Our homes and neighborhoods have a powerful impact on our physical and mental health, with the potential to exacerbate chronic and acute health problems and cost the U.S. billions of dollars annually. Sherry Ahrentzen and Lynne Dearborn investigated how the Low-Income Housing Tax Credit (LIHTC), the nation’s largest source of funding for the development and preservation of affordable rental housing, can contribute to shaping a healthier housing stock. 


Using an extensive checklist of housing quality and neighborhood provisions relevant to improved health outcomes for individuals and communities, the research team conducted a comprehensive content analysis of each state’s 2016 Qualified Allocation Plan (QAP), which establishes the criteria for scoring and awarding tax credits to housing developers and investors. Also, in response to a survey, staff in state housing finance agencies (HFA) responsible for developing the annual QAP provided their assessments of priorities, opportunities, and challenges of advancing healthier housing through LIHTC.

Highlights include:

  • Over half of the agencies indicated the most common health-related housing issues in their state included: indoor air quality and ventilation; building accessibility; ease of access to amenities and services that promote health; and toxic or hazardous substances. 
  • While most state QAPs have at least one criteria addressing indoor air quality, moisture control, and toxic substances, few states require or incentivize multiple measures shown to improve asthma, respiratory health, and physiological damage resulting from toxins.
  • States incentivize locating affordable housing in neighborhoods with amenities and services that encourage healthier living but rarely require proximity to these amenities.
  • States that mandate green building certifications also include many healthy housing provisions in their QAP.

Implications for Policy and Practice

The research findings suggest several approaches policymakers can use to expand a healthier affordable housing stock:

Prioritize specific health outcomes for individuals and communities:

Most states, for example, suffer from adverse consequences of high rates of children’s asthma. A complex challenge such as this demands not just a single solution but rather an interconnected set of design and construction provisions for IAQ, eliminating toxic substances, and moisture control.

Strengthen and expand IAQ criteria in post-pandemic building and renovation:

The COVID-19 pandemic highlights the need to incorporate a broader range and deeper concentration of design and construction features that address IAQ, such as those affecting humidification of indoor air or sanitized entryways, as well as access to spaces like daylit rooms and private outdoor spaces that are crucial for supporting mental and social health. 

Mandate GBCs with robust healthy building criteria or Healthy Building Certifications (HBCs): Recent updates to several GBCs incorporate additional healthy building criteria. Moreover, within the last several years a number of HBCs have become more prominent and accessible to affordable housing: Fitwel, National Healthy Housing Standard, and WELL.

Partner with state public health officials in development of QAPs:

While this research suggests some states already collaborate with public health specialists to address supportive housing for specific vulnerable populations, expanding collaborations to public health officials with environmental health expertise can underpin a more holistic approach to incorporate healthy housing criteria in QAPs.