Elevating healthy housing solutions as a pathway to achieve health equity and well-being
Housing insecurity, multiplied by structural racism and climate change, is a major threat to health equity.
Housing is a key determinant of health. A safe, healthy home in a thriving neighborhood can positively impact everything from physical, behavioral, and mental health, to educational success, employment opportunities, and social connections. However, in today’s economic, political, and environmental climate, access to safe and affordable housing remains out of reach for many. The barriers to achieving this basic right are significant and include:
- Housing has become increasingly unaffordable, leading to a rise in the number of families and children experiencing homelessness.
- Industry, with the approval of policies, disproportionately targets low-wealth communities and communities of color, frequently placing highways and toxic waste sites in their neighborhoods.
- Many families, due to low wages and limited options, are forced to live in homes plagued by lead, mold, and other toxins, contributing to higher rates of childhood asthma and other health risks.
- Past and current policies — upheld by elected officials, financial institutions, and other entities — continue to deny families access to housing and generational wealth.
- Unchecked, destructive climate events are rendering entire communities uninhabitable.
In the summer of 2024 the Supreme Court of the United States, in Grants Pass (Oregon) v. Johnson, criminalized houselessness, which has critical implications for people living outside — in increasingly deadly heat and cold — and for public health broadly. Housing advocates say this ruling will embolden law enforcement to be more aggressive toward people who are unhoused. While some argue that the decision will improve public safety, public health experts say it criminalizes basic biological functions like sleeping, and does little to improve community safety. These — and many other — intentional practices leave far too many people unhoused or in precarious living situations, which in turn affects their ability to achieve well-being and realize the future they want.
As conveners on intersectional social impact issues, MG hosted an expert virtual panel on housing, climate, and health equity. Melissa Navas, from our public health team, facilitated the conversation, which you can watch here, with innovators working at the intersection of these issues. Drawing on decades of experience, as well as current challenges, the group engaged in a robust discussion on healthy housing, local opportunities and limitations, climate justice, and more. Melissa kicked off the webinar with this question: What are the essential actions to advance housing equity as a public health issue — especially with the amplifiers of structural racism and climate change? These are some of the highlights of the conversation with our expert panel.
Amanda Reddy is the executive director of the National Center for Healthy Housing. Founded on the premise that better housing can be a powerful platform for better health, Amanda’s work focuses on working with communities to prevent housing-related illness and injury by implementing evidence-based and equitable policies that improve housing quality. Amanda began the discussion by sharing several statistics about housing, emphasizing that it is one of the most well-documented social determinants of health and well-being. She noted that we spend around 70% of our time in residential environments, making housing a critical factor in our lives. Home settings are particularly important for early childhood development, as most children under five receive care in these spaces. Despite housing being a basic human need and right, the U.S. has long neglected its housing stock, failing to provide safe, secure, and affordable options for the majority of residents.
Poorly constructed or poorly maintained homes, or those that are too expensive to rent, heat, or cool, have a significant negative impact on the health and safety of their occupants. In fact, about 40% of homes in the U.S. have one or more health or safety hazards that pose risks such as illness, injury, or even death. These risks are not evenly distributed: Black residents are twice as likely to live in homes with severe structural problems compared to the general population. Such disparities, along with the lack of affordable housing, exacerbate poor health outcomes for historically marginalized and excluded communities.
With regards to targeted health policies, Amanda cited this resource on the topic of infectious disease “Association of poor housing conditions with COVID-19 incidence and mortality across US counties.” The study found that counties with higher percentages of poor housing had significantly higher rates of both COVID-19 cases and deaths. These findings highlight the critical role housing plays in public health, suggesting that targeted health policies addressing poor housing conditions could help mitigate adverse infectious disease outcomes.
Amanda concluded her opening remarks on an optimistic note, encouraging the audience to view housing not as a problem, but as a powerful solution for improving health and well-being outcomes in communities across the country.
Ed Johnson is the director of litigation at the Oregon Law Center. He has been a legal aid lawyer in Oregon since 1996. His work focuses on fair housing, subsidized housing, housing preservation and homeless rights litigation. Ed has spent the last 30 years representing people who have to live outside. In the recent Grants Pass vs. Johnson decision, the Supreme Court ruled to criminalize individuals living outdoors, even when they have no other place to go. Ed highlights how alarming this is for those experiencing homelessness, stressing that the issue at hand is one of housing, not criminality. He emphasizes that the problem is solvable, with both the causes and solutions well-documented. Currently, the U.S. faces a shortage of 7.2 million housing units — a critical failure of the system, reflecting policymakers’ inaction in pushing for more accessible and affordable housing. The homelessness crisis cannot be addressed through litigation or policing; instead, we need policies that build bipartisan support for creating permanent, affordable, and supportive housing for all in need.
The daily struggles of people living outdoors are undeniable, as they face severe health risks, such as hypothermia in the winter and heat exposure in the summer. Additionally, they are forced into polluted areas, suffer from inadequate access to clean water, food, and healthcare, and those battling substance abuse are at higher risk of using lethal narcotics. Over the past decade, the mortality rate among unhoused individuals in the U.S. has tripled, disproportionately affecting people of color due to systemic racism. These issues are exacerbated by politicians aiming to appear “tough on homelessness,” despite the severity of the crisis.
Nevertheless, there is hope, as seen in Oregon, where bipartisan support for zoning reform is emerging. Ed is confident that homelessness is a solvable problem and urges collaboration to build the necessary housing, ensuring everyone in the community has a safe place to live, which will ultimately improve public health and well-being.
