How Can Partnering with the Housing Sector Improve Health?

Jun 8, 2016, 11:00 AM, Posted by Pamela Russo, Rebecca Morley

Collaboration between public health and housing sectors can vastly improve the quality of life within communities across the nation.  

The house that Robert and Celeste Bridgeford bought in Curry County, Oregon over a decade ago wasn’t just old. It was dangerous. Water damage and thin walls wracked by decades of severe storms unleashed wide swaths of mold. The damaged floors put the whole family at risk of falling, especially Robert, disabled years ago by a work injury. “We had always planned to replace the house, but... then...life happened,” says Celeste.

The Bridgeford family—like a third of Curry County’s residents—lives in a prefab house that is manufactured in a factory and then transported to the site. About 40 percent of the prefab housing in Curry County is substandard. With little industry in the area, many families struggled to find work and couldn’t afford to fix or replace their homes.

This all started changing in 2013 when community groups, non-profits and public agencies joined to propose a pilot project for the state of Oregon. This project would, for the first time, provide low cost loans or other funds to help prefab home-owners repair or replace their homes.

At the same time, the Oregon Health Authority conducted a Health Impact Assessment (HIA) to evaluate the potential health impacts of the plan. HIAs have been conducted on the health effects of a vast range of projects, from proposed casinos to prohibiting the sale of high calorie snacks and sugary beverages on school grounds.

Curry County exemplifies the connections between housing and health equity, as explored in two policy briefs for both housing and health officials by the Health Impact Project. The Project is a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts which promotes the use of HIAs.

The Curry County HIA confirmed what the partners had suspected—that a proposal had potential to improve indoor air quality, reduce injuries from home hazards and create the opportunity for some residents to stay in their homes longer as they aged.

The HIA recommendations included:

  • Design new prefab homes to address the needs of aging residents, including bathroom grab bars and wider doorways to accommodate wheelchairs. 
  • Boost the local economy by hiring local residents to repair and replace homes.
  • Educate residents about the health risks in their homes and about potential grants and loans to fund repairs or new homes to reduce and remove those health risks.

As a result of the HIA, the Oregon governor’s office called a meeting for community advocacy groups, prefab home manufacturers and lenders to discuss how to design and finance new or repaired homes. One result—manufacturers were asked to design prefab homes that could withstand the region’s severe weather. In November 2013, NeighborWorks Umpqua was awarded a $450,000 grant to start the pilot program. So far, 100 families have applied for loans or grants. Repairs to 23 homes will be completed by the end of this May, and five families, including the Bridgefords, are now living in brand new prefab homes; homes for two more families will arrive shortly. The program could potentially serve as many as 3,000 Curry County residents.

Educating Stakeholders and Informing Decisions

A key goal of the HIA policy briefs is to help health and housing leaders understand that integrating public health considerations into housing decisions can improve the health of residents, the quality of the environment and ensure strong financial stewardship of public funds.

And HIAs are not one size fits all. Some can take a year or more to complete because they can involve a series of public meetings, discussion and collection of new data. But other HIAs are more narrow and can be completed in weeks or months and take into account deadlines and limited resources.

Groups embarking on HIA’s have also used basic principles to develop tools such as checklists and guidelines. A good example comes from the Metropolitan Design Center at the University of Minnesota where researchers created a land use checklist to look at health issues that can be impacted or improved by urban planning. Such tools can be used to ensure that health benefits are optimized when stakeholders consider changes to neighborhoods ranging from zoning to new housing in cases where an HIA is not possible or appropriate.

Interactive Map Shows How HIAs Support Healthier Communities Across the Country

One important resource is the Health Impact Project’s map of where and which HIAs have been conducted. The map can be searched by category, including housing. It has created an evidence base to share with community leaders, policy makers and funders to show the impact of housing on many health factors. That is critical since funding for affordable housing has become more tenuous.

We’ve had to think about how to underscore the value of housing to local and state government officials, the business community and funders. Once you show how a house can help kids do better in school or help people live longer, the conversation captures the attention of those who might not have been interested in housing before. For example, in 2012 the Healthy Homes Program of the University of Massachusetts at Lowell helped reduce emergency room visits for more than 170 children with asthma by 81 percent within one year. Program staff members helped families reduce environmental triggers for asthma attacks such as dust mites, mold and cockroaches that trigger asthma attacks.

The staff also provided products to families to help lower the risks such as specialized vacuum cleaners, pillow covers and pest control items and also trained property managers on healthy home practices to reduce asthma attacks such as sealing up holes to avoid cockroaches.

And we’re seeing the links between housing and health being made much more these days in calls for proposals by Housing and Urban Design. Diverse stakeholders such as the Federal Reserve Bank and the MacArthur Foundation are dedicating staff and funds to the connection. And the Affordable Care Act gave the connections a boost by talking about the many things that are needed outside the medical office in order for people to be healthy.

Measuring Success

The Robert Wood Johnson Foundation and the Health Impact Project would like to see these policy briefs widely shared among those working in housing. We hope public health leaders will use them to start discussions with housing programs and suggest an HIA or bringing a health lens into what they are doing. Governors and mayors should be handing these briefs to their housing and health commissioners and asking them to consider using HIA as a tool for bringing health evidence to decisions, engaging with communities affected by their decisions and ultimately, to advance health equity. And grassroots organizations can use them to unite people who work on health and housing.

The best thing we can do is to highlight examples of housing HIAs that have resulted in positive impacts for the community. Housing HIAs can lead to improvements in housing quality, affordability and location. They also can help uncover and address factors such as segregation and poverty that influence housing and neighborhood opportunities.

Read a brief by the Robert Wood Johnson Foundation’s Commission to Build a Healthier America on the inter-related aspects of housing and health.

Pamela Russo, MD, MPH, is a senior program officer. The major area of her work is improving health at the community level, based on the understanding of health as the result of interactions between social, environmental, behavioral, health care and genetic determinants. Read her full bio.

Rebecca Morley directs the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The Health Impact Project is a national initiative designed to promote the use of health impact assessments (HIAs) as a decision-making tool for policymakers. Read her full bio.