Justice is good for health [and] . . . health is the byproduct of justice.
— Norman Daniels, Bruce Kennedy & Ichiro Kawachi (Boston Review, 2000)
Among the most salient lessons to be learned from the coronavirus pandemic are that unjust laws produce unjust health outcomes, and that justice is just plain good for America’s health.
Health justice is the moral mandate to protect and advance an equal opportunity for all to enjoy greatest health and well-being possible. Health justice means that no one person or group of people are granted or excluded from the means of pursuing health on an inequitable basis. To achieve health justice, societal institutions such as governments and health care providers must act to advance equality, by increasing fairness and decreasing unfairness of their current and historic impacts on populations.
Image from “Mapping Inequality,” American Panorama, ed. Robert K. Nelson and Edward L. Ayers.
By Courtney Anderson
Only 10-20% of health outcomes are attributed to health care. Social, economic, and environmental factors thus account for the vast majority of population and individual health outcomes. And housing encompasses many of these factors, as it largely determines the built environment and exposure to stressors.
Section 801 of the Fair Housing Act declares, “It is the policy of the United States to provide, within constitutional limitations, for fair housing throughout the United States.” This Act was the culmination of racial justice protests, resistance to discrimination and violence, and other aspects of the civil rights movement. Despite the stated intention of this Act, housing remains unequal across the nation.
Mr Justice Chamberlain in the Queen’s Bench Division of the High Court of Justice ruled recently that a patient, known as MB, who had occupied an NHS bed for over a year, must vacate it and instead receive care in the community. Her room could be required urgently by COVID-19 patients and there would be an increased risk of MB contracting COVID-19 if she remained in hospital.
Inclusionary zoning (IZ) laws are one such approach, and are intended to create affordable housing through collaboration between public and private developers. These laws create requirements and incentives for developers, such as unit size minimums and establishing income eligibility criteria. IZ laws counter preceding ‘exclusionary zoning’ policy where large-lot zoning is used to prevent low-income integration into rising developments. Contrary to the original intent, IZ laws have been criticized for creating potential financial disincentives to develop in low-income areas and increasing housing price inflation.
To combat this risk, states like New Jersey, Massachusetts, and California have added additional incentives such as density bonuses, expedited approvals, and fee waivers. These have been presented to developers as part of state ordinances and regulations. Under its Affordable Housing Act, Illinois seeks to create grants, mortgages, and loans to rehabilitate, develop, operate, and maintain housing for low-income and very-low-income families. The Act requires local governments to create affordable housing plans based upon their municipalities’ median incomes. For example, based upon population median incomes and housing values, the town of Evanston, Illinois is required to provide 4,993 affordable housing units to accommodate its population of 75,472 who have an area median income of $63,327.
The Cook County Health Department in Illinois just published a dataset to LawAtlas.org as part of a yearlong legal epidemiology project funded by the CDC Public Health Law Program and ChangeLab Solutions. The health department created a policy surveillance dataset tracking IZ laws in 10 municipalities across the country, concentrating on residential areas around Cook County and the Chicago Metropolitan area: Boulder, Colorado; Burlington, Vermont; Cambridge, Massachusetts; Evanston, Illinois; Highland Park-Lake County, Illinois; Irvine, California; Lake Forest-Lake County, Illinois; San Diego, California; Santa Fe, California; Stamford, Connecticut.
One common provision of IZ policies are set-asides. These are ordinances that require developers to reserve a portion of the new development for low-income residents. Through its policy surveillance project, the health department found that nine of the jurisdictions have implemented mandatory IZ policies and six jurisdictions have established preferences for who can live in set-aside units. The percentage of set-aside required for low-income housing varies by jurisdiction – from 10 percent in two jurisdictions, up to 25 percent in one. Of the 10 jurisdictions studied, one (Stamford, Connecticut) doesn’t require any set-aside, and nine allow for alternatives to set-asides, such as fee-in-lieu (nine jurisdictions), land dedication (six jurisdictions), and alternative proposals (four jurisdictions). For those jurisdictions with fee-in-lieu alternatives, seven provide those payments to Affordable Housing Funds.
