News

Housing Quality and Health: Revealing the Connections, Addressing the Challenges (Part 5)

August 16th, 2021 by Don Bianchi & Elana Brochin

Revitalize CDC in Springfield improves housing conditions by performing assessments and interventions for adults and children with asthma to safely remain in their home. (Photo credit: Revitalize CDC)

MACDC has long supported its members in their work to improve housing quality. In recent years, MACDC worked with it's members to establish health equity work as a defining characteristic of the contemporary community development movement in Massachusetts. We are now in the beginning stages of an initiative to link these two strands of our work. We would like to engage with as many stakeholders as possible in this process, and, therefore, are publishing this series of blog posts to share out ideas and get your feedback.

Data, Dollars, and Direction

In our first blog in this series, we identified housing quality and safety challenges that plague the Massachusetts housing stock. In our second blog post we examined the ways these challenges directly impact individual and community health outcomes. The third blog in our series examined current Massachusetts programs that address property-level distress. Our fourth, and most recent blog, focused on current efforts to address two broader factors: neighborhood disinvestment and climate change. In this last blog in our series, we will:
  • Surface gaps in existing efforts and propose ways to scale up efforts to improve housing quality and safety, and therefore health outcomes, in Massachusetts.
  • Advocate for an infusion of funds from the American Rescue Plan Act for this important work.
 
Gaps and Ways to Scale Up Efforts
While there are many initiatives that support housing quality and safety challenges in Massachusetts, there is no coordinated approach, and these efforts lack the scale we need to address the problems. In order to increase the capacity of state and local governments, CDCs, housing courts, and others to successfully improve the safety and quality of older homes across the state, we need to fill existing gaps and scale up our efforts in the following areas:
 
Data:
  • Streamlined and publicly accessible data on housing quality and safety throughout the Commonwealth. For example, we need to have accurate and timely data on the number of homes in MA that still are not lead-safe.
  • Timely data on the impact of existing policy interventions to address housing quality.
  • Demographic data that indicates which populations are most impacted by poor housing quality, including people of color, immigrants, children, elderly, disabled and specific neighborhoods or communities.
  • Data that will help inform decisions by helping both policymakers and advocates to fully understand the gaps.
 
Dollars:
  • Increased public and private investment in home-specific housing rehabilitation, lead paint abatement, and addressing other housing quality concerns.
  • Increased public and private investment in energy efficiency, renewable energy and building decarbonization, which will:
  1. improve housing quality and lower costs for residents of older homes; and 
  2. contribute to urgent efforts to combat the climate crisis.
  • Increased funding for neighborhood-scale initiatives to address vacant and distressed housing.
  • Better alignment of different funding streams from the housing, energy and health sectors so property owners and public housing authorities can leverage dollars and undertake comprehensive renovations at one time. 
 
Direction:
  • Formation of a Task Force comprised of a broad array of public, private, nonprofit, and community members to set goals and monitor progress around housing safety and quality in Massachusetts.
  • Incorporation of housing quality improvements into our long-term resiliency strategy to ensure that our most vulnerable communities are protected from the impacts of climate change, extreme weather, flooding, etc., and development of mitigation plans in advance of when disasters occur.
  • Streamlined systems for integrating housing, energy, climate and health programs and dollars into a coordinated property improvement strategy.
  • Neighborhood and community-level initiatives to address property distress, abandonment, and disinvestment.
  • Engagement of the health sector, including hospitals, to:
  1. champion the effectiveness of healthy housing programs on impacting patient health outcomes; and
  2. implement and support healthy housing programs as part of their Community Health Improvement Plans and Community Benefits programs.
  • Development of policies and tools to ensure that improved housing quality does not lead to escalating rents and displacement.
 
When utilizing these strategies, we suggest using and improving upon the framework of the existing programs when possible. This includes:
  • Increasing funding for effective programs, such as the State’s Get the Lead Out (GTLO) Program.
  • Ensuring that available programs and funding are accessible to all populations. For example, we should be using and strengthening the infrastructure of community-based organizations which provide support to individuals and families facing language and other barriers.
 
These strategies, by definition, must be adopted by a wide range of players to be successful. 
MACDC will continue to leverage our role as a thought-leader in the Community Development field and our deep relationships with our members to embed housing quality and health equity work into the fabric of the CD movement. 
 
Use of American Rescue Plan Act Funding
One crucial and timely opportunity to jumpstart a large-scale effort to improve the Massachusetts housing stock is to use funding from the federal American Rescue Plan Act of 2021 (ARPA). This is a once in a generation opportunity to address longstanding housing quality and safety problems in Massachusetts. Massachusetts and local jurisdictions expect to receive $8.7 billion in funds from the Coronavirus State and Local Fiscal Recovery Funds, established by ARPA. The Governor has proposed spending $1 billion on housing (evenly split between home ownership and rental housing), which MACDC supports. The Legislature needs to build upon the Governor’s baseline proposal by devoting additional funding to improve the quality and safety of Massachusetts’ housing stock. 
 
