Healthy Housing and Connected Communities: NewPublicHealth Q&A with Erika Poethig
In the last few years the Department of Housing and Urban Development (HUD) has launched a number of initiatives focused on making homes and communities healthier while also helping to reduce health disparities and promote health equity—a focus of several presentations at the recent annual meeting of the American Public Health Association. NewPublicHealth spoke with Erika Poethig, Deputy Assistant Secretary for Policy Development, about the role of HUD in helping improve the health of Americans.
NewPublicHealth: What’s the relationship between the Department of Housing and Urban Development and the nation’s health?
Erika Poethig: For probably a hundred years we’ve understood that housing quality has a relationship to health outcomes. That’s why zoning laws were changed to reduce crowding and major housing reforms were advanced to improve the quality of housing mid-century. More recently, in the last 10 years, a group of scientists including physicians have really focused on the connection between socioeconomic status and health.
Health outcomes can be really affected by people’s environments, and that includes the housing unit but it also includes the neighborhoods in which people live. Most recently we have had a major 15-year social experiment called Moving to Opportunity. The project tested the impact of giving people who live in public housing the opportunity to move to lower-poverty communities.
At the time the hoped-for result was around labor attachment and labor force outcomes and better education. These were the theories that people had about why it was important for people to move to low poverty communities. But with the partnership of other federal agencies and the MacArthur Foundation, for the first time we included biomarker data collection to really get rigorous measurement of the markers for diabetes. The main finding is that for low-income women, moving from high-poverty neighborhoods to lower-poverty neighborhoods is associated with reductions in both extreme obesity and diabetes of about 20 percent.
NPH: What’s the chief significance of the study’s findings?
Erika Poethig: In conversations with people in the medical field on the issues of socioeconomic status and health they said we feel like we’ve met the limits of what we can do on the behavior side and possibly through medication. So, this opens up a whole new way for us to think about how we really affect these health conditions, which disproportionately affect minority populations and costs our healthcare system about $5,000 per person per year.
NPH: How does that play out in the real world?
Erika Poethig: We’ve sort of embedded the rental idea of providing greater choice in our public housing policies through our proposed Rental Demonstration Program, but also in our Choice Neighborhoods Program, we’ve adopted also the point of view that yes, you need to enable people to move, and we do. Choice Neighborhoods is about a revitalization of concentrated poverty and giving people an opportunity to move, but also saying we have to make the places that people live in better connected. They should be better connected to transportation, better connected to opportunities, fresh food access, and educational opportunities. It’s not just enough to enable people to move, it’s very important that we revitalize the existing communities.
NPH: What’s next, now that the study has been published?
Erika Poethig: I think we really want to use this to open up a conversation with [public health and health care]. We want to communicate this more broadly so we can look for opportunities to align our policies better. We have an excellent partnership with the Department of Health & Human Services (HHS). Our two secretaries at the most senior level have collaborated closely on ways that HUD and HHS can align our policies and approaches and at the staff level, we have had a partnership for the last two and a half years to look for various ways to promote the connection between housing and health.
We’ve had other research that has demonstrated that health is actually an important factor in the pathway to employment. So we want to focus on how to support the people we serve in their access to employment.
NPH: What are some of the newer initiatives?
Erika Poethig: Newer initiatives build on the evidence base that shows, okay, we’ve made a lot of headway on removing lead from homes, but what we also know that housing is the leading cause of death for young children due to accidents in the home, and there are asthma triggers in the home that we also need to attend to. So the Healthy Homes Initiative is trying to align a variety of different kinds of investments and look at when we are working in a house, making sure that we’re rehabbing it to the healthiest kinds of standards possible to reduce any of the risks to the people living in the house.
[Across the board], we’re trying to align specific programs in each of those agencies so that we can have a more connected and effective strategy. What does that mean for people in those communities? It means that they’re living in neighborhoods where they feel safer, that they have access to fresh food, that they can walk less than a half a mile to the nearest bus or train, and that they have great schools in their community as well. And the mechanisms for doing that also involve federal funding and we’re trying to do a better job of targeting our federal funding to those communities that have unfortunately been isolated for many, many years. We are working hard to really create the connections that will enable people to live healthier lives.