Health, Housing and the Law

Abstract

A decent dwelling in a healthy community is necessary for health and well-being.

This article assumes that increasing the proportion of Americans who live in healthy homes in socially and racially heterogeneous communities would be good for individual and collective well-being alike. Both healthy homes and diverse communities are consistent with the stated values and preferences of most Americans,1 and the law has done much to promote them through levers like the Fair Housing Act and the Low Income Housing Tax Credit (LIHTC). Regulations have taken aim at residential lead hazards, and federal housing subsidy programs have put billions of dollars every year into low income rental assistance. Dedicated lawyers, community organizations, and bureaucrats work with these tools every day, and every day they win battles. It is not their fault we have lost the war.

The promise of fair housing law has more often been honored in the breach than the observance, and the United States remains segregated by race and class. Poor tenants remain largely powerless in conflicts with their landlords, facing tragic choices between housing and exposure to toxins, such as lead and mold. For the poorest, eviction is a common, devastating experience. The country has a shortage of affordable units. Vouchers remain a perpetual pilot, available to only a small proportion of those who need them. Sadly, law was much more successful in promoting segregation in the first 70 years of the 20th century than it has been in remedying the problems in the last 50 years.

In this article, we take three preliminary steps that strike us as necessary for using law more effectively in an adaptive, system-oriented process of promoting healthier, more equitable communities. In Part II, we propose (and defend) a broad goal of health equity in housing. In Part III, we offer a heuristic model of the system of legal levers that are arguably instrumental to that goal. We hope that such a model can be a useful tool for breaking the wicked problem of health equity in housing into a set of tamer ones. Finally, in Part IV, we grapple with what we actually know about these legal levers. Despite the importance of housing, the effects and operation of many of the primary legal levers have not been studied. While research cannot produce definitive answers to wicked problems, it can serve to help define problem elements, narrow the range of solutions, and improve implementation. We conclude in Part V with some early thoughts about next steps for a renewal of systematic efforts toward housing equity.

Keywords: equity, legal epidemiology, public health law research, evidence

JEL Classification: I14, K11