As we’ve established in our previous blogs, the presence of lead, poor indoor air quality, and other substandard housing conditions leads to developmental delays in children, respiratory disease, accidents and injuries, and spread of infectious disease, among other serious, preventable health consequences. Therefore, MACDC is advocating that the Commonwealth devote an additional $100 million from the ARPA funds to improving the existing Massachusetts housing stock, with $50 million devoted to making homes lead safe and $50 million for housing rehab, with a healthy homes focus. We see this commitment as a significant first step toward scaling up efforts to fill the gaps that we have identified.
 
Conclusions
We look forward to utilizing these tools and to collaborating with our partners in the public, private, and nonprofit sectors to coordinate initiatives and to improve housing quality in Massachusetts using the Data, Dollars, and Direction framework that we’ve described. Improving housing quality will ultimately provide dignity and physical security to Massachusetts residents and will lead to improved community health outcomes. Devoting $100 million dollars of funding from ARPA will jumpstart these efforts.
 
Acknowledgment
While the series of blog posts represents the opinions of and analysis by the authors, our conclusions have been informed by discussions with a working group that we convened to help guide this work. The working group included representatives from the public and nonprofit sectors, each of whom work on and think about housing quality, and health equity, from different perspectives. We owe deep gratitude to each of the members of this working group for their thoughtfulness, engagement, and commitment to this important work.
Commenting Closed

Housing Quality and Health: Revealing the Connections, Addressing the Challenges (Part 4)

August 9th, 2021 by Don Bianchi & Elana Brochin

Revitalize CDC in Springfield improves housing conditions by performing assessments and interventions for adults and children with asthma to safely remain in their home. (Photo credit: Revitalize CDC)

MACDC has long supported its members in their work to improve housing quality. In recent years, MACDC worked with it's members to establish health equity work as a defining characteristic of the contemporary community development movement in Massachusetts. We are now in the beginning stages of an initiative to link these two strands of our work. We would like to engage with as many stakeholders as possible in this process, and, therefore, are publishing this series of blog posts to share out ideas and get your feedback.

 

Current Initiatives Targeted at Neighborhood Disinvestment and Climate Change 

In our most recent blog, the third in our series, we examined current programs focused on addressing property-level distress. These programs including ones that confront lead hazards in homes, poor indoor air quality, and other unsafe housing conditions. In the current blog, we focus on current efforts to address two broader factors: neighborhood disinvestment and climate change. Attention to these “underlying conditions” is necessary for efforts to address property-level distress to succeed. 

Addressing neighborhood disinvestment:

As noted in our prior blog, many lower-income neighborhoods in Massachusetts—most notably, but not solely, in the state’s Gateway Cities and some rural communities —struggle with the challenges of weak real estate markets, with low rents and declining or stagnant home values. In these neighborhoods, too often property owners lack economic incentives to invest in these structures for long-term sustainability, making neighborhood-or community-wide interventions necessary. 

The COVID-19 pandemic has exacerbated the problems associated with neighborhood disinvestment. As author Alan Mallach from the Center for Community Progress noted in his June 2020 Report: Hope for the Best, Plan for the Worst: Addressing the Aftermath of the COVID-19 Pandemic in America’s Struggling Neighborhoods, “one thing we can expect is that the effects will be much more severe in struggling cities, lower income neighborhoods, and communities of color.” 

Fortunately, there are a number of promising programs and interventions: 

Local Code Enforcement as Neighborhood Stabilization: Municipal governments can enforce the State Building Code and Sanitary Code, to incentivize owners to maintain their properties, and sanction those who do not do so.  This can be challenging, as many lack the resources to identify problem properties and maintain current records. Fortunately, Massachusetts will receive approximately $.5.3 million in Coronavirus State and Local Fiscal Recovery Funds from the federal American Rescue Plan Act (ARPA), that will address both lost revenue and pandemic-related costs, and thereby strengthen the capacity of local governments to enforce codes.  

Receivership: Receivership is a tool by which the Court can appoint a person or organization to temporarily manage a property (occupied or vacant) to enforce the state Sanitary Code and respond to an irresponsible or absentee landlord.  For occupied buildings, Receivership can address needed repairs and prevent a building from deteriorating, to provide better living conditions for tenants. For abandoned properties, the MA Attorney General’s Neighborhood Renewal Division is a resource for municipalities in utilizing Receivership. Many CDCs have supported these efforts. For example, OneHolyoke CDC has acted as a Court-Ordered Receiver in Holyoke, and Worcester Community Housing Resources has operated a Receivership loan fund in addition to serving as Receiver itself in some cases.   

Liabilities to Assets (LTA) Program to Address Abandoned Homes: The MA Department of Housing and Community Development (DHCD) is administering a $7.5 million, five-year pilot program to work with a CDC, NewVue Communities, to acquire and rehabilitate more than 40 abandoned homes in North Central Massachusetts, and then sell the homes to low-and moderate-income homebuyers. An energy efficiency consultant recommends steps that can be taken during the rehab to make the homes more efficient and the Massachusetts Clean Energy Center will help to defray the cost of some of the upgrades. Despite numerous challenges (often due to the deteriorated condition of many vacant properties), LTA provides a promising model for a broader statewide initiative. 

