Affordable Housing as a health intervention
By Thom Amdur
4 min read
The intersection of housing and healthcare is a fascinating topic that I keep coming back to in this column and in my work with NH&RA. It’s exciting to mull over new innovations and creative capital and operating partnerships between affordable housing providers and hospitals, medical schools, accountable care organizations, as well as Medicaid and Medicare administrators. As I have written about in the past, bringing healthcare dollars and healthcare services to affordable housing, particularly housing for the homeless, frail elderly and disabled, makes obvious public policy sense. While Social Impact Bonds, Pay-For-Success and Medicaid Waivers are “hot” topics getting a lot of attention today, I think it is important that we not forget the basics: namely that safe, sanitary affordable housing, in and of itself, even without any of the bells and whistles, is probably one of the most important healthcare interventions of all.
We know that we have a critical affordable housing shortage; the Joint Center for Housing Studies’ most recent State of the Nation’s Housing Report is a timely reminder that eight years after the financial meltdown too many individuals and communities are struggling to make ends meet. We also know that when housing is unaffordable people are forced to make sacrifices that negatively impact their health in the short- and long-term. When housing is unaffordable, individuals and families must often choose between rent and nutrition, utilities, medication and/or preventative healthcare.
Services and affordability matter to health but so does the actual quality of the built environment. Poor indoor air quality (be it from inadequate ventilation or toxic building materials or environmental factors, like smoke) routinely leads to debilitating respiratory conditions, like asthma or severe allergies. Poorly maintained properties lead to life-safety issues and result in increased on-site accidents and crippling physical injuries. It may be hard to believe, but even today lead paint continues to be an issue in many communities.
When we fail on these issues there is an obvious and significant human cost and that should be reason enough to act. But there are also economic and legal exposures to the owners, as well as measurable and long-term costs to society, particularly where children are involved. It is well documented that success in school and achievement at higher education directly correlate to lower unemployment rates and higher lifetime earnings potential. During the critical early years between birth and four years old, children develop the majority of the neural pathways and brain architecture that are necessary for them to be able to succeed in school and compete in modern society. When kids are not school-ready because they live in adverse environmental conditions, have nutritional deficiencies and/or chronic health issues, they are far less likely to achieve academically—and this perpetuates the cycle of poverty.
Affordable housing is a positive health intervention and there is much more we can do from a policy perspective to positively impact health outcomes. For starters, Congress can adopt SB 2962 (Co-Sponsored by Senators Maria Cantwell and Orrin Hatch), which will significantly expand the supply of new affordable housing. We can incentivize affordable housing projects to go smoke-free, which will go a long way toward addressing chronic diseases, like asthma, heart disease and hypertension. We can make existing housing safer and more affordable by expanding resources through health conscious energy retrofits. We can redesign our health care system to allow for its resources to pay for housing costs since inadequate housing is a significant cause of poor health outcomes. We can build healthy in the future by adopting health conscious building standards, like Enterprise Green Communities or LEED.
Affordable housing must be a bigger part of the national healthcare discussion. It is good for our residents, it is good for our businesses and it is good for society.
