Strategies to improve housing should be a core component of initiatives that want to make a significant, long-term impact on community health. Housing may be one of the most critical social determinants of health because it so directly affects employment, education, and social environments.
However, despite the fundamental role that housing plays in community wellbeing, little has been done to address the ongoing housing crisis, which particularly impacts low-income families and communities of color.1 As outlined in a 2018 report from the Joint Center for Housing Studies at Harvard University2 (and in a concise Huffington Post overview of that report3), there are a number of intersecting housing trends that make it increasingly difficult for communities to thrive.
Simply put, there’s not enough supply to meet demand. Although America’s economy and its population are growing, new housing construction hasn’t kept up. Two key causes are increased development costs and a shortage of skilled labor. NIMBYism has been cited as another barrier. A Freddie Mac report warns, “If supply continues to fall short of demand, home prices and rents are likely to outpace income.”4
To make matters worse, fewer and fewer existing housing options are affordable. The Harvard University 2018 housing report notes that:
When income, another important social determinant of health, is consumed by high housing costs, people have less money for health care, healthy food, active recreation, and leisure. Other causes of housing instability, like eviction and foreclosure, are also associated with adverse health outcomes1.
The affordability crisis has caused lower-wage workers to move further out from wealthier cities in search of affordable homes. This increased distance between where people live and where they work “leads to sprawl, long commutes, and workers spending more time away from their families. From cheap restaurants to affordable child care to neighborhood community centers, rising rents… [sweep] away support networks and social amenities critical to low-income residents.”3 In recent years, and for the first time ever, suburbs have become home to more low-income residents than cities.5 And as community health advocates have known for decades, where people live ultimately matters more to their health than healthcare and genetics combined.
Limited supply and rising costs have also pushed more people into neighborhoods of concentrated poverty, which impacts them whether they’re poor or not. “Residents of poor neighborhoods face higher crime rates and exhibit poorer physical and mental health outcomes. They tend to go to poor-performing neighborhood schools with higher dropout rates. Their job-seeking networks tend to be weaker and they face higher levels of financial insecurity.”6
While housing access and affordability have upstream impacts on community health, substandard housing conditions, like poor heat control and the presence of lead, mold, pest infestations, and indoor air pollutants, directly damage individuals’ health.
Across all these trends, people of color are most affected. The Harvard University 2018 housing report finds that:
And as a 2017 paper in the journal Cities and Health notes, “Communities of color also disproportionally live in neighborhoods with high concentrations of low-quality housing. This pattern is partly due to historical disinvestment from communities of color, causing economic and racial segregation and entrenched disparities.”1 In addition to disinvestment, there is often outright discrimination within the housing system. (For example, a recent report from the Los Angeles Homeless Services Authority identified institutional racism as the main driver of Black homelessness.)
Large philanthropies and corporations are stepping up to fund initiatives that address the problems of access and affordability. Two initiatives in particular, led by the Chan-Zuckerberg Initiative in the Bay Area and Microsoft in King County/Seattle, are funding projects with investment capital for new construction and conservation of existing housing. Early this year, Kaiser Permanente announced three new initiatives to improve community health by tackling housing insecurity. Beyond the West Coast, nine of the nation’s largest private foundations have partnered to form the Funders for Housing and Opportunity collaborative. Funding awarded to grantees across the country will help ensure that Americans who spend more than half of their income on rent—or have no homes at all—will be able to afford safe, stable rentals in thriving communities.
In rural areas, national nonprofits are establishing partnership models with local governments and health departments to address housing. Rural LISC’s Healthy Housing Initiative funds rural community-based organizations to ensure that all new housing is built following healthy housing principles, and that existing homes are assessed and improved. NeighborWorks America, which helps provide access to homeownership and safe, affordable rental housing, created the Safe and Sound program to complete 40 rural housing rehabilitation or replacement projects in at least four rural regions within the US. And last year, Enterprise’s Rural and Native American Initiative announced over $1.3 million in Section 4 funding to 27 organizations working in rural and Native American communities across the country to preserve properties, increase homeownership, and improve community health outcomes.
Cities are also testing new approaches to improving housing stability:
Right now, these efforts are experimental. Many still don’t solve systemic, root causes of the housing crisis. But these leaders are providing models that other communities can learn from and adapt to fit their unique contexts. What’s most important is that housing is not only recognized as a key to health, but that local leaders are better equipped to implement strategies to improve equitable housing affordability, stability, and quality in their own communities.
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