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Achieving Health and Social Equity Through Housing

Date posted: Tuesday, June 5, 2018 

An interview with the Green and Healthy Homes Initiative – part of a NEHA effort to highlight stories of dedicated professionals working to keep our communities healthy and safe.

Lead poisoning impacts an estimated 535,000 children younger than 6 annually in the United States, and the effects can last for a lifetime.

NEHA interviewed with Ruth Ann Norton, President & CEO of the Green & Healthy Homes Initiative (GHHI) about the economic, social, and health impacts that lead can cause. Norton focused on the solutions that collaborative efforts can provide and highlighted the challenges ahead.

NEHA: What brought you to the environmental health profession?

Norton: I came to this work as the Director for the Coalition to End Childhood Lead Poisoning in Baltimore, a parent-driven advocacy group that addresses childhood lead poisoning in the state of Maryland. Since 1993, childhood lead poisoning in the state of Maryland has dropped by 98%. Through our work we learned important lessons about the prevalence of environmental health and safety hazards in low-income housing, and that families frequently experience multiple issues simultaneously. From this experience we built a framework for cross-sector collaboration in Baltimore and the State of Maryland to efficiently deliver green, healthy, and safe homes. The organization has grown and broadened its scope, becoming the Green & Healthy Homes Initiative (GHHI), and has expanded application of the service delivery model in communities throughout the United States.

NEHA: Your AEC abstract submission discusses bringing social and ecological benefits to the table with the topic of affordable housing. What are some examples where you’ve seen the inclusion of other frameworks transform the conversation? How do non-energy benefits tie into this, and can you define these in greater detail?

Norton: The energy cost burden for low-income households is another important lens to put on the analysis of investment needs for affordable housing. Low-income residents are spending an average of 20 percent of their income on energy, compared to 3.5 percent for other households. The burdens of unaffordable, unhealthy, and inefficient housing are interconnected, and limit opportunities for economic mobility for families as well as their access to healthcare, healthy foods, and basic needs. In our paper, Achieving Health and Social Equity Through Housing, we look at ways in which housing interventions designed to increase equitable access to safe, efficient, healthy, and affordable housing can generate benefits at multiple scales (from individual households to national health and economic outcomes). Broadening the understanding of non-energy benefits and the wider socio-economic outcomes that arise from efficiency improvements is essential to GHHI's goal of working across sectors to capture the total value of quality, affordable, and efficient housing.

NEHA: Poor quality affordable housing has systemic negative impacts on not only the residents of that housing, but on the community as a whole. Can you discuss some of these impacts and how environmental interventions can alleviate them?

Norton: In Achieving Health and Social Equity Through Housing, we identify the negative impacts of unaffordable and unhealthy housing for the residents of those housing units. We also present evidence that demonstrates that in the communities where poverty and poor-quality housing are concentrated, neighborhood quality can be impacted. One way to contextualize this issue is to think about the impact of poor quality housing on education and schools. In neighborhoods where much of the housing stock is older with deferred maintenance, we are likely to see housing with lead-based paint and asthma triggers like pests and mold. Lead poisoning can severely hinder neurological development, and lead to lifelong health and behavioral conditions. Asthma is the leading medical cause of school absenteeism. Neighborhood-based elementary schools with students experiencing these health issues are more likely to have high absenteeism rates, lower rates of children reading at grade level, and other issues that impact school budgets. With environmental interventions in homes occupied by children, we can increase their educational opportunities and become more productive throughout their lives.

NEHA: GHHI appears to have made progress collaborating at the federal level. How does this work when addressing needs of the private sector as well as those of the community and citizens of an area?

Norton: GHHI has worked in partnership with the U.S. Department of Housing and Urban Development, the U.S. Centers for Disease Control and Prevention, the U.S. Department of Energy, and other federal agencies and organizations to design cost effective, integrated service delivery systems for comprehensive housing interventions.

Our approach involves presenting strong evidence for the estimated return on investment for support of affordable, healthy, and efficient housing. This information is not only valued by federal policymakers and administrators, it is also important to stakeholders working at local and state levels. Currently, only 1 in 4 households who are income-eligible for public housing programs are receiving benefits through public programs, which means the majority of low-income households nationally are occupying privately-owned housing units. To address the needs for healthy, efficient, and affordable housing nationwide, local leaders, community organizations, and housing developers must be engaged in creating solutions. GHHI works in 30 communities across the country to connect stakeholders and implement a cross-sector approach.

NEHA: If the disparity and inequity in healthy, affordable housing is not addressed, what are the long-term challenges that you foresee? How do community-based initiatives improve the longevity of these projects?

Norton: Without action to address housing needs with comprehensive and coordinated interventions, the United States will continue to experience disparities in health, economic, and education outcomes related to race, geography, and other related determinants. In other words, the zip codes we are born into will continue to be the best predictors for the quality and length of life of Americans. In the healthcare sector, we will continue to see $155 billion in economic costs annually to treat health conditions related to hazardous housing. In the energy sector, we will not realize the potential to generate $41 billion in savings that could result from investments in residential energy efficiency. When we commit to building cross-sector responses to needs for healthy and efficient housing, we can make an impact on social determinants of health, improve energy efficiency, and build more equitable and sustainable communities. GHHI has found that local community engagement and leadership are essential to the partnerships needed for coordinated housing interventions that meet the particular needs and realities of communities.

The Green & Healthy Homes Initiative is a presenting sponsor of the 2018 Annual Education Conference (AEC) & HUD Healthy Homes Conference. GHHI will be sharing more about their work at the conference in Anaheim, CA June 25-28.

You can learn more about lead and its hazards by reading the following articles from the Journal of Environmental Health:

  • Health and Housing Outcomes From Green Renovation of Low-Income Housing in Washington, DC, March 2014, Volume 76, Number 7 | PDF
  • An Exploratory Analysis to Determine Priority Areas for Lead Poisoning Prevention Education Progams in Missouri, March 2015, Volume 77, Number 7 | PDF
  • Effective Recruitment Strategies for Lead Hazard Control and Healthy Homes Programs, March 2018, Volume 80, Number 7 | PDF
  • Elevated Blood Lead Levels in Buncombe County Children: Implications of Lowering the North Carolina Intervention Level to the Centers for Disease Control and Prevention Blood Lead Reference Value, June 2018, Volume 80, Number 10 | PDF

Support the work of the National Environmental Health Association and those keeping our communities safe through Membership.

This project was facilitated by NEHA staff members Jonna Ashley (Membership Manager) and Nancy Finney, MPA (Technical Editor).