While extensive literature provides evidence for a positive association between levels of wealth in an area and the levels of health in that area, more research is needed to establish the efficacy of IZ laws. Governments are increasingly implementing relevant policies to combat the negative effects of gentrification and IZ policies could be part of the mix, particularly when used in conjunction with efforts to preserve existing community culture beyond property interest, as neighborhoods provide important social support networks for residents. “Revitalization without displacement” is a rising standard for preserving the positive economic benefits of gentrification without destroying communities through displacement. This policy advocates increasing the total population by filling vacancies and increasing housing densities and preserving community bonds. Experts consider ‘social mix’ to be a common good.
The ten policies in this dataset are just the tip of the iceberg, but they do offer an interesting, important look into the complexity and variation of these laws.
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. Read More
Here’s the latest news from housing law and equity, for the week of November 6-10, 2017:
The Public Health Institute released a study that calculates the number of children with lead poisoning in the United States.
A new law in Seattle will prevent landlords from screening tenants based on their criminal history, via The Regulatory Review.
“It’s time to stop ignoring our crumbling housing code enforcement” — coverage of APHA2017 sessions on housing code enforcement, featuring CPHLR Director Scott Burris and the Five Essential Public Health Law Services Framework developed in collaboration with ChangeLab Solutions and the Network for Public Health Law, via Public Health Newswire.
San Jose has a new plan to get downtown landlords to clean up their vacant storefronts using a pilot program that would create a registry of vacant buildings and fine property owners who are neglecting their properties, via NextCity.
Civil rights groups are fighting the suspension of a HUD rule they say helps low-income families move to better neighborhoods, via CityLab.
Texans voted to loosen some of the tightest home lending restrictions in the country. via Governing.
As sea levels rise, wealthy people can more easily afford to move to high ground, making gentrification worse, via Yale Climate Connections.
A new study finds a correlation between the number of patents a city produces and economic segregation within its limits, via the Atlantic.
Benjamin Somogyi argues in the Regulatory Review, to solve the next foreclosure crisis, look to Sacramento
New York, Philadelphia and Washington, D.C., have approved funding to provide legal defense to low-income tenants at risk of eviction. A look at how free legal help could prevent evictions, via Huffington Post.
The week of Sept. 4-11, 2017 brought more housing-related news from the southeast in the wake of Harvey and Irma, and a few new resources. The latest in housing equity and the law, below:
Matthew Desmond writes a Housing State of the Union for the Stanford Center on Inequality and Poverty’s Pathways Magazine State of the Union issue. The report emphasizes the home-ownership racial gap, the relationship with the affordability crisis, and the reform that is needed for the mortgage interest tax deduction.
Paul Krugman of the New York Times writes about the need to find equilibrium between negative sprawl (such as in Houston) and NIMBYism (as experienced in San Francisco). He asks, “Why can’t we get cities right?”
Community Land Trust has a tool for community focused development.
Much of the devastation from Harvey is centered on homes and housing. Our focus this week is on the housing and equity issues related to displacement, and recovery and development in the future. The news from the world of housing after Harvey, for the week of August 28-September 5, 2017:
Although tenants’ homes are under water, their landlords are still demanding that they pay rent. Texas law allows a tenant or a landlord to terminate a contract due to a natural disaster only if the property is “totally unusable,” via the Guardian.
Harvey will dramatically change the housing market in Houston for a long time. Once a city with a glut of rental properties, Houston almost overnight became a city without enough habitable housing units. Some estimate that 60,000 units have been damaged in the storm, about 85 percent of all available units before the storm. Rents are expected to go up as much as 10 percent in the area, the Wall Street Journal reports.
Susan Popkin at the Urban Institute writes on the importance of inclusive development and learning from the past after a disaster.
Here’s the latest news in housing law and equity, for the week of August 15-21, 2017:
The Urban Institute has released a new tool about using fair housing data. The report contains details on data sources related to demographics and segregation, housing, land use, disability, education, employment, environment, health, and public safety.
The Washington Post reports that California lawmakers are planning on putting housing as a top priority after the summer.
Richard Rothstein, author of the critically acclaimed book The Color of Law, writes an op-ed for the LA Times about the role law plays in maintaining racial segregation in Los Angeles.