armed with this data, the U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Health and Human Services (HHS) have joined efforts and resources to make a bigger impact than either of our agencies could alone.  We’re building on the foundation of cooperation we created to take on lead abatement to pursue a broader healthy homes agenda.

President Obama has said, “If poverty is a disease that infects an entire community in the form of unemployment and violence, failing schools and broken homes, then we can’t just treat those symptoms in isolation. We have to heal that entire community.”

Through the interagency Neighborhood Revitalization Initiative, we are doing just that by partnering with government, business, and institutional leaders as they work to create neighborhoods of opportunity.  NRI tools like Choice Neighborhoods have pushed us to connect housing and services more directly, while also strengthening the links between housing, health, and education.

And this summer, the Affordable Care Act brought together 17 federal agencies, including HHS and HUD, to create our nation’s first ever comprehensive National Prevention Strategy rooted in the idea that good health begins at home and in the community. The Strategy represents this Administration’s commitment to take concrete action – together with our partners in every sector – to keep America healthy and fit.

One area where we’ve made substantial progress combining housing and health strategies is helping people with disabilities.

Using HHS’ “Money Follows the Person” resources, HUD and HHS are working together on a significant capacity building effort in five states to learn how to create a more seamless partnership between public housing authorities and state Medicaid agencies to help people with disabilities transition from institutional care to community living.

We know these sorts of partnerships work.  Just ask Kay from Cleveland, who, because of her psychiatric disability, had gone between shelters and nursing homes for the majority of her life.

Kay was discharged from a nursing facility to a temporary shelter, but couldn’t afford a permanent home and was at risk of being re-institutionalized.  With a Housing Choice Voucher provided through HUD and the help of Ohio’s Home Choice Program, funded by HHS, Kay got the support she needed to transition into her community.

We hope our work around disabilities will serve as a foundation for supporting other vulnerable populations like seniors.  HUD and HHS have been collaborating on a project to understand how affordable housing can be an important platform for lowering health care costs and improving care.

As Dr. Megan Sandel said at MacArthur’s How Housing Matters conference, “a safe, affordable home is like a vaccine” because it protects families and children against devastating – and costly – consequences of poverty.  That’s the evidence-based, smart government approach we’ve been pursuing in the Obama Administration—and intend to keep building on in the months to come.

Shaun Donovan is the secretary of the U.S. Department of Housing and Urban Development.

Kathleen Sebelius is the secretary of the U.S. Department of Health and Human Services.