The Commonwealth’s Neighborhood Stabilization Initiative is modeled on LTA. MACDC, working with MassINC, MassHousing, and other public and nonprofit partners, has launched an initiative intended to put vacant housing back on the market, restore poor quality housing to good condition, and improve the quality of life in struggling neighborhoods and communities across the Commonwealth.  While there are several components to this initiative, implementation of The Neighborhood Hub, supported by more than $2 million in state funds, and staffed by MassHousing, is well underway. The technical and financial assistance to improve capacity on the local level will soon be accompanied by state capital dollars to support property rehabilitation. 

Other Initiatives to Address Neighborhood Disinvestment: 

  • CDCs in Gateway Cities, and in small towns, have long taken an active role in neighborhood stabilization initiatives.  Their housing development efforts and housing rehab programs are often part of a neighborhood-wide strategy.  
  • While limited, affordable homeownership development efforts in these weaker market areas have several goals: providing low-and moderate-income first-time homebuyers with affordable homeownership, providing these homebuyers with the opportunities to build wealth, and stabilizing disinvested neighborhoods. As an example, the State’s Commonwealth Builder Program, administered by MassHousing, provides funding for both new construction and adaptive reuse to turn vacant factories or schools in Gateway Cities into affordable home ownership opportunities. 
  • The MA Public Health Association is partnering with Neighbor to Neighbor on an initiative to improve housing and transportation in Springfield and Worcester. They are currently convening residents to get their input, and then will decide on advocacy strategies.  

Addressing climate change: 

Climate change impacts many aspects of our lives. Efforts to combat climate change, and its impact, are underway in Massachusetts, including passage of legislation to dramatically reduce climate emissions. Nonetheless, the harmful impacts of a warming climate are already being felt, in homes and neighborhoods across the Commonwealth.  

The broad scale of the climate crisis, and its already devastating impacts on residents and communities, require urgent, comprehensive, and aggressive strategies.  Currently, there are several such initiatives: 

Energy efficiency and renewable energy: 

Energy efficiency programs mitigate the impacts of climate change, including extreme temperatures.  These programs additionally lower utility costs to enhance affordability and can directly address health hazards, such as windows containing lead-based paint and poor ventilation. 

Massachusetts is in the process of developing its 3-year Energy Efficiency Plan, for calendar years 2022 through 2024, funded by utility ratepayers and guided by a public process overseen by the MA Department of Public Utilities (DPU). Under the current 3-year Plan, the Mass Save Program offers income eligible households in 1-4 family homes no- and low-cost energy efficiency upgrades. Furthermore, through the LEAN Multifamily Program, owners of multifamily projects where at least 50% of the households have incomes at or below 60% of area median income can access no-cost energy upgrades.  

CDCs have used available resources to provide energy efficiency retrofits: 

  • In Calendar Year 2020, CDCs reported energy retrofits on 1,135 units in their rental portfolios. The combined dollar amount of these energy retrofits was $5.3 Million. 
  • In the communities they serve, in CY 2020, CDCs provided funding for energy efficiency improvements for more than 1,500 homes, for a combined amount of $3.9 Million. 

Other initiatives address the need for energy efficiency and renewable energy: 

  • The MA Clean Energy Center, a state economic development agency, provides information, referrals, and resources for everything from weatherization to renewable energy technologies. 
  • Resonant Energy, LISC Boston and MACDC have launched the Solar Technical Assistance Retrofit (STAR) program, designed to remove barriers and dramatically increase the adoption for solar PV across the Commonwealth. 
  • LISC Boston, MACDC, and New Ecology have formed the Clean Energy Cohort, a peer learning group for affordable housing professionals to network, learn, and share information.  

Decarbonization: 

LISC Boston, MACDC, and New Ecology are using our established partnership as a springboard to launch the Decarbonization of Affordable Subsidized Housing (DASH) project. In FY2022, DASH will focus on two main areas: (1) education and technical assistance for CDCs and others in the affordable housing field on the need to decarbonize the affordable housing sector via deep energy retrofits and electrification of new and existing buildings, and (2) policy advocacy to remove barriers, provide incentives, and drive resources to the affordable housing sector so owners can meaningfully accelerate decarbonization. 

The goal of DASH is to get affordable housing a proverbial seat (and meal) at the electrification and building decarbonization table. Toward that end, we intend to surface – and start generating potential solutions for – the financial, technical, and knowledge barriers that are getting in the way of affordable housing fully participating in an all-electric, carbon free future. 

Policy advocacy: 

The Housing and Environmental Revenue Opportunities (HERO) coalition is a diverse coalition of environmental and housing advocacy organizations that are pushing for major new state investments to address the affordable housing and climate crises. HERO urges the Massachusetts State Legislature to enact legislation that would double the current Deeds Excise Tax, upon the sale of real property in Massachusetts, to generate approximately $300 million in new revenue each year, to be split evenly between Affordable Housing and Climate. 

This new revenue would create or preserve additional housing for 18,000 working-class homeowners and renters over 10 years; finance hundreds of millions of dollars in competitive, flexible grants to localities for climate resilience and mitigation; and assist between 3,500 and 6,500 additional extremely low-income families per year with housing vouchers or project-based rental assistance. 

Through a combination of property-level interventions, along with a commitment to and expansion of these programs aimed at addressing climate change and neighborhood disinvestment, we can move the needle on housing quality and associated health outcomes in Massachusetts. In our fifth, and final, blog post, we will suggest ways we can scale up and better align current efforts addressing both underlying conditions as well as property-level distress. Our goal is to identify how a more coordinated, data-driven and better resourced approach can tie together disparate threads to create healthier homes, resulting in healthier communities and healthier residents of those communities. 

