Housing in the United States is in bad shape. There are not enough units, and where there are units, they are often not affordable, and not in the right places. These problems are a result of the U.S. housing system, which is a complex set of people, organizations, laws, and conditions that interact to produce our current housing arrangements. This system has created a chronic shortage and affordability gap and persistently inequitable, segregated, and unhealthy living conditions for millions of Americans. 

In our view, achieving health equity in housing means that a substantial proportion of people living in the U.S. will have the option to live in racially and socio-economically mixed communities where all residents benefit from safe and affordable homes, good schools, transportation, parks and recreational facilities, and economic opportunities. Access to safe, stable, affordable housing in diverse communities is incredibly important for health. Housing hazards such as lead and mold can lead to or exacerbate respiratory issues or neurocognitive problems; families who spend a large portion of their income on housing may forego healthcare or healthy foods; and living in a highly racially segregated neighborhood has been associated with several negative health outcomes.

Law has done much to create and maintain the communities we live in now, and it will be indispensable to changing them for the better. So, how can laws and policies help realize this vision? We need to change those that are most harmful, improve those that seem to be working, and further study those that have potential to create equity, but still lack a strong evidence base.

In a new report series, our team at the Center for Public Health Law Research at Temple University’s Beasley School of Law has identified 30 legal mechanisms, or policy levers, aimed at shaping the housing system and that may potentially affect health equity in housing.

Changing laws that cause harm to communities

In our research, we identified some legal levers that are recognized as doing more damage than good. Exclusionary zoning laws are perhaps the biggest culprit. These are laws that dictate and restrict land use for specific reasons (e.g., to control neighborhood density). In practice, exclusionary zoning laws have been used to prevent the development of multi-family units, which often means barring access to these neighborhoods for people with low incomes or people of color.

Exclusionary zoning laws could be changed to allow for greater density. In October 2019, Minneapolis city council approved a plan that essentially ended single-family zoning. Other legal mechanisms to address exclusionary zoning -- such as state laws requiring consideration of affordability in local housing plans, and laws removing barriers to developing affordable housing (e.g., the Mount Laurel doctrine, California’s housing element law, and Massachusetts’s 40B) -- have had some success, but overall their impact on producing health equity in housing has been limited.  Obstacles to full success include NIMBY (“not in my back yard”) attitudes that can lead groups in a community to use zoning laws to prevent the building of affordable housing.

The Fair Housing Act could be used to combat zoning laws that disproportionately exclude people of color from certain neighborhoods. However, the U.S. Department of Housing and Urban Development’s (HUD) proposed disparate impact rule may impact the Act’s ability to fight policies that have discriminatory effects, such as some zoning laws.

Tweaking laws that have potential to do good

Some legal levers seem to be working to improve health equity in housing—at least in some ways. Both the Low-Income Housing Tax Credit (LIHTC) program and the Housing Choice Voucher program make housing affordable for many people, but neither program has sufficiently contributed to eliminating the affordability crisis. And so far, it doesn’t appear that either program has significantly reduced concentrations of poverty or racial segregation.

With the LIHTC program, states use the Qualified Allocation Plan (QAP) to set priorities and determine which projects will get credits. States could use these plans to extend affordability requirements, or to encourage the siting of developments in high opportunity (low-poverty) areas. For example, New Jersey’s QAP requires approximately 60 percent of the tax credits to be allocated in low-poverty areas, and awards points to developments near places such as health care facilities or full-service grocery stores.

For the Housing Choice Voucher program, policymakers could consider adopting a method of calculating subsidies that makes it easier for voucher holders to move to higher-resourced, lower-poverty areas. Currently HUD mandates that 24 metropolitan areas use such a method. Increasing voucher anti-discrimination laws could reduce discrimination by landlords against tenants based on voucher use. Another important consideration is the underfunding of this program: currently, only 1 in 4 people who are eligible for a voucher actually get one.

Filling the knowledge gaps about housing law and health equity

There is still so much to learn about how housing laws can be used to support health equity.

In our research, we identified a number of levers that might have potential, but have not been sufficiently evaluated, so we don’t really know enough about their effectiveness and potential impact. These are the “research agenda levers” — the areas where we should consider investing time and research dollars to understanding more about these laws. 

For example, there are some recent trends toward adopting tenant protection laws. Earlier this year, Oregon became the first state to impose statewide rent control, and California recently followed. New York City and Newark, NJ have laws requiring that free legal representation in housing court be provided for low-income tenants facing eviction. San Francisco has a similar law and more jurisdictions are expected to follow. These types of laws may be generally beneficial for the individuals directly affected, but the larger impacts on the housing system are mostly unknown. Do they impact rents in general? The number of units on the market? The eviction filing rate? We don’t know yet, but we should.

More broadly, it is important to take learning more seriously. Successful use of legal levers to produce health equity in housing requires a systematic experimental approach -- a deliberate process of rapidly evaluating the implementation and impact of innovative ideas, and spreading those that work. We can’t leave legal “treatments” to chance.

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