Legal Levers for Health Equity in Housing

Overview

To date, the U.S. housing system has created a chronic affordability gap and persistently inequitable and unhealthy living conditions. Law plays an important role in shaping that system, but there is too much unknown about the impact of housing laws and policies on health and health equity. This report series by the P4A Research Hub at the Center for Public Health Law Research at Temple University’s Beasley School of Law aims to highlight these gaps, and to suggest areas for research and action needed to produce healthier communities.

1. A Vision of Health Equity in Housing – This report reviews old and new evidence about health, health equity and housing, to make the case for “health equity in housing” as a top goal of the movement to create a Culture of Health in America.
2. Legal Levers for Health Equity in Housing: A Systems Approach-- The second report describes some of the factors that make housing in the U.S. a complex system, and establishes a model of the key legal elements, or levers, in that system. The five domains in the model include: Increasing the Supply of New Affordable Housing; Maintaining Existing Housing as Affordable, Stable, and Safe; Affirmatively Furthering Fair Housing; Enhancing Economic Choice for the Poor; and Governance.
3. Health Equity in Housing: Evidence and Evidence Gaps – The third report outlines what we know and don’t know about the impacts of 30 legal levers across the five domains, and how they are influencing health equity in housing.
4. Creative People and Places Building Health Equity in Housing – This report shares findings from interviews with 50 housing practitioners and leading researchers about the use of legal levers for health equity in housing.
5. Governing Health Equity in Housing – The fifth report focuses on governance as an approach to the challenge of achieving health equity in housing. It illustrates a successful practice of effective governance in one of fair housing’s greatest success stories, the achievement and maintenance of health equity in housing in Oak Park, Illinois.
6. Health Equity through Housing: A Blueprint for Systematic Legal Action – The final report in the series offers a set of qualified recommendations that integrate the empirical evidence, the voices from the field, and the theories of system governance that we reviewed in the previous reports.

Findings

The research team identified 30 legal mechanisms, or policy levers, aimed at addressing housing problems in the United States. Recognizing that housing is a complex system, involving many different people, organizations, and conditions, the team organized these levers into five domains. They conducted extensive literature scans to establish what is known about the impacts and effectiveness of these levers, and semi-structured interviews with 50 individuals active in housing policy and practice to gauge the effectiveness of the legal levers in achieving health equity in housing: what works, what does not, and what might be tried next?

Findings suggest a lack of evidence on whether legal levers are actually doing what they purport to do, and whether they are tending to produce the broader goal of health equity in housing.

Due to the complexity and interconnectedness of the U.S. housing system, the solution requires a systems approach – no one lever alone can be the answer.

Using legal levers to achieve health equity in housing will require:

1. changes to levers that seem to be mostly harmful (e.g., exclusionary zoning), 
2. tweaks to levers that seem to be mostly positive (e.g., LIHTC and Housing Choice Voucher program), and 
3. systematic evaluation of laws that seem to have potential but little is known about their impacts (e.g., laws aimed at protecting tenants).

Implications for Policy and Practice

Like other treatments, laws can have unexpected side effects. This means that evaluation — and less formally, careful observation and frequent reflection — must be integral to strategies for change. Laws that don’t work, or cause harm, squander the efforts that went into enacting and enforcing them. Worse, as long as they are perceived as “solutions,” they can stand in the way of further policy innovation and reform. This report series organizes what is known and unknown about the impacts of housing law and policies on health and equity across a broad landscape of the housing system. It establishes a research agenda for legal epidemiology on housing, and presents a roadmap for policymakers, advocates and others working in housing to guide decision-making.