 

Commenting Closed

Housing Quality and Health: Revealing the Connections, Addressing the Challenges (Part 3)

July 26th, 2021 by Don Bianchi & Elana Brochin

Revitalize CDC in Springfield improves housing conditions by performing assessments and interventions for adults and children with asthma to safely remain in their home. (Photo credit: Revitalize CDC)

 

MACDC has long supported its members in their work to improve housing quality. In recent years, MACDC worked with it's members to establish health equity work as a defining characteristic of the contemporary community development movement in Massachusetts. We are now in the beginning stages of an initiative to link these two strands of our work. We would like to engage with as many stakeholders as possible in this process, and, therefore, are publishing this series of blog posts to share out ideas and get your feedback.

Part 3: Current Programs Addressing Property-Level Distress

In our prior blog, we provided a snapshot of current housing quality and safety problems that negatively impact resident and community health.  For each of these problems, we identified the unsafe housing conditions, the resulting health and safety problems, and the impact on at-risk populations.  

 We now turn to an examination of current interventions to address these housing quality problems. Because of the broad dimensions of current efforts, we will cover these efforts in two blogs, the third and fourth in our series: 

  • This blog, our third, will examine current programs focused on addressing property-level distress, including programs to confront lead hazards in homes, poor indoor air quality, and other unsafe housing conditions. 
  • Our following blog will focus on efforts to address broader factors, without which, initiatives to address property-level distress are destined to be inadequate: neighborhood disinvestment, and climate change. 

 

The fifth and final blog post in our series will identify gaps and advocate for increased investment in and alignment of housing quality and health programming and funding. The American Rescue Plan Act (ARPA) – which will bring more than $8 billion dollars into the Commonwealth of Massachusetts – is a once in a generation opportunity to invest in creating affordable housing, and also to invest in improvements to the quality and safety of Massachusetts existing housing stock, which is among the oldest in the nation. Through investing $100 million in healthy housing and de-leading programs, we can improve the housing stock and improve the health and well-being of residents across the Commonwealth. 

  

Programs to address lead hazards: 

The Massachusetts Lead Law requires the removal or covering of lead paint hazards in homes built before 1978 where any children under 6 live. A landlord can be held legally responsible if a child living in a unit they own becomes poisoned from lead.  It is illegal under MA law to evict, or refuse to rent to, a family with a young child; this is enforced by the Massachusetts Commission Against Discrimination (MCAD). Yet, 50 years after passage of the Lead Law, we have not come close to addressing the hazards, and landlords routinely discriminate against families with children- underscoring the need for new legislation. 

 

There are public programs, including the State’s Get the Lead Out Program (GTLO) administered by MassHousing, and the federal Department of Housing and Urban Development’s (HUD) Lead-Based Paint and Lead Hazard Reduction Demonstration Grant Programs that aim to accelerate lead removal from residences.  Local agencies, both public and nonprofit, administer these programs. For example, Worcester’s lead abatement program assists property owners with costs associated with lead abatement and conducts studies to protect children and families from health hazards in their homes. 

The Boston Public Health Commission (BPHC) offers training to build capacity to address lead hazards and ensure safe lead abatement.  It provides training for renovation, repair, and painting contractors on how to work safely in housing with lead-based paint and comply with EPA's Renovation, Repair, and Painting (RRP) Rule, and HUD's Lead Safe Housing Rule. It also provides Moderate Risk De-leading training to certify contractors, agents and property owners that want to remove lead in Massachusetts on their own.  

 

Programs to address poor indoor air quality: 

The Environmental Epidemiology Program (EEP) within the State’s Bureau of Environmental Health (BEH) provides information about asthma and the environment and helps to educate the public about the variety of environmental exposures that can trigger asthma attacks. BEH conducts annual asthma surveillance of children ages 5-14 by gender, grade, school, and community in Massachusetts. 

 

Regulations and incentives to make multi-unit buildings smoke-free can reduce exposure to secondhand smoke which causes asthma, poor blood circulation, heart disease, and lung cancer. For example, as of 2018, all Public Housing Authorities funded by the US Department of Housing and Urban Development are required to implement a smoke-free housing policy. The Massachusetts Smoke-free Housing Project provides support to tenants, landlords, and condominium owners and associations to understand the benefits and challenges of making homes smoke-free.1  

 

On the local level, public agencies, nonprofits, and healthcare institutions have joined forces to address indoor air quality. The Boston Public Health Commission runs a variety of programs focused on various aspects of home health and indoor air qualityThrough the Boston Asthma Home Visit Collaborative, Community Health Workers conduct home visits to assess the environment for asthma triggers, share information on resources to reduce or eliminate them, and work with the family to create an Asthma Action Plan.  BPHC also offers a training program to help landlords make their properties smoke-free. 