Jasmine Hall Ratliff is the executive director of Build Missouri Health, a statewide nonprofit that works to support community-led innovations to radically change systems that result in equitable health outcomes. Throughout her career, Jasmine has focused on achieving equity across communities, particularly for communities of color and LGBTQ+ individuals. St. Louis, Missouri, is home to about 300,000 residents. Demographically, the city is approximately 45% Black and 43% white. It is divided into north and south by a highway and is considered one of the most segregated cities in the nation, with the majority of Black residents living north of the highway. This segregation has its roots in Missouri’s decision to join the Confederacy during the Civil War as a slaveholding state. The next phase of systemic injustice came in the form of housing discrimination, including restrictive zoning, deed covenants barring Black residents from owning or renting homes, and redlining practices between the 1940s and 1960s, which divided the city into “desirable” and “undesirable” areas.
Redlining made it nearly impossible for people in the “undesirable” areas to obtain mortgages or find affordable housing. These sections, marked in red and orange, were primarily in the north, where Black families lived. In contrast, white families were given opportunities to build generational wealth and lived in green-coded areas with better resources. Jasmine highlights that these decades-long practices entrenched racial and economic segregation, relegating Black residents to the north side, which led to concentrated poverty and disinvestment.
The legacy of these injustices persists today, manifesting as poverty, lower property values, and greater health disparities. Black residents in St. Louis disproportionately experience higher levels of air pollution, car traffic, and smog; exposure to lead paint, which poisons children; proximity to industrial sites; and lower life expectancies, often suffering from chronic illnesses like asthma. The connection between housing and health is undeniable. However, Jasmine notes that there is hope, with a shift toward more equitable housing policies and practices.
St. Louis received significant funding from the American Rescue Plan (ARPA), and after a series of community town halls and surveys, the mayor Tishaura Jones allocated $3.7 million in ARPA funds for housing revitalization, including new builds and renovations of vacant homes in the north side. Organizers are advocating for fair housing policies that promote integration and prevent discrimination, while groups like the Green City Coalition are transforming vacant lots into green spaces. Though there is still much work to be done, there is a growing sense of optimism, with progress toward a brighter future for the residents of St. Louis.
Steph Jarem is Oregon Health Authority’s (OHA) director of the Office of Health Policy. She serves as the director of Oregon’s 1115 Waiver, which allows states to test new approaches to their Medicaid programs. She partners on health system transformation efforts driven by the Legislature and the Oregon Health Policy Board. Steph discussed how OHA is integrating housing equity into its systems and services, emphasizing the critical link between health and housing. Similarly to Ed Johnson she referenced the criminalization of homelessness, which often leads to incarceration being used as a substitute for housing services. This approach accelerates the decline in both mental and physical health for those caught in the carceral system. Relying on emergency systems instead of stable housing is far more costly than preventive care. OHA is framing housing as a form of preventive healthcare, which they are currently testing.
When we balk at the cost of providing equitable housing for our most vulnerable populations, we still end up paying a price that affects all communities. In Oregon and across the country, many people move in and out of homelessness or live in a chronic state of homelessness due to the lack of affordable housing, which is exacerbated by medical and mental health conditions, including substance use disorders. The absence of safe and healthy housing can worsen any illness. Those most affected by this crisis often exist at the intersection of multiple vulnerabilities, such as race, sexuality, gender identity, chronic health, and mental illness. This is why OHA views homelessness as a public health crisis that cannot be ignored.
Historically, Oregon has treated health and housing as separate systems. However OHA recognizes that the availability of affordable, accessible housing and health equity outcomes are connected. The agency is now seeking to address historical oppression, such as systemic racism, and to eliminate bias in both health and housing systems. One of their goals is to establish housing supports and services as a legitimate, appealable Medicaid benefit. Medicaid, the system for low-income individuals, should ensure that those eligible for Medicaid are also entitled access to safe, affordable housing.
OHA is taking essential steps toward cross-system collaboration by clarifying the roles of health and housing systems and building shared strategies to address needs at the community and grassroots level. A key part of this effort is linking healthcare coordinators with housing case managers, who currently work alongside each other but not always in collaboration. OHA aims to strengthen the coordination and information sharing between these two groups.
Due to systemic racism and a general mistrust in the healthcare system, many members of the Medicaid program, particularly those without diagnoses, are hesitant to engage with providers. Steph and her team have been working to build trust with these individuals, helping them receive diagnoses (if they choose) so they can access the support they need, ultimately improving health outcomes and well-being.
Steph concluded by highlighting OHA’s most exciting initiative: utilizing the Medicaid 1115 Waiver to address health-related social needs, such as housing, nutrition, outreach and engagement, as well as providing climate devices (air conditioners, heaters, air filters, etc.). By focusing on prevention and mitigating acute episodes — such as unexpected hospitalizations leading to an inability to pay rent — OHA aims to interrupt the downward spiral of health issues contributing to housing insecurity. Their goal is to find strategic, collaborative solutions to enhance health equity across Oregon and improve the lives of all residents.
This conversation between MG and these housing experts solidified the need to address the profound link between housing insecurity and public health. As a society we must confront the underlying systemic racism, criminalization, and structural inequalities that perpetuate health disparities in marginalized communities and prevent people from finding safe and affordable places to live. The lack of housing stock for all exacerbates chronic illnesses, mental health struggles, and vulnerability to disease, creating a vicious cycle of poverty and poor health outcomes. However, there is hope as grassroots organizers, experts, advocates, and policymakers work to dismantle these barriers, pushing for affordable housing, inclusive policies, and equitable solutions. Through collective action, community engagement, and the reimagining of housing as a human right, we can create healthier, more just communities where every person has the opportunity to move towards more stability, well-being, and equity.
To watch this conversation on YouTube visit this link.
