Housing and eliminating disparities – Opportunities in policy-making

Housing is included in multiple calls, tools, and policies at the global, national, and state levels to create healthy neighborhoods and communities. Home interiors however, are largely absent from consideration. Below, we outline a few of these initiatives to illustrate the opportunities that exist for incorporating home interiors and how these intersect with peoples’ ability to live healthy and connected lives into policy decision-making. For a more detailed elaboration see The Right To Home Appendix.

Global

  • The World Health Organization’s Housing and Health initiative notes that “Poor housing and indoor environments cause or contribute to many preventable diseases and injuries, such as respiratory, nervous system and cardiovascular diseases and cancer. A degraded urban environment, with air and noise pollution and lack of green spaces and mobility options, also poses health risks.

    How home interiors intersect with meaning-making and the health implications of these processes must also be considered.

National

  • The National Center for Healthy Housing’s principles focus on housing conditions: dry (prevent asthma triggers, such as mites, roaches, rodents, and molds); clean and pest-free (reduce pest infestations and exposure to contaminants); safe (reduce falls, the most frequent cause of residential injuries to children, followed by injuries from objects in the home, burns, and poisonings); contaminant-free (lead, radon, pesticides, volatile organic compounds, and environmental tobacco smoke); ventilated (fresh air supply); maintained (reduce risk for moisture, pest problems, and lead-based paint); and thermally controlled homes (prevent prolonged exposure to excessive heat or cold).

    Design elements of home interiors, from spatial layout to lighting and furniture, and now these impact how people cook, eat, live, work, play, etc must also be considered.

  • In the National Prevention Council’s Action Plan (2012) the “Elimination of Health Disparities” strategic direction is vague on housing – speaking about opportunities for healthy living (e.g., access to parks, grocery stores, and safe neighborhoods) (p.22). “Healthy Eating,” which is part of Priorities (pp.29-31), does not refer to housing at all, even though the house is where many decisions of what to eat and how to prepare meals are made.

    Home interiors should be part of eliminating disparities efforts.

  • The Centers for Disease Control and Prevention Built Environment Assessment Tool focuses on exterior features at the neighborhood level: infrastructure (such as road types and public transportation), walkability (such as access to safe, attractive sidewalks and paths), bikeability (such as the presence of bike paths), recreational sites and structures, and food environment (such as access to grocery stores and farmers markets).

    Home interiors are as instrumental to health as exterior environments.

  • The CDC’s National Action Plan for Child Injury Prevention touches on interior features of home environments, asking for example: are there gates in the appropriate stairways and doorways (p.2)? Do you leave food unattended while it is cooking and the child is in the room (p.4)? And, is the television secured to the wall or other furniture (p.5)?

    A more targeted and intentional effort can expand awareness of how interior elements can result in child injury.

  • How Housing Matters.org argues that “The disparities are linked because where you live offers access to what makes you healthy or unhealthy, from housing without lead or asthma triggers to grocery stores with fresh vegetables, to parks and sidewalks, and access to jobs” (p.3).

    The list of environmental facets that impact health would be more holistic if elements of home interiors and how they impact peoples’ ability to live healthy lives were included.

  • The County Health Rankings & Roadmaps program ranks the health of nearly every county in the nation and shows what we can do to create healthier places to live, learn, work, and play. “Severe housing problems” include percent of households with overcrowding, high housing costs, or lack of kitchen or plumbing facilities (p.5).

    Expand considerations of what can constitute severe housing problems.

Minnesota

  • The Minnesota Department of Health’s (MDH) Advancing Health Equity in Minnesota – Report to the Legislature calls for a comprehensive approach to achieving health equity that includes a broad spectrum of public investments in housing, transportation, education, economic opportunity and criminal justice – structural systems that can benefit one population unfairly. Home ownership for example, is singled out due to the significant segregation in Minnesota’s neighborhoods and disparities in home ownership. In 2012, more than 75 percent of the White population in Minnesota owned a home, but only 21 percent of African Americans in Minnesota were homeowners (p.91). This gap creates inequities as it prevents people of color from the multiple benefits associated with home ownership, including having a source of financial stability that facilitates school performance and health.

    Delve deeper into the role of housing in health equity by considering unexpected uses and unintended consequences in home interiors.

  • The Minnesota Student Survey asks questions about activities, experiences and behaviors, tackling topics such as tobacco, alcohol and drug use, school climate, physical activity, violence and safety, connections with school and family, and health. Nutrition for example, tackles consumption of milk or sodas (2013, p.12), leaving out factors related to the built environment.

    Include questions around home interiors to help gauge impacts of the built environment on student health.

  • The Project EAT study asks: “During the past seven days, how many times did all, or most, of your family living in your house eat a meal together?” (p.10) or “In my family, it is important that the family eat at least one meal a day together” (p.13) and “In my family, we don’t have to eat meals at the kitchen/dining room table” (p.13). The survey also looks at identifying impediments to family meals, including difficulty to find a time to eat together, different schedules, and having access to adequate food.

    Challenge assumptions such as that all families have a place to sit together and share a meal. Add questions that establish the place-related factors that can impact how and when one eats.