The Springfield Healthy Homes Program is partnership among Revitalize CDC, Baystate Medical Center, Health New England, and the Public Health Institute of Western Massachusetts. The program connects Springfield residents to services that address a variety housing quality and safety concerns that impact health, including asbestos, asthma triggers, carbon monoxide, and pests, among othersHospitals throughout Massachusetts participate in programs that aim to decrease home asthma triggers. For example, Boston Children’s Hospital’s Community Asthma Initiative conducts home visits to identify asthma triggers and provides tools for asthma mitigation, including vacuums, bedding encasement, and integrated pest management services. 

 

Programs to address other unsafe conditions in homes (and keep safe homes in that condition): 

Responsible Property Management: In multifamily properties, sound property management practices are essential to providing a safe living environment. One resource for property managers, the New England Affordable Housing Management Association (NEAHMA) provides training to encourage best practices. Through quality property management, proactive maintenance, and timely upgrading and replacement of building systems, properties in good condition can be maintained as such.  

 

Code Enforcement: Code regulations and enforcement of existing housing quality requirements are a tool for ensuring adequate housing quality and safety. Through the Massachusetts State Sanitary Code, and other laws and regulations, all homes, including those in the private market, are subject to certain minimum standards of health and safety. Tenants in Massachusetts have legal protections from landlords who are not responsive to tenant complaints, including the ability to withhold a portion of the rent or move out, even if there is a lease or rental agreement in place. These rights are described in the MA Attorney General’s Guide to Landlord and Tenant Rights 

 

Housing Rehabilitation Programs: Several CDCs and many municipalities administer Housing Rehabilitation Programs using public funds such as federal CDBG funding to address code violations and improve living conditions. Hilltown CDC administers its Housing Rehabilitation Program for several towns in its rural region, making funds available to property owners as zero interest deferred-payment loans, with repayment due upon sale or refinancing of the property, and forgiven over time Revitalize CDC in Springfield administers a home improvement program for veteransand others, with a focus on making their homes safe, healthy, accessible, and energy-efficient. 

 

MassHousing administers a Home Improvement Loan Program, with loans of up to $50,000 to address home repair needs.  MassHousing also assists first-time homebuyers to address home repair needs when their home is purchased through its Loan Program for purchase and rehabilitation. 

 

The Home Modification Loan Program is a state-funded program that provides loans to homeowners and small landlords to fund changes to keep people with disabilities and elderly individuals in their homes, through improvements such as installing grab bars which can allow elderly residents to safely live in their homes. 

 

The programs and interventions discussed in this article have addressed health and safety problems in thousands of homes, and dramatically improved the lives of countless families.  In our next blog, we’ll describe existing programs that address two broader problems that must be addressed if we are to sustain property-level improvements: neighborhood disinvestment and climate change. We will then detail the ways in which, through greater program alignment and a significant investment of ARPA dollars, we can improve housing quality and safety for current Massachusetts residents and generations to come. 

 

Commenting Closed

Housing Quality and Health: Revealing the Connections, Addressing the Challenges (Part 2)

July 7th, 2021 by Don Bianchi & Elana Brochin

Revitalize CDC in Springfield improves housing conditions by performing assessments and interventions for adults and children with asthma to safely remain in their home. (Photo credit: Revitalize CDC)

​​

MACDC has long supported its members in their work to improve housing quality. In recent years, MACDC worked with it's members to establish health equity work as a defining characteristic of the contemporary community development movement in Massachusetts. We are now in the beginning stages of an initiative to link these two strands of our work. We would like to engage with as many stakeholders as possible in this process, and, therefore, are publishing this series of blog posts to share out ideas and get your feedback.

 

Defining the Problem

In our first blog post, we discussed how housing quality can impact health on a broad scale and how Massachusetts’ housing stock is particularly susceptible to these challenges because of its age. In the following blog post, we detail how specific housing quality and safety problems can result in negative health outcomes for individuals and communities. We also discuss how and why many of these challenges disproportionately impact vulnerable populations such as children, elderly, low-income families and people of color.

Lead
Unsafe Housing Conditions:
Over 70% of homes in Massachusetts were constructed before lead paint was banned in 1978. All homes built before 1978 are likely to contain some lead-based paint which can be inhaled or ingested1 unless steps have already been taken to make them lead-safe or remove that lead paint.

The Resulting Health and Safety Problems:
Any amount of lead in the body can hurt the brain, kidneys, and nervous system, slow down growth and development, make it hard to learn, damage hearing and speech, and cause behavior problems. These problems are particularly harmful to children who absorb lead more easily than adults and who are still growing and developing. Between 2013 and 2017, 16,961 children in Massachusetts were estimated to have blood levels above 5 micrograms per deciliter – the level at which the Center for Disease Control and Prevention says the source of lead exposure should be investigated.2

Impact on Populations at Risk:
Lead exposure is unevenly distributed across the Commonwealth with communities that face inequities in accessing quality housing being particularly susceptible.3 According to the Massachusetts Department of Public Health, Black children are nearly 2.5 times more likely to have lead poisoning than white children. Additionally, children living in low-income communities are over 3 times more likely to have elevated lead levels than children living in high income communities.4 This disproportionate impact translates to over half of children with confirmed elevated blood levels being concentrated in just 19 cities and towns in Massachusetts.5

Poor Indoor Air Quality
Unsafe Housing Conditions:
Poor indoor air quality is caused by mold, dust, second-hand smoke, poor ventilation, and leaky pipes and faucets. Outdoor air pollution, from cars, smoke, and industrial sources, can also impact indoor air quality, as can weather patterns like humidity, precipitation, and wind patterns.

