Reconnecting Health and Housing Policy: Preliminary Insights from Action Research in Memphis

January 04, 2018

by Joe Schilling

Memphis has a substandard housing problem and a housing affordability problem. According to the National Center for Healthy Housing, the Memphis metropolitan area ranked last for having the unhealthiest housing in the nation, with pests, mold, water infiltration, and lead paint being some of the most common housing hazards. Despite a physically unhealthy housing stock, Memphis renters are more likely than other US renters to pay 30 percent or more of their income on rent (or to pay at least 50 percent of income on rent). Each problem takes a toll on residents’ health. Unsafe and unhealthy homes can contribute to many serious health issues—from asthma to lead poisoning to mental stress—that stem from living in and around poor housing conditions. Meanwhile, spending too much on housing leads to budget trade-offs that affect food security and health care compliance.

Although the nation’s current housing policies and programs arose from public health concerns, health and housing have evolved into separate policy fields administered by different government agencies with networks of distinct nonprofit organizations and partners. Under the umbrella of social determinants of health, foundations, policymakers, and practitioners are launching initiatives to reconnect housing and health policy.

A partnership between Urban Institute researchers and a Memphis-based community revitalization intermediary, Neighborhood Preservation Inc., is tackling the city’s housing and health issues head-on. A first-of-its-kind Health Impact Assessment (HIA) of the city’s code enforcement programs and policies to address substandard housing will document and assess how these policies affect health. The HIA will also show local leaders how to revamp code enforcement and inspections programs and forge more meaningful partnerships with nonprofits, health care institutions, medical clinics, and local green and healthy homes organizations. The HIA rests on the simple premise that Memphis can improve health outcomes for tenants, families, and neighbors if the city and its partners can implement more proactive approaches to address substandard housing through systematic, data-driven code enforcement.

As part of the HIA scoping process, we identified a complex web of housing and health stakeholders and policies that often work in isolation. A comprehensive inventory and systematic policy scan can provide public health and housing professionals a common foundation for greater cross-sector and cross-agency collaboration. To reconnect health and housing, map out the following four aspects of your local housing and health policy ecosystems.

1. Substandard housing by type

Though the Memphis HIA focuses on substandard rental housing, clear information on the landscape of all substandard, dilapidated, and unsafe housing points to a more complete set of policy, market, program, and community actions. Who owns and manages the housing, the type of legal entity, and the resources they can access (or not) can explain why and how the property became substandard and its prospects for rehabilitation.

Apartments. Some Memphis apartment buildings are large-scale complexes (100 to 1,000 units), many of which are at least 35 years old, while others are smaller (25 to 50 units) and do not have on-site management. Both age and property management can influence a building’s history of housing code enforcement cases.
Single-family homes. Owners who live in substandard single-family homes often lack the financial or physical ability to keep their property up to code. Some are senior citizens, and others are struggling financially in the wake of job loss, predatory lending, or mortgage foreclosure. Single-family rental homes present unique challenges to code enforcement because they are often spread out, and landlords of multiple single-family homes often have difficulty keeping track of their properties’ conditions.
Vacant, foreclosed, and abandoned housing. Although vacant units have no inhabitants to harm, they can foster crime, stress, and injury. Numerous studies document the strong relationship between vacant, blighted properties and public health impacts. But removing or renovating these homes is often difficult and expensive, especially in older industrial cities where large-scale demolitions may be warranted because of dramatic population loss. Many of these neighborhoods do not have enough people and resources to justify rehabilitation.

2. Substandard housing by neighborhood and market conditions

At the neighborhood level, determining whether substandard apartment buildings are located on the same block or owned by the same person can be a critical first step in shaping an intervention. Clusters of substandard apartment buildings can affect health issues beyond a housing unit. For example, high crime rates can prevent residents from being active or can be a barrier for opening grocery stores that can provide fresh and healthy food. Distressed neighborhoods demand different housing and health interventions and local partnerships than neighborhoods that have just a handful of problem properties. These conditions make it difficult for private investment to repair and rehabilitate substandard units.

In economically vibrant cities, housing affordability, gentrification, and displacement are usually high priorities. But even strong-market cities have substandard housing that pose health risks and are often inequitably distributed geographically. Improving these housing conditions without causing displacement is a challenge.

3. Organizational capacities and programs

All agencies and nonprofit entities are not equal. It is imperative to take stock and conduct an inventory of existing programs, resources, and policies—who is doing what, where they are doing it, and how they are doing it. Such an assessment can identify opportunities for synergy, minimize duplication of effort, leverage existing capabilities and resources, and move closer to collective impact. It can also help identify gaps in assessment and prevention to expand and build new capacities in organizations that can address those issues.

4. Emerging partnerships or prospects

No single entity or initiative can connect housing and health policies and programs. Forging partnerships across agencies and sectors can be difficult, considering the range of legal and policy barriers and the lack of political incentives to collaborate. But more and more health care institutions are stepping up to consider housing conditions as key triggers for the ailments they treat. Emerging partnerships that allow health care organizations and housing groups to better communicate can help address these challenges proactively.

In some communities, a nonprofit intermediary, foundation, or university is the catalyst to forge deeper coordination with housing and health agencies. In Memphis, Neighborhood Preservation Inc. is leveraging its credibility on the issues of blight to manage a team that includes managers from public and nonprofit organizations and agencies, including Shelby County Health and City Housing Code Enforcement. In other communities, clinics and hospitals adjacent to distressed neighborhoods may take greater interest in training their medical professionals and staff to refer cases for repair and rehabilitation to nonprofit housing providers. Such early interventions to rectify substandard housing conditions could be the best prescription a doctor could write.

This scan provides information that local officials, nonprofits, community-based organizations, and health care institutions can use to better connect health and housing policy. As our team finishes the HIA scoping phase, we will begin to merge Memphis health, crime, housing, and code enforcement data with insights from meetings with local government officials, health professionals, landlords, tenants, and community development organizations—adding even more evidence to support Memphis in crafting and implementing proactive and strategic interventions to address substandard rental properties.