Category Archives: Housing/public housing
A Hospital Helps Revitalize the Community Outside Its Walls: Q&A with George Kleb and Christine Madigan
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of more than 40 organizations, including 36 non-profit health systems that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One Stakeholder Health member is the Bon Secours Baltimore Health System in Maryland, whose Community Works initiative helps improve the lives of the people in one of the poorest neighborhoods in the city. Bon Secours Baltimore is part of a national health system founded by the Sisters of the Order of Bon Secours.
Bon Secours engaged the community before embarking on projects and have created programs aimed at improving the community’s health through services that include the hospital, community clinics and visiting nurse programs, as well as housing, GED and financial literacy programs and revitalization programs.
The ambitious housing program will ultimately provide more than 1,000 units of affordable housing in the streets just around the hospital.
Bon Secours’ partner in its housing program is Enterprise Community Partners Inc., which builds affordable housing throughout the United States. NewPublicHealth recently visited the Bon Secours housing and services sites in Baltimore and spoke with George Kleb, executive director Bon Secours Health System, and Christine Madigan, senior vice president of development at Enterprise Homes.
NewPublicHealth: When did the housing program begin?
George Kleb: Bon Secours here in Baltimore has been developing and operating housing since 1988. We started by developing a couple of senior buildings through a U.S. Department of Housing and Urban Development (HUD) program. Both buildings had been schools that were part of the surplus capacity in Baltimore. The HUD program serves people who are elderly, disabled, or very low income. There was a clear need and so we pursued that, and that was the start of our reach into housing. Then in the ‘90s we began work on housing really in line with a neighborhood revitalization strategy attached to our presence in the neighborhood of Southwest Baltimore. There was an area of West Baltimore Street, which is the street the hospital is on, that had become largely vacant. Two-thirds of the units in the three blocks leading up to the hospital were empty and we acquired 31 of those buildings and started a project we now call Bon Secours Apartments. We renovated three-story Victorian row homes into affordable apartments, and that’s when we started working with Enterprise. That’s a relationship that goes back to the mid-1990s.
The U.S. Department of Housing and Urban Development (HUD) recently posted an interview with Teresa Bainton, director of the New York Multifamily HUB, which manages multifamily housing programs in the Northeast. Bainton’s job puts her in constant contact with families, veterans, seniors, developers, elected officials and building owners and managers. Bainton says the work, though so rewarding, is especially challenging in the Northeast, where housing prices are often higher than average costs for the rest of the United States.
>>Read the full interview.
Unemployment and poverty top the reasons why homelessness and hunger continue to grow in the U.S., according to the U.S. Conference of Mayors 31st Hunger and Homelessness Survey, released yesterday. “There’s no question that the nation’s economy is on the mend, but there’s also no question that the slow pace of recovery is making it difficult and, for many, impossible, to respond to the growing needs of the hungry and the homeless,” said Tom Cochran, executive director of the Conference of Mayors during a conference call with reporters yesterday about the report.
The new report is based on surveys of city officials in the 25 cities that make up the Conference’s task force on Hunger and Homelessness, and all but one of the participating cities said requests for help had either gone up or stayed the same as the previous year.
Additional findings of the report include:
- The number of families and individuals experiencing homelessness increased across the survey cities by an average of 4 percent.
- More than one in five people needing assistance did not receive it because of insufficient city and donated funds.
- Because of the increase in requests many emergency kitchens and food pantries in the 25 cities surveyed had to reduce the amount of food provided to individuals or families.
One positive note in this year’s report was an increase in aid provided to homeless veterans because of targeted efforts by cities, the Department of Housing and Urban Development and the Veterans Administration. Eighty percent of the survey cities were able to find stable housing for some previously homeless veterans.
Many of the 25 survey cities addressed homelessness and hunger problems by adopting innovative programs specific to their communities to address and improve the situation. The Conference of Mayors report includes many examples both to highlight innovation and to serve as models for other cities working to improve the housing and food security conditions of their citizens:
When thinking about ways to improve the public's health, housing may not leap to mind at first. Reducing obesity, increasing access to healthy food and promoting tobacco control are all more popular and more obvious public health strategies. But in the past several years, leaders in the field are realizing the vital role that housing can also play in health.
So why is housing so important for health? And how can we create "healthy housing" for the public? That was the focus of Monday's American Public Health Association (APHA) panel, "Landscape of Healthy Housing: Strategies, Policies, and Initiatives."
Panelists from the U.S. Department of Housing and Urban Development (HUD) to Maryland's Green and Healthy Homes Initiative to the U.S. Environmental Protection Agency (EPA) discussed issues ranging from lead-based paint hazards, to smoke-free housing, to infrastructure problems—and how all of these impact health.