The Resulting Health and Safety Problems:
Poor air quality can cause respiratory and allergy symptoms including coughing, sneezing, and difficulty breathing. Exposure to air pollution can also cause asthma or make asthma symptoms worse.  Asthma is particularly pervasive in Massachusetts: about one in eleven people currently has asthma,  including 10.2% of adults and 12.9% of children. Asthma that is not well-controlled interferes with daily lives. For example, almost half of children with current asthma missed at least one day of school or day care as a result of their asthma symptoms.7

Impact on Populations at Risk:
Like many other health outcomes associated with housing quality, asthma is unevenly distributed across the Commonwealth. In Massachusetts 13.8% of Black, Non-Hispanic adults in Massachusetts suffer from asthma as compared with 10.4% of white adults.8 This trend is mirrored in children where, according to a 2017 report9, Emergency Department visits were 2.5 and 3.5 times higher for Hispanic and Black non-Hispanic children as compared with white children in 2012. This same report showed that 17.1% of children living in a household with income of less than $25,000 suffered from asthma as compared with 8.1% of children living in households with an income of $75,000 or greater.

Properties in Unsafe Condition
Unsafe Housing Conditions:
In rental housing in MA, the landlord is responsible for compliance with the Massachusetts State Sanitary Code. The Code requires, among other things, that the rental unit have adequate sewage disposal, heating, and hot water. The home must also be free of hazards, ranging from pest infestation to asbestos and, for households with a child under 6 years old, lead paint. While a tenant has rights in the event a landlord is not in compliance with the Sanitary Code, enforcing these rights can be time-consuming and challenging, while in the interim the unsafe conditions persist. Owner-occupants may lack the resources to address unsafe conditions in their homes. 

The Resulting Health and Safety Problems:
Renters and homeowners who live in homes that are substandard or not suitable for them can suffer health consequences, including accidents and falls and the spread of infectious disease. The risks associated with overcrowded living conditions became potentially deadly during the COVID-19 pandemic. Fires, whether stemming from unsafe (and often hidden) electrical problems or other causes, can have deadly consequences. 

Impact on Populations at Risk:
The same populations that are particularly impacted by unsafe housing face the double whammy of having fewer housing choices when they determine that their current homes are unsuitable.  Many elders and persons with disabilities encounter a dearth of homes with the accessible or adaptable features they require. For low-income and low-wealth households, the high cost of renting or buying limits their options. For all of these households, and households encountering discrimination, finding other safe, suitable and affordable housing may not be an option at all. Further, in the event that a family is able to relocate to safer housing, the unsafe conditions that they left persist for the next family. 

Despite state and federal laws that prohibit discrimination in the sale and rental of housing, discrimination persists in MA. A study released in 2020 by the Housing Discrimination Testing Program (HDTP) at Suffolk University Law School, showed that housing providers showed Black testers about half the number of apartments they showed to white testers.  The same study demonstrated that, about 40 percent of the time, the housing providers stopped communicating after testers revealed they intended to use vouchers. HDTP researchers also found that families with young children faced rampant housing discrimination.

Two Factors That Exacerbate the Impact of Substandard Housing on Resident and Community Health
Two broader problems deepen substandard housing’s impact on health, and make addressing this impact more complex and challenging:

  • Neighborhood-and community-level property distress requires policy interventions that go beyond individual property strategies; and
  • The already pernicious impacts of climate change render addressing housing quality, without addressing climate resilience, inadequate in order to protect resident and community health.

Neighborhood Disinvestment:
Lead paint, poor indoor air quality, and unsafe housing conditions each affect community and individual health in distinct ways. As noted previously, they each disproportionately impact particular populations. Geography also plays an important role. 

Many lower-income neighborhoods in Massachusetts—most notably, but not solely, in the state’s Gateway Cities and some rural communities —struggle with the challenges of weak real estate markets, where low rents and declining values, caused in significant part by decades of discriminatory housing policies, make it difficult to maintain an aging housing stock. According to a 2018 study by the Brookings Institution, “Homes of similar quality in neighborhoods with similar amenities are worth 23 percent less in majority Black neighborhoods, compared to those with very few or no Black residents.”  As a result, all of the housing quality and safety problems described above can exist, and persist, on a neighborhood or community-wide scale.

In these neighborhoods, as the cost of maintenance rises, home values can steadily decline to the point where it can stop making economic sense to invest in these structures for the long term. Where this happens, one sees absentee owners buying cheap and collecting as much rent as they can before rot wins out and the building is no longer habitable. Often the result is a dilapidated problem property sitting idle, sapping value from surrounding homes and devaluing the equity that nearby homeowners were counting on to provide financial security and a nest egg for retirement.10 These community-wide impacts call for community-level (or even regional) responses.

Climate Change:
Climate change impacts many aspects of our lives. Efforts to combat climate change, and its impact, are underway in Massachusetts, including passage of legislation to dramatically reduce climate emissions.  Nonetheless, the harmful impacts of a warming climate are already being felt, in homes and neighborhoods across the Commonwealth.

