Far from Abstract: Housing Determinants of Health Explained
Housing determinants of health are part of a broad set of factors perpetuating health inequity within the Public Health (PH) Economy. These determinants are typically defined as a type of social determinant of health explained by the lack of affordable housing, housing insecurity, shortened residential tenure, and poor housing conditions. [1] However, this definition fails to capture system failures wherein PH economic agents are responsible for exacerbating these housing determinants. This article will focus on the role of government agencies.
The US government created public housing, in part, to attenuate housing determinants of health, “to provide decent and safe rental housing for eligible low-income families, the elderly, and persons with disabilities”. [2] Decades of federal divestment in public housing funding has led to the inability of many US housing agencies and cities to maintain quality conditions. It is estimated that $70 billion is needed for capital funds to address renovation needs. [3] While federal funding for tenant-based vouchers and project-based rental assistance increased between 2010-2020, the public housing operating fund decreased by $998 million. [4] Such major reductions in support for operational costs diminish residents’ quality of life. The physical and psychological effects due to inadequate resources for housing authorities to address disrepair, plumbing emergencies, lead remediation, vermin, pests, mold, and basic preventative maintain can become serious and contribute to allostatic load. “Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health.” [5] This discussion fits with the typical conceptualization of housing determinants of health.
There is, however, an equally important source worsening housing determinants of health that does not widely appear in the literature - namely, poor agency performance of public housing authorities (PHAs). We highlight the District of Columbia Housing Authority (DCHA). The DC Office of Attorney General initiated the lawsuit against DCHA due to its failures to address confront “ongoing drug- and firearm-related nuisances”. OAG settled the lawsuit in which DCHA agreed to greater funding to improve security measures, personnel, and inspections. [6] OAG filed a separate civil rights lawsuit in June 2022 alleging that DCHA is failing to comply with the Americans with Disabilities Act. [7]
Prompted by a federal investigation of a former Board member, the US Department of Housing and Urban Development conducted an extensive audit of the DCHA in 2022. Their report found 82 deficiencies with clear public health import. These include: 1) lack of compliance with Violence Against Women Act (VAWA), 2) low occupancy rate (lowest occupancy rate in the US), 3) conducting criminal record screening and maintain record records in accordance with HUD regulations, 4) not conducting annual property inspections, 5) not preventing crime, 6) not free of health and safety hazards, including mold and water leaks, 7) not maintaining units in decent, safe, and sanitary condition, and 8) backup of wastewater into units. The HUD report does not access the health impact, as its purpose is to document non-compliance with federal and District regulations. The physical and psychological harm to residents has been underexplored. [8]
Residents in Distress Due to Housing Determinants of Health
View the testimonies of two senior residents in DC Housing Authority properties to listen to their experiences with poor agency practices to address leaks, mold, and other emergencies. [Move to timestamp: 2:44:15]
