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

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

May 2021
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)