The Massachusetts Executive Office of Health and Human Services (EOHHS), in its Massachusetts Environmental Public Health tracking, identifies the most serious climate-related health hazards as those resulting from:

  • Increasing numbers of very hot (>90°F) summer days
  • Increasing precipitation leading to flooding
  • Increasing storm-related inland and coastal flooding
  • Rising sea levels

According to EOHHS, climate change is expected to increase the number of days over 90°F each year, which may increase hospitalizations for heat-related illnesses. People who work outdoors, live in urban areas with limited greenspace, or lack air-conditioning are more likely to experience heat illness during extreme heat events. The U.S. Environmental Protection Agency has determined that “heat islands” (urban areas where structures are highly concentrated and greenery is limited) were responsible for daytime temperatures in urban neighborhoods rising as much as 7 degrees higher than those in outlying areas. The EPA found that the worst temperature differences are in more humid cities along the East Coast.

There are a wide variety of other ways that climate change can negatively impact human health. Air pollution events, sea-level rise, flooding, and severe weather that can result in both acute and chronic health impacts, including mental health. People who live near rivers or coastlines that experience flooding may come in contact with contaminated flood waters or experience respiratory impacts from mold growth in water-damaged homes or buildings.

Conclusion: 
While housing quality and safety challenges pose a threat to community and individual health, and an even more serious threat to particular populations, there are a number of interventions that are designed to address these problems. In our next blog post, we will introduce you to these interventions and begin to identify where there are gaps. 

We welcome your thoughts and reactions and would encourage you to share them with us. Elana Brochin can be reached at elanab@macdc.org; Don Bianchi at donb@macdc.org.

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1 - https://matracking.ehs.state.ma.us/Inspections/lead-inspection.html
2 - http://www.mass.gov/guides/phit-data-childhood-lead-poisoning https://www.mass.gov/guides/phit-data-childhood-lead-poisoning
3 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222490/; https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/quality-of-housing
4 - https://www.mass.gov/doc/childhood-lead-exposure-impact-at-a-glance/download
5 - High-risk communities are defined as those with a 5-year incidence rate of children who have a confirmed concentration of ≥ 10 micrograms of lead per deciliter cases that is above the state 5-year incidence rate after adjusting for low to moderate income and old housing stock (built pre-1978)
6 - www.mass.gov/service-details/statistics-about-asthma#:~:text=About%20one%20out%20of%20every,United%20States%20and%20in%20Massachusetts.
7 - https://www.mass.gov/service-details/statistics-about-asthma
8 - https://www.mass.gov/service-details/statistics-about-asthma#:~:text=The%20prevalence%20of%20asthma%20is%20high%20in%20Massachusetts&text=The%20prevalence%20of%20current%20asthma,ethnicity%20subgroups%20in%2020152.
9 - https://www.mass.gov/doc/pediatric-asthma-data-bulletin-0/download
10 - Ben Forman and Alan Mallach, “Building Communities of Promise and Possibility: State and Local Blueprints for Comprehensive Neighborhood Stabilization”, January 2019

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Housing Quality and Health: Revealing the Connections, Addressing the Challenges (Part 1)

May 24th, 2021 by Don Bianchi & Elana Brochin

Revitalize CDC in Springfield improves housing conditions by performing assessments and interventions for adults and children with asthma to safely remain in their home. (Photo credit: Revitalize CDC)

MACDC has long supported its members in their work to improve housing quality. In recent years, MACDC worked with it's members to establish health equity work as a defining characteristic of the contemporary community development movement in Massachusetts. We are now in the beginning stages of an initiative to link these two strands of our work. We would like to engage with as many stakeholders as possible in this process, and, therefore, are publishing this series of blog posts to share out ideas and get your feedback.

Surveying the Landscape

Springfield ranks 12th among cities nationwide in the prevalence of asthma, a distinction that the City’s residents and institutions are working hard to overcome. Revitalize CDC partners with Baystate Medical Center, Health New England, and the Public Health Institute of Western MA on the Greater Springfield Healthy Homes Asthma Program. The CDC conducts a home assessment to identify and eliminate asthma triggers, such as poor ventilation, leaks, and pests. The program then provides supplies to help mitigate triggers, provides education, and administers an asthma control test (ACT) before and after services are provided, to determine if symptoms have been alleviated. By addressing the unsafe and unhealthy housing that can trigger asthma, Revitalize CDC is seeing improvements in resident health after just 6 months of the program.

Like the residents of Springfield, all people need and deserve access to safe, stable, and affordable housing. Yet, for too many families, their housing is anything but safe. Persistent housing quality problems have serious consequences for those who occupy the homes, and for the broader community; among these consequences are poor health outcomes, such as asthma. The silver lining in this bleak landscape is that, by improving housing quality, we can also provide an antidote to many of these health problems. MACDC’s Housing Quality & Health (HQH) Initiative is intended to shed light on this troubling link, assess what existing interventions exist, and get to work on filling in the gaps on these remedies.

Why Focus on Housing Quality Now and Why Apply a Health Lens to This Problem?

According to a 2016 report from the National Association of Home Builders, the median age of owner-occupied homes in Massachusetts was 54 years, second oldest in the nation. In other words, half of the owner-occupied homes in MA were built before 1962, more than 15 years before lead paint was outlawed. Furthermore, New England’s harsh winters can wreak havoc on neglected homes.

