How Localities Are Leveraging Laws and Policies to Promote Health and Housing

Having a safe, stable, affordable place to live is something that a lot of us take for granted. But for too many people that prospect is rapidly fading—particularly if you are a low-income person or a person of color. Rising housing costs combined with a lack of good paying jobs, distressed local economies, and gentrification are all making it increasingly difficult to afford housing.

According to the 2019 annual County Health Rankings (CHR) report, which ranks the health of nearly every U. S. county, one in ten households spend more than half of their income on housing costs. When broken down by race, nearly one in four households headed by blacks spend more than half of their income on housing. Across counties, increases in the share of households severely cost burdened are leading to more food insecurity, poverty, and people in poor health.

Decades of research have shown that safe, stable, affordable housing sets the foundation for a healthy life. Conversely, housing instability is associated with poor health outcomes, particularly for children and youth. Eviction can lead to poor mental health, depression, and material hardship for adults, which perpetuates poverty. And residential segregation is a primary reason that racial health disparities continue to persist, particularly between blacks and whites.

The 2019 CHR shows that more segregated counties have higher rates of severe cost burdens, however, black residents face greater barriers to opportunity and health than white residents. The stark differences in opportunities to live in safe, affordable homes, especially for black residents, are tied to discrimination and institutional racism from enduring, deep-rooted, and unfair systems, policies, and practices, such as the pernicious effects of redlining, which have led to consistently worse health outcomes for people with low incomes and people of color.

While research demonstrates the link between housing and health, housing policies have not ensured equitable access to healthy communities. Many federal, state, and local housing policies have established land-use patterns and codified racist cultural norms in communities. The legacy of insidious discriminatory practices like restrictive land covenants and predatory lending, drive health disparities, wealth inequities and segregation even today. Moreover, state preemption of local health-promoting housing policies such as inclusionary zoning, proactive rental inspections, and source-of-income anti-discrimination laws are common.

Communities need a holistic approach to address the complex ways our health is tied to our homes and the right tools to reverse adverse policies.

The good news is that there are communities and local institutions working together at the intersection of health and housing. Hospitals, public housing authorities, and public health departments are examples of local entities leveraging investment and community leadership to improve housing policies and health outcomes. By working with local and state government, these organizations can help stabilize housing and expand options for quality affordable housing.

An example is Bon Secours Hospital, which began working on housing in West Baltimore Maryland after it recognized that poor health among residents was driven by unaffordable rents and residents feeling unsafe in the neighborhood where the hospital was located. Bon Secours used its capital and worked with the city and state to redevelop vacant properties to stabilize the neighborhood and make it safer for residents, patients, and employees. The city and the state helped with financing, zoning, and tax-credit changes. Over the years, the hospital has created 800 homes for residents. And, it recently acquired state funding to develop a health enterprise zone to improve residents’ health.

Public health departments also are stabilizing housing and preventing residential displacement. In California, the Alameda County Public Health Department’s (ACPHD) work on asthma control prompted Oakland to proactively enforce rules to protect children from exposure to mold, lead, and other adverse housing conditions. ACPHD works with community-organizing groups and governmental partners to help tenants keep utilities on while living in foreclosed, bank-owned properties. An ACPHD report on foreclosures led to a policy preventing utilities from shutting off tenants’ water and established a registration for vacant properties to mitigate the negative impacts of gentrification.

A final example is the Denver Housing Authority, which gathered input from residents who lived and worked in the mixed-income Mariposa neighborhood in order to better prioritize health and housing stability. In response to residents’ desires, it developed convenient and reliable transit options to get them to good-paying jobs, schools, and other health-promoting opportunities.

These examples reveal that many local institutions and communities are leveraging available tools to make things better. There is no one-size fits all solution nor is there a magic formula. But there are things communities can do now with partners to advance change. Let’s look to these models and replicate what’s working so we can make sure that everyone – no matter where they live – has the opportunity to live a healthy life.

Shauneequa Owusu is Senior Vice President of Innovation and Impact at ChangeLab Solutions.