Housing and Health: From Research to Real Deals

Panelists advocated for policies leading to healthier lives, built on a platform of affordable, green, and community-oriented housing at the 2014 ULI Fall Meeting in New York City.

As a pediatrician, “a decent, affordable home is the best intervention I can get for my patients” to support a healthy life, said Megan Sandel, coprincipal investigator for Children’s HealthWatch, a research and policy organization that focuses on how to alleviate insecurities around hunger, housing, and energy, especially for young children. “Housing is like a vaccine, because it provides long-term benefits” for children’s health and is linked to other indices of healthy stable lives, such as academic achievement, said Sandel, associate professor of pediatrics at the Boston University School of Medicine.

Health care spending in the United States—at more than $8,000 per person—is the highest in the world, but produces some of the poorest health outcomes among 34 industrialized countries. The United States ranks 31st in infant mortality, for example, meaning 30 other countries are more effective at keeping babies alive. “Other countries with good outcomes spend more like $2 on health elements like housing” for every $1 the United States spends on health care, noted Sandel. Her own and others’ research has shown that children whose families received subsidized housing vouchers ate better and were healthier. “Housing instability goes beyond homelessness,” she added, and includes not being able to pay the rent or the heating and lighting bills, and living among pests such as cockroaches and mice. She advocated for a shift in U.S. investments to more subsidized housing and nutrition services to improve children’s health.

Jonathan F.P. Rose, chief executive officer of Jonathan Rose Companies LLC, noted that more than 20 million people in the United States spend more than 50 percent of their income on housing, which is undermining not only the health but also the economic and social stability of the nation. As city living has become more desirable, incomes have fallen, rents have risen, and poverty has shifted to the suburbs, where many families spend 80 percent of their incomes on housing and transportation, with only 20 percent left for food, clothing, health care, and education. “It’s essential when we build around transit lines that we build for density and reserve 20 percent of housing for affordable housing,” he said.

Rose noted that many successful examples of healthy affordable housing have been built by private developers with nonprofit partners, rather than by public agencies. He described one of his firm’s healthy green developments, Paseo Verde, the first LEED-ND Platinum-certified neighborhood in the United States. Located next to Temple University and a commuter rail station in north Philadelphia, Paseo Verde features 120 low- and moderate-income rental apartments, plus primary-care and fitness facilities, a pharmacy, community-based social services, green roofs, and community gardens. Design and construction focus on fresh air, daylight, and nontoxic materials. Rose said that one resident told him her three-year-old son had emergency room (ER) visits for asthma every month of his life, but in the three months since they’d moved into Paseo Verde, he had not needed to go to the ER.

The panelists advocated for health impact assessments (HIAs) of neighborhoods to assess the relationship among building, design, and health. “We need HIAs as a natural part of our planning and development process,” said Rose.

Becoming advocates for healthy affordable housing requires working across professional silos with local health care institutions, said Sandel. Housing insecurity should be assessed as part of a community health needs assessment (CHNA), required for tax-exempt hospitals, she said. “Health care institutions do their own development, understand financing, and have their own investment portfolios, and it’s important to have them understand the value of building healthy affordable housing near their institutions.”

“Find the right health care partners,” advised Sandel, beginning with the health care institution’s vice president of community health. “Look to be on their board, and have that health care representative on your board.” Another benefit of such relationships: Many health care institutions are downsizing or developing elsewhere, resulting in real estate opportunities, said Sandel. She said that Boston City Hospital and Boston University Medical Center are merging and will sell half their combined campus, which could provide housing for seniors and others.

Key findings from ULI research show that the market response to health- and community-focused development “exceeded developers’ expectations,” that costs attributable to health were a minimal percentage of the overall budget, and that upfront costs were worth the expense, said ULI Senior Resident Fellow Edward T. McMahon, Charles E. Fraser Chair for Sustainable Development and Environmental Policy.

Via6 in Seattle was designed and built by the bike community for the bike community, said McMahon. The twin towers feature a Velo bike shop, bike lockers, a fitness facility, a restaurant, and a market. The 624 apartments rent for a premium, and were 90 percent leased within the first year. Seventy percent of renters don’t own a car, and parking spaces have been converted for bike parking. He said that Via6’s healthy green lifestyle also was appealing to Amazon, which moved in across the street.

With an incentive of doing well while doing good, “you can build a brand of health and community, which will be extremely important going forward,” said McMahon.

Kathleen McCormick of Fountainhead Communications, in Boulder, Colorado, writes about design, the environment, and healthy communities.