Over the last several years, there has been increasing recognition of the ways in which social, economic, and physical factors affect individual and community health. In 2017 the Massachusetts Department of Public Health adopted six health priorities that address these factors, which are collectively referred to as “Social Determinants of Health.” Housing is one these identified health priorities. The COVID-19 pandemic has elucidated the link between housing and health. We witnessed the ways in which overcrowding and improper ventilation led to increased disease transmission. Devastating in so many ways, the COVID-19 pandemic highlights the inextricable convergence of health and housing and presents an opportunity to further envision the ways we can leverage a health lens to scale up efforts to improve housing quality and safety.

Indeed, opportunity can spring from crisis, and the Commonwealth’s response to the climate crisis presents such an opportunity. Passage of the Climate Roadmap legislation requires Massachusetts to achieve a 50% reduction in statewide greenhouse gas emissions by 2030, and net zero emissions by 2050. This will require major investments that go beyond typical energy efficiency measures, to include aggressive electrification and decarbonization efforts, and prioritizing climate resiliency. Healthier homes will be one important byproduct of this work.

The Link Between Housing Quality and Health

The prevalence of asthma in Springfield is just one example of the ways in which poor housing quality can cause and exacerbate serious health problems for its occupants and for the broader community. These health problems often reflect structural inequities.

    For example:
  • Substandard housing creates health hazards for its occupants, including increasing the likelihood of accidents and falls and the spread of infectious disease.
  • Substandard housing can also increase susceptibility to the impacts of climate change, including extreme temperatures and weather events.
  • Lead-based paint hurts the brain and other organs and has particularly harmful effects on children.

​The negative health outcomes associated with poor quality housing disproportionately impact the most vulnerable among us- children, seniors, people with disabilities and lower incomes, and many communities of color. For example, in Massachusetts, 13.8% of Black, Non-Hispanic adults in Massachusetts suffer from asthma as compared with 10.4% of white adults1 and over half of children with confirmed elevated blood levels live in just 19 cities and towns in Massachusetts.2 The particularly insidious impacts on children of exposure to lead paint are noted above. Elderly residents are most at risk for falls and are particularly impacted by exposure to extreme temperatures. People with disabilities, who often have fewer housing options available to them, may find it more difficult to move from housing that poses health risks.

Current Efforts to Address the Problems:

    There are several current policies, programs, and practices in place to address the housing quality and safety challenges, which can be grouped into four categories:
  • Efforts to prevent and reduce hazards and improve housing quality range from responsible property management to strong code enforcement and tenant protection policies, to programs that improve housing quality and abate lead-based paint. These include smoke-free housing policies and support for the development and operation of the well-regulated, high quality, affordable housing stock.
  • Energy efficiency and climate initiatives can reduce energy costs and provide a safer living environment. These include utility ratepayer-funded energy retrofit programs, increased availability and affordability of renewable energy, and implementation of climate resiliency and mitigation strategies.
  • Neighborhood stabilization strategies provide tools and incentives for both the private and public sectors, so that distressed and vacant buildings are brought back into productive use and maintained as quality residential and commercial properties.
  • Local healthy homes programs, and partnerships with health institutions, are among the initiatives that act on the explicit connection between housing quality and health.

Filling the Gaps

While there are many initiatives that support housing quality and safety challenges in Massachusetts, there is no coordinated approach, and these efforts lack the scale we need to address the problems. In order to increase the capacity of state and local governments, CDCs, housing courts, and others to successfully improve the safety and quality of older homes across the state, we need to fill existing gaps and scale up our efforts. We suggest the following strategies:

  • Increased availability of data on housing quality and safety challenges that is timely, publicly accessible, and reflects the disproportionate impacts of substandard housing on the health on Communities of Color, immigrants, residents of disinvested neighborhoods, and others. We also need data on the impact that current programs have on addressing these challenges, and where they fall short.
  • Increased public and private investment addressing home-specific substandard quality, energy-inefficient and climate-vulnerable buildings, and neighborhood-level distress.
  • Establishment of a Task Force, representing the various stakeholders, to better coordinate the strategies that address the broad spectrum of housing quality problems impacting families, and the homes and neighborhoods where they reside.

These strategies must be adopted by a wide range of players in order to be successful. In subsequent blogs, we will dig deeper into the housing quality problems that negatively impact resident and community health, current programs intended to address the problems, and strategies to fill the existing gaps and meaningfully address both housing quality and health.

As noted above, this, and other blogs in this series, are intended to start a conversation. We’ve convened a working group to help us navigate this work. We’d also welcome your thoughts and reactions and would encourage you to share them with us. Elana Brochin can be reached at elanab@macdc.org; Don Bianchi at donb@macdc.org.


[1] https://www.mass.gov/service-details/statistics-about-asthma#:~:text=The%20prevalence%20of%20asthma%20is%20high%20in%20Massachusetts&text=The%20prevalence%20of%20current%20asthma,ethnicity%20subgroups%20in%2020152.

[2] High-risk communities are defined as those with a 5-year incidence rate of children who have a confirmed concentration of ≥ 10 micrograms of lead per deciliter cases that is above the state 5-year incidence rate after adjusting for low to moderate income and old housing stock (built pre-1978)

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