Health Impact Assessments: Low-Income Rental Housing Inspections
Last week’s inaugural National Health Impact Assessment (HIA) Meeting held in Washington, discussed the impact of decisions in a broad range of sectors on the health of individuals and communities, and housing sector decisions featured prominently. In a recent interview with NewPublicHealth, Aaron Wernham, MD, MPH, director of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, said he was excited to see the growing number of housing HIAs, which he called “very important to health.” Among the housing HIAs presented at the conference were two on low-income rental housing inspections—one on a rental housing inspection program in Portland, Ore. and the other on interagency housing inspection coordination based out of Ohio. NewPublicHealth spoke with lead authors of both HIAs.
>>Follow our coverage from the National HIA Meeting.
Ohio Housing Inspections
Ohio currently has a proposal on the books to streamline the rental housing inspection program on affordable housing units, including improved interagency coordination. An HIA is underway to help inform decisions on the proposal. Right now, separate individual inspections are conducted or required by local housing authorities, the U.S. Department of Housing and Urban Development (HUD), the Internal Revenue Service, and the U.S. Department of Agriculture (USDA) to help identify and repair substandard physical conditions such as water leaks and mold, pests, peeling paint and structural hazards, which can contribute to a wide range of health problems including asthma, injury and burns, and mental illness.
NewPublicHealth spoke with Holly Holtzen, PHD, Strategic Research Coordinator at the Ohio Housing Finance Agency, about the HIA.
NewPublicHealth: What is the goal of the HIA?
Holly Holtzen: The HIA looks at the impact of a proposed federal policy trying to align multi-agency physical inspections of low-income rental housing units, which will most likely reduce the frequency of inspections.
The potential positive impacts of the alignment are that inspections are disruptive for managers and tenants and the three agencies can often require three different inspections. That means a tenant has to be prepared to have strangers come into their house perhaps multiple times, which can be stressful, takes time and may require time off work. For extremely vulnerable populations, it can have the impact of disrupting routines and having a stranger in their home. The goal of the HIA is to inform the federal policy decision-making process to help inform them of impacts as they consider the agency inspection alignment on the health of the tenant. The tenant is not a consideration right now.
NPH: And are there even wider ramifications of the HIA?
Holly Holtzen: Yes. Ohio is a participant in the rental policy working group, a federal group that includes several states involved in informing federal policy decisions. A pilot project going on right now is aligning these inspections. What we learn will be brought to the federal policy group.
NPH: How do you ensure a balanced, systematic process rooted in data while also maintaining relationships with various stakeholders, including advocacy groups?”
Holly Holtzen: Stakeholders are involved at every step of our HIA, from the very beginning of the screening process looking at the policy decision to see if it is something an HIA could inform, through to the entire rest of the project including developing recommendations and an evaluation of how we conducted the HIA.
HIA of Portland City Council’s Rental Housing Inspections Program
Oregon Public Health Institute (OPHI) and its partners recently received funding to conduct a health impact assessment (HIA) of the City of Portland’s rental housing inspections program. The purpose of the HIA is to assess the relative health impacts of two different rental housing inspections models that Portland currently uses. The standard inspections model that the city has used for many years is a complaint-driven process in which complaints by renters lead to inspections of their units. In 2009, the City also began to pilot an “enhanced” inspections model where complaints also trigger inspections of additional rental units for a particular property owner. The HIA will use existing data collected by the Portland Bureau of Development Services and the Multnomah County Health Department, and also conduct interviews and surveys with renters and landlords. The steering committee will report its findings this spring, along with recommendations based on the potential for expansion or contraction of the enhanced model to impact the health of Portlanders.
NewPublicHealth spoke with Steve White, project coordinator at OPHI and a lead author of the HIA.
NPH: What might the current HIA help inform?
Steve White: We’re doing an assessment of the enhanced inspection pilot project to demonstrate the value of maintaining the enhanced project, expanding it to other parts of the city or eliminating it, all of which are options the city council will be looking at.
NPH: Why is this so important?
Steve White: This is important for both health and healthy equity. The standard program is a complaint-driven process. That poses a lot of barriers for vulnerable populations such as language barriers and fear of retaliation, including raised rents or eviction. There is also lack of knowledge about the complaint program among some tenants so they don’t even know of it as an option. With enhanced inspections, some inspections will occur without the need for a complaint. We’d see more inspections based on one complaint.
NPH: How do you ensure a balanced, systematic process rooted in data while also maintaining relationships with various stakeholders, including advocacy groups?
Steve White: There’s always a bit of tension in HIA work, and in some cases people fear an advocacy organization will use an HIA to advocate rather than provide balanced information.
What we really try to do is involve a number of different organizations so that the process we develop for an assessment is transparent, and also make sure that we emphasize the objective nature of the process so that people can understand how we frame the issue, do the assessment and produce our findings and recommendations.
We want to make sure we’re seen as creating an objective and neutral process so that people won’t feel we’re impacted by a particular agenda. This HIA has representation from landlords and tenants as well as the Multnomah County Health Department, which is recognized by those groups as being fairly objective. We want to be seen as addressing everyone’s concerns and interests.