Chris Trent, who's worked on HUD's Advancing Healthy Housing a Strategy for Action, asked: "Do we really have to be concerned about our homes? Yes, we do. There are 23 million housing units with one or more lead-based paint hazards. Six million housing units in the U.S. have moderate-to-severe physical infrastructure problems."
She also re-emphasized why housing is so important to health for everybody, even if we don't think about it: 69 percent of our time is spent in a residence, and therefore housing automatically impacts how healthy people are.
Trent also pointed out the return on investment (ROI) in creating healthy housing for people. "We know these [healthy housing strategies] are working. There is a return on your investment that is beneficial to everybody."
For example, she noted, spending $1 on preventing lead hazards lead to a $17-$221 savings in health costs.
Ruth Ann Norton, Executive Director of Green & Healthy Homes Initiative, noted the impact that unhealthy housing can have on people— especially children and their education.
"The largest reason kids don't come to school is asthma," she pointed out. "And this asthma is often coming from their home environment. We need to break the link between unhealthy housing and unhealthy children."
"All of these housing issues are health issues," Norton said.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
In the 1970s and 80s, residents of the Bronx, one of New York City’s five boroughs, were so anxious to leave the crime-ridden area that many residential and commercial buildings—once majestic and architecturally rich—were torched and empty for decades. Now fifty years later there’s a waiting list of thousands for Via Verde, a new low- and middle-income Bronx housing complex that opened last year. Many features set the complex apart from almost any other housing development in the United States, including an emphasis on greenery from almost every vantage point of the building. This helps create a calming and beautiful atmosphere for the residents, many of whom grew up in crowded housing projects where any nearby parks were usually too dangerous to enjoy.
Why is housing important for health? A lack of affordable rental housing can push more tenants into substandard or overcrowded living situations. Living in unaffordable housing also leaves fewer resources for the things that can keep a family healthy, such as healthy food or preventative health care. Low-income housing also has a reputation for being unhealthy, and for good reason—more than 6 million housing units in the U.S. have deficiencies such as lead paint hazards; allergens, dampness and mold that can trigger asthma; and unsafe structural issues that can cause falls and other injuries. Via Verde and other similar efforts seek to change all that, with housing that is not only affordable but also safe, healthy and even environmentally sound and sustainable (which in turn also saves on costs).
The design for Via Verde was the winner of a 2006 competition hosted by the New York City Department of Housing Preservation and Development; the New York Chapter of the American Institute of Architects; the New York State Energy Research and Development Authority (NYSERDA); and the Enterprise Foundation. It was New York City’s first juried design competition for affordable and sustainable housing.
Approximately 362,100 residential fires left 2,555 civilians dead and another 13,275 injured in 2010, according to the U.S. Federal Emergency Management Agency (FEMA). They also caused about $6.6 billion in property damage.
According to FEMA, automatic fire sprinklers are the “most effective fire loss prevention and reduction measure with respect to both life and property.” The numbers regarding just home fires are especially impressive: the risk of death drops 80 percent and the cost of property damage drops 71 percent, according to Preemption Watch. And when comparing simple costs to the lives saved, they’re without question cheap. Residential sprinkler systems cost only about $1.61 per square foot to install and typically help lower insurance costs.
When seen through the lens of public health, residential fire sprinklers are an inexpensive and easy tool to prevent injuries and save lives. They’re low in cost, quick to respond, small in size and require little work to install, which makes for a high return on investment.
The successful implementation of more than 300 local ordinances since the 1970’s demonstrates the power of grassroots movements in public health. And, in the reactions by many state governments, it helps illustrate the “preemptive” legislation that can hinder efforts to advance public health.
While residential use of lead-based paint has been banned in the U.S. since 1978, millions of homes still have the paint, and the health dangers it brings with it, on their walls. Lead paint has been linked to cognitive and behavior issues as well as anemia and even death, especially in young children because their brains are still developing. But according to the Centers for Disease Control and Prevention, about half a million children ages 1 through 5 have potentially dangerous blood lead levels.
In Philadelphia, according to the 2009 American Housing Survey data, 91.6 percent of the housing units were built before 1978. Exacerbating the issue, close to 30 percent of families live in poverty, which can delay household maintenance and lead to peeling paint—a major lead risk to children in older homes. Studies also show that the number of children in Philadelphia with elevated blood levels is higher than the national average.
