By Katie Moran-McCabe and Scott Burris
Florence Nightingale once said, “The connection between health and the dwellings of the population is one of the most important that exists” — a statement that is as true today as it was at the turn of the 20th century. A decent dwelling and diverse communities, where there is access to transportation, good schools, shops, parks, socioeconomic mixture, social capital and collective efficacy, and economic opportunity are all features necessary for both a high-level and equitable distribution of well-being.
The promise of healthy housing and communities, however, falls short in the United States. Much of the housing in the U.S. is expensive, unsafe, and inadequate in supply.
Almost one-in-three households in the US is cost-burdened, which is defined as paying more than 30 percent of annual income for housing. About half of those are severely cost-burdened, paying more than half of annual income for shelter, according to the Harvard University Joint Center for Housing Studies.
In 2018, the CDC estimated that 4 million households still had children exposed to high levels of lead, and reported elevated-blood lead levels in some 500,000 children in 2016. Prolonged residential exposure to radon is the second leading cause of lung cancer in the U.S.
According to an analysis conducted by the National Low Income Housing Coalition, there are only 35 affordable and available units for every 100 extremely low-income renter households. That translates to a shortage of more than 7.2 million units.
There are many explanations for the housing crisis in the U.S. One is that the law has never stopped promoting and preserving segregation, nor has it adequately supported the supply of enough affordable, safe, and stable housing for all citizens.
In a new article in the Northeastern University Law Review, we outline 23 legal mechanisms, or levers, that may impact health equity in housing in the U.S., and review the evidence base evaluating each lever. These levers include the Low-Income Housing Tax Credit program, nuisance property ordinances, inclusionary zoning laws, rent control, fair housing protections, and minimum wage laws, among others.
The 23 levers are split across five domains:
- Increasing the Supply of New Affordable Housing
- Maintaining Existing Housing as Affordable, Stable and Safe
- Affirmatively Furthering Fair Housing
- Promoting and Enhancing Economic Choice for the Poor, and
- Governance and Planning
What we find in our review of the literature is simultaneously disappointing and dangerous: The evidence base regarding the impact of these levers is minimal, and the number of quality, rigorous scientific studies is even smaller.
This ignorance of the law’s effects can foster and support the belief that problems that have been addressed in law have been solved, or are in the process of being solved, when in fact the solutions may not really be solutions at all.
In the U.S., we have thrown a great deal of law at housing, discrimination, and poor neighborhoods for a generation, with unsatisfying results. We believe that only through a systematic approach grounded in legal epidemiology can we begin to chip away at this “wicked problem” and promote health equity in housing. We hope this article serves as grounds for a blueprint.
This article is the first product in a project funded by the Robert Wood Johnson Foundation’s Policies for Action program. A future series of reports will expand the list of legal levers and evidence presented in this article, and offer a research and action roadmap for policymakers, advocates and others to support health equity in housing.