Connecting the Three E’s of Healthy Housing

photo - Connecting the Three E’s of Healthy Housing
photo - Connecting the Three E’s of Healthy Housing
When city leaders work to align their resources and partners, residents can better access housing environments that promote healthy growth and development. (Getty Images)

These cities show that a commitment to equity, engagement and enforcement can provide city leaders with the information they need to adopt an integrated approach to healthy housing efforts that is driven by data, informed by the community, and addresses housing code violations.

This post was co-authored by Michelle Miller and Alyia Gaskins. It is part of NLC’s Culture of Health series.

A house is more than just a physical structure. Our health – how long and how well we live – is shaped by the opportunities and environments where children, youth and families live. In cities across the county, hazards in homes such as lead-based paint, mold and pests, among others, threaten the health, safety and lifelong potential of far too many children, youth and adults. For example:

Local elected officials, their staff and community partners know all too well the responsibilities of enforcing local building codes and inspecting properties for health-related code violations to create safe, hazard-free housing. Although cities have been engaged in this work for decades, new opportunities exist to further strengthen efforts to ensure all residents live in housing that promotes health and well-being.

A recent, deeper exploration of city models by the National League of Cities (NLC), illuminates that healthy housing strategies are most effective when there is an intentional commitment by city leaders to the "Three E’s:" Equity, Engagement and Enforcement.

  • Equity – To ensure improved health, academic and economic outcomes in cities, it is critical to use data to understand disparities in life expectancy across different geographical boundaries within a city. Understanding both the differences present and the root causes of these differences will allow cities to better tailor and target interventions to communities experiencing the poorest housing and health outcomes. By leading with a commitment to equity, city leaders can move beyond “services” and focus on changing policies, institutions and structures that contribute to poor housing.
  • Engagement – Shared buy-in and ownership among city residents builds trust. Deeper engagement of diverse voices can lead to healthy housing policies and interventions that better meets the needs of residents and ultimately advance sustainable outcomes.
  • Enforcement – Enforcement is one of the most powerful tools city leaders have to hold landlords accountable for poor housing conditions. Compliance with housing codes and standards is critical to protecting the health and safety of children and families as well as maintaining the appearance and functioning of neighborhoods.

A commitment to the Three E’s can equip city leaders with the information they need to adopt an integrated approach to healthy housing efforts that is driven by data, informed by the community, and addresses housing code violations.

Spotlight: Advancing Outcomes Through Equity in Kansas City, Missouri

Tackling disparities head-on is critical to improving health outcomes for vulnerable residents and advancing more equitable health outcomes. To ensure Kansas City’s healthy housing efforts are reaching communities experiencing the poorest housing conditions and health outcomes, city leaders prioritize the following strategies:

  • Collecting data on housing quality, health outcomes and the social determinants of health (i.e., the conditions where we live, learn, work and play) and disaggregating it by race, income, zip code and neighborhood
  • Engaging residents and other stakeholders most affected by poor housing in discussions about root causes as well as solutions
  • Establishing a citywide commitment to, and objectives for, addressing unhealthy housing conditions and reducing health inequities in the Kansas City business plan, one of the major guiding documents for city operations, resulting in shared ownership and a commitment to improvement

Spotlight: Building Trust Through Engagement in Greensboro, North Carolina

Meaningful, outcome-oriented resident engagement is critical to ensure that city efforts are responding to local needs and minimize resistance to proposed policies or interventions. According to Brett Byerly, executive director for the Greensboro Housing Coalition (GHC), “communities have real issues with broken promises, and many times do not trust outsiders.” In order to build trust, the GHC prioritizes the following strategies:

  • Developing a community engagement and community building plan before creating new programs, policies or housing interventions
  • Getting buy-in for the plan by creating shared ownership in the community and ensuring that the community sees itself in the plan
  • Hiring community members as community health workers to collect information on housing needs and concerns

Spotlight on Enforcement in Rochester, New York

Effective enforcement efforts leverage data sharing and collaboration between those entities that have data on hazards, those who enforce code violations, and those who prosecute cases. According to Gary Kirkmire, director of inspection and compliance services for the city of Rochester, “effective housing policies to reduce lead hazards should prioritize access, training, quality assurance/accountability and reporting.” Specifically:

  • Access – ability to gain access to housing units
  • Training – internal training of inspectors, supervisors and support staff and external training of landlords and other property agents and third party lead clearance providers
  • Quality assurance/accountability – internal and external audits of inspection staff, third party lead clearance providers, and landlords
  • Efficient means of statistical reporting – collecting and sharing data with partners (such as the health department, local schools and health providers) on the number of units inspected and the areas of the city with high numbers of properties that fail interior paint inspections, dust wipe tests, or exterior inspections

Housing matters to individuals, families, communities and cities – and where you live should not determine your access to safe and healthy housing and, ultimately, your ability to thrive. When city leaders work to align their resources and partners, residents – regardless of race, the neighborhood they live in, or their financial status – can better access housing environments that promote healthy growth and development.

City leaders are uniquely positioned to leverage their bully pulpit to convene stakeholders to develop comprehensive solutions that increase opportunities for low- to moderate-income residents who are disproportionately affected by the consequences of unhealthy housing. Alleviating the economic, health and socio-emotional problems associated with poor housing can improve health outcomes and help children and families succeed in school and work and contribute to the economic prosperity and vibrancy of cities.

About the authors:

Michelle Miller is the Deputy Director of the Office of Lead Hazard Control and Healthy Homes at the U.S. Department of Housing and Urban Development.

Alyia Gaskins is a Senior Associate on the Health and Wellness team at the NLC Institute for Youth, Education, and Families.

Senior Associate, Health and Wellness
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