“This problem requires a public health solution since [preventing childhood] lead exposure…involves multiple stakeholders, including the child and parents, the property owner, and the local authorities who make and enforce laws, ordinances and codes,” says Carla Campbell an associate teaching professor in the School of Public Health at Drexel University. Campbell is the author of a new study on a lead court established in Philadelphia in 2003. The lead court is designed to speed the cleanup of lead hazards in apartments and rented homes. Campbell’s research was funded by the Public Health Law Research, a project of the Robert Wood Johnson Foundation, based at the Temple University School of Law. Campbell’s study appears in a special issue of the Journal of Health Politics, Policy and Law focused on public health law research.
NewPublicHealth recently spoke with Carla Campbell about Philadelphia’s lead court and the implications of its success for other public health issues.
NewPublicHealth: What did your study find?
Several federal agencies have teamed up for a joint initiative, Advancing Healthy Housing: A Strategy for Action, to reduce home-based injury and illness. Agencies at the table include the Office of the Surgeon General, the Environmental Protection Agency, the Department of Housing and Urban Development and the Department of Energy.
People spend up to 70 percent of their time in a home, according to the group, and millions of homes each year are the source of serious health problems including asthma, lung cancer, unintentional injuries and lead poisoning. Home health hazards can include structural problems, damaged roofs, heating, plumbing and electrical deficiencies, leaks, pests, peeling walls that exposing children to lead-based paint and high levels of radon gas.
The initiative has five goals:
- Establish healthy home recommendations.
- Encourage adoption of healthy home recommendations.
- Create and support training and workforce development to address health hazards in housing.
- Educate the public about healthy homes.
- Support research that informs and advances healthy housing in a cost-effective manner.
Surgeon General Regina Benjamin spoke at a press conference to launch the new Action Plan and in 2009 released a healthy homes strategy that the new initiative builds on. This Action Plan dovetails with the National Prevention Strategy, launched two years ago to improve the health of all Americans. Dr. Benjamin told NewPublicHealth, “Health is in everything we do. We need to make it a part of our lives. Our home should be a place you feel safe.”
Substandard housing has been linked to a variety of health problems including higher blood lead levels in children and an increased asthma risk. Now a new study by researchers at the Johns Hopkins Center for Injury Research and Policy finds kids living in poor housing may also be at an increased risk for fire and scald burns. The research was published in the journal Pediatrics.
The researchers surveyed the homes of 246 low-income families in Baltimore with at least one young child, and found homes with more housing quality code violations were less likely to have a working smoke alarm and safe hot water temperatures. "The effect of substandard housing on children’s risk of diseases such as asthma is well-known, however little was known about how it affects injury risk,” says Andrea Gielen, ScD, ScM, the study’s lead author and director of the Johns Hopkins Center for Injury Research and Policy. “The results of this study clearly demonstrate that substandard housing is also related to home injury risks, Gielen adds. "Even more disturbing is the finding that virtually all of the children in our urban sample were living in substandard housing."
Injury is the leading cause of death for young people in the U.S., and is responsible for more than180, 000 deaths annually, according to data from the Centers for Disease Control and Prevention. Deaths from fires and burns are the third leading cause of fatal home injury. Smoke alarms and lower water temperatures reduce the risk of burns, says Gielen, but living in substandard housing appears to be a barrier to having these protective measures in place.
- Read a NewPublicHealth post on how low income families can get free smoke alarms
- Read a NewPublicHealth National Prevention Strategy series interview with Estelle Richman, Senior Advisor to the Secretary of the Department of Housing and Urban Development on the intersection of housing and health.
- Read a NewPublicHealth interview with Andrea Gielen on injury prevention.
How does housing impact health?
A new commentary in the journal Health Affairs tracks the history of health and housing in the United States and says that while a connection between housing conditions and public health has been known since the 1800s, federal housing policy only began during the Great Depression. The Department of Housing and Urban Development (HUD) has increased awareness of that connection since the agency was founded in the 1960s.
HUD’s housing initiatives have included:
- Prohibitions on lead and gasoline in HUD housing
- Programs to allow HUD tenants to move to more affluent neighborhoods
- Integration of health-oriented policies with other departments including the Department of Health and Human Services
Authors of the commentary worry that current congressional funding policies lead to “predetermined silos,” which could impede the needed integration of projects among federal agencies. HUD’s adoption of a health in all policies approach, according to the authors, “signals an active recognition that the investments have implications for social determinants of health and ultimately for the health of the populations HUD serves.”
>>Read the full article.
>>Bonus Links: Read a NewPublichealth interview with one of the commentary authors, Raphael Bostic, called “Housing Policy is Health Policy” and an interview from our National Prevention Strategy Series with Estelle Richman, senior advisor to the Secretary of Housing and Urban Development.