In collaboration with the John D. and
Catherine T. MacArthur Foundation’s How
Housing Matters Initiative, Spotlight
on Poverty and Opportunity will be running a series of commentaries
for the next two months exploring the relationship between housing and three
topics: health, economic opportunity, and education. Please be sure to read
Michael Stegman’s “An Introductory Note” to learn more.
This commentary is the fifth installment in
the series, which is entitled “How Housing Matters to Families and Communities.”
When we think of improving the health
outcomes of Americans, we often think of better medicine, lower health care
costs, and smarter prevention strategies. But in many ways, safe, decent
affordable housing is just as important.
Perhaps the clearest example is an effort by
the federal government that began a decade ago to reduce people’s exposure to
lead hazards in their homes. Since that time, these efforts have reduced the
number of children with lead poisoning by 75 percent.
That’s just the beginning. Several studies have demonstrated that
“permanent supportive housing” ends homelessness, which is associated with
serious health problems. Providing
people with a combination of housing vouchers and supportive health services actually
ends up costing less than the revolving door of shelters, emergency rooms,
detox centers, prisons, and hospitals.
We also have a growing understanding that the
connection between people’s homes and their health doesn’t stop when they walk
out their front door. The New England
Journal of Medicine recently published the results of “Moving to
Opportunity,” a study showing connections between health and housing at the
Looking at 4,500 very low-income families
living in public housing projects in high-poverty neighborhoods in five major
cities, the study found that very low-income women who have the opportunity to
move from high- to lower-poverty areas are significantly less likely to be
extremely obese or to have diabetes.
What’s significant is that most of these
studies have been coming not from journals focused on housing or social policy,
but from premiere medical journals. And each study came to the same conclusion:
that housing is a powerful public health intervention that actually saves
Armed with this data, the U.S. Department of
Housing and Urban Development (HUD) and the U.S. Department of Health and Human
Services (HHS) have joined efforts and resources to make a bigger impact than
either of our agencies could alone. We’re
building on the foundation of cooperation we created to take on lead abatement to
pursue a broader healthy homes agenda.
President Obama has said, “If poverty is a
disease that infects an entire community in the form of unemployment and
violence, failing schools and broken homes, then we can’t just treat those
symptoms in isolation. We have to heal that entire community.”
Through the interagency Neighborhood
Revitalization Initiative, we are doing just that by partnering with
government, business, and institutional leaders as they work to create
neighborhoods of opportunity. NRI tools
like Choice Neighborhoods have pushed us to connect housing and services more
directly, while also strengthening the links between housing, health, and
And this summer, the Affordable Care Act
brought together 17 federal agencies, including HHS and HUD, to create our
nation’s first ever comprehensive National Prevention Strategy rooted in the
idea that good health begins at home and in the community. The Strategy
represents this Administration’s commitment to take concrete action - together
with our partners in every sector - to keep America healthy and fit.
One area where we’ve made substantial
progress combining housing and health strategies is helping people with
Using HHS’ “Money Follows the Person”
resources, HUD and HHS are working together on a significant capacity building
effort in five states to learn how to create a more seamless partnership
between public housing authorities and state Medicaid agencies to help people
with disabilities transition from institutional care to community living.
We know these sorts of partnerships
work. Just ask Kay from Cleveland, who,
because of her psychiatric disability, had gone between shelters and nursing
homes for the majority of her life.
Kay was discharged from a nursing facility to
a temporary shelter, but couldn’t afford a permanent home and was at risk of
being re-institutionalized. With a
Housing Choice Voucher provided through HUD and the help of Ohio’s Home Choice
Program, funded by HHS, Kay got the support she needed to transition into her
We hope our work around disabilities will
serve as a foundation for supporting other vulnerable populations like seniors. HUD and HHS have been collaborating on a
project to understand how affordable housing can be an important platform for
lowering health care costs and improving care.
As Dr. Megan Sandel said at MacArthur’s How Housing Matters conference, “a safe,
affordable home is like a vaccine” because it protects families and children
against devastating - and costly - consequences of poverty. That’s the evidence-based, smart government
approach we’ve been pursuing in the Obama Administration—and intend to keep
building on in the months to come.
To print a PDF version of this document, click here.
Donovan is the secretary of the U.S. Department of Housing and Urban
Sebelius is the secretary of the U.S. Department of Health and Human Services.