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Housing policy affects population health, research shows | GUEST COMMENTARY

MANHATTAN, NEW YORK CITY, NEW YORK, UNITED STATES - 2016/03/23: "A City We Cal All Live In" sign held aloft in Foley Square. Mayor de Blasio, Chirlane McCray, Melissa Mark-Viverito & HUD director Julian Castro highlighted a rally in Foley Square to celebrate passage of the city's new mandatory inclusionary zoning law to promote affordable housing. (Photo by Andy Katz/Pacific Press/LightRocket via Getty Images)
MANHATTAN, NEW YORK CITY, NEW YORK, UNITED STATES - 2016/03/23: "A City We Cal All Live In" sign held aloft in Foley Square. Mayor de Blasio, Chirlane McCray, Melissa Mark-Viverito & HUD director Julian Castro highlighted a rally in Foley Square to celebrate passage of the city's new mandatory inclusionary zoning law to promote affordable housing. (Photo by Andy Katz/Pacific Press/LightRocket via Getty Images) (Pacific Press / LightRocket via Getty Images)

The shortage of affordable housing for both renters and homeowners in the U.S. is one of the most persistent and critical challenges our country faces, especially since housing affects so many aspects of American life. Studies show that providing Americans with more options for safe, affordable housing could yield a broad array of benefits for the nation, from greater social cohesion to helping close the educational achievement gap. Not least, providing more affordable housing also has the potential to improve community health and address some of the stark health disparities that became so vivid and heartbreaking during the pandemic.

While there has been a growing recognition that housing and health are intertwined, current research and policy debates around these two emergent issues remain woefully siloed. There are, however, existing policies, that — as our recent research shows — demonstrate the relationship between affordable housing and better population health.

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Inclusionary zoning, a popular policy tool that emerged in the 1970s, aims to provide low-income residents with affordable housing in good neighborhoods characterized by safer streets, better schools, more employment opportunities, and easier access to healthy foods and health care services. Cities with inclusionary zoning policies provide developers with incentives such as tax breaks or expedited permitting in exchange for a commitment to set aside a share of new, affordable housing developments. Policies vary. For example, some are mandatory, while others are voluntary. Some policies focus on rental properties, others on homeownership.

Regardless the differences, the more than 800 inclusionary zoning policies that exist today across 25 states offered us an opportunity to study the relationship between housing policy and population health. In our recently peer-reviewed study published in the medical journal Circulation, we found important associations between inclusionary zoning policies and cardiovascular health, in particular cardiovascular disease. Using multiple sources of data, we found that populations in cities with inclusionary zoning policies exhibited lower levels of coronary heart disease, a lower prevalence of high blood pressure and high cholesterol, and fewer people on blood pressure medication. These associations persisted even after controlling for median income, poverty rate, crime rate, labor force participation and other socio-economic factors.

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This study is one more reminder of the relationship between housing and health. People living in cities with inclusionary zoning laws appear to exhibit better health — in this case, less heart disease — than those in cities without such policies. Moreover, we have found that the strongest health effects were found in those cities in which the inclusionary zoning policies were mandatory, focused on rental housing, and required larger shares of affordable housing units in developments covered by such policies.

Inclusionary zoning is not a panacea for all our housing and health troubles, but policies like these demonstrate the net positive impact of decent, stable and affordable housing. They also underscore the need for housing and health care experts to break out of our research and public policy silos and generate creative solutions.

In fact, we’re seeing some stirrings of this in the private sector. Already some of our largest health insurers (including UnitedHealthcare and Humana) are working with financial institutions (like Wells Fargo) on initiatives that combine the creation of affordable housing with on-site health care. This is not necessarily out of charity — access to health care results in fewer health care problems leading to fewer claims and higher profits for insurers. Yet, regardless of the motivations, these types of initiatives offer a win-win for the health insurance industry, financial institutions and traditionally underserved communities.

Such initiatives offer important lessons for today’s local and national debates over infrastructure policy, its potential implications for housing and beyond. It’s heartening to see the proposed reconciliation bill calls for $300 billion in spending toward housing and transportation. Where affordable housing organizers and health care advocates can join forces, their voices will be louder and more likely to be listened to by policymakers. And as more policymakers and their constituents come to better understand the many social determinants of health, including the critical role housing plays, the more innovative and effective policies we can expect to witness.

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Gregory Squires (squires@gwu.edu) is a professor of sociology, public policy and public administration at the George Washington University. Antwan Jones (antwan@gwu.edu) is an associate professor of sociology, epidemiology and Africana studies also at the George Washington University. Their observational study on the associations between inclusionary zoning policies and heart disease risk prevalence was recently published in the medical journal Circulation.

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