OHFA Releases Health Impact Assessment Report

The Ohio Housing Finance Agency (OHFA) recently released the Health Impact Assessment (HIA), a report that examines the health implications of a proposed government policy to align affordable housing inspections. OHFA was awarded a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, to conduct the assessment. The HIA is intended to inform the revision of compliance rules and policies for housing inspections, both within OHFA’s state-level compliance standards and at the federal level.

The HIA is also intended to guide decisions on a proposal to improve interagency coordination and streamline the current system for housing inspections of affordable housing units. At present, different inspections are conducted or required by local housing authorities, HUD, the IRS, and the USDA.

The Link Between Housing Quality and Health

Living in poorly maintained housing contributes to a variety of health conditions including asthma and other respiratory symptoms, neurological disorders, injury, and mental health problems. Indoor moisture, visible mold, and pests have been associated with the development of asthma and other respiratory symptoms. Housing conditions also contribute to accidental injuries and deaths, as the presence of functional smoke alarms and clear means of egress are associated with a lower risk of residential fire morbidity and mortality.

Housing conditions that have been linked to the development of chronic disease or chronic disease risk factors include interior and exterior housing deterioration, general poor quality of housing, lack of satisfaction with one’s dwelling, and poor ventilation. The report stated that there is weaker evidence for the impacts of housing conditions on mental health, as the effects of housing quality are difficult to separate from other housing-related factors, such as instability and disarray (that is, housing that’s cluttered or dark). However, well-maintained housing conditions have been associated with higher psychological well-being compared to poorly maintained housing.

Substandard Housing Has High Economic Costs

Since the home is the source of many environmental exposures that can negatively affect health, substandard housing itself can have high economic costs. Conditions, like those linked to the development of lead poisoning, respiratory disorders, and chronic diseases are estimated to have significant economic costs due to increased medical expenditures for treatment and lost productivity in the workplace resulting from the illness. For example, childhood environmental exposures leading to asthma, cancer, lead poisoning, and neurobehavioral disorders are estimated to cost the nation $54.9 billion per year (in 1997 dollars).

Affordable Housing Serves Vulnerable Populations

Substandard housing has disproportionately negative effects on certain subpopulations living in affordable housing. Affordable housing tenants are vulnerable due to extremely low incomes, but also 21 percent of households report a disabled household member and 38 percent are single adult households with children. Specifically, African Americans are at a higher risk for asthma, very young children are at risk for lead exposure, and young children and the elderly share a higher risk for injuries. While chronic diseases affect older adults, there’s evidence that housing conditions during childhood can affect their disease development.

Role of Affordable Housing Physical Inspections

Physical inspections monitor housing quality, act as a catalyst for tenants to report housing maintenance issues, and are used to educate tenants about how to maintain their units. Public housing, housing assisted under certain HUD programs, and LIHTC properties adhere to the Uniform Physical Condition Standards (UPCS). The UPCS inspection protocol was designed to ensure that affordable housing properties are “decent, safe, sanitary, and in good repair” while maintaining objectivity and uniformity in reporting standards.

While physical inspections are based on UPCS, the inspection findings differed between housing agencies on most of the health-related housing quality issues, suggesting the need to strengthen the affordable housing inspection process. Better enforcement of existing housing codes and coordination of assessment protocols could help to address housing conditions associated with health problems, such as moisture intrusion, pests and other sources of allergens, non-working smoke alarms, and unprotected stairs/windows. With the variety of existing housing inspection protocols available for use, consideration of which tool will be the most health protective to both monitor housing quality and identify areas for repair is necessary.

While reducing affordable housing inspections may make sense financially, the report found that there are serious health implications for residents. The report includes several key findings:

• The prevalence of specific health-related violations (relating to fire, pests, mold, appliances, air quality, ground fault circuit interrupters, accessibility, plumbing, and trip hazards) varied by funding agency, project size, and project age.
• Properties inspected by more than one funding agency frequently found the same housing quality issues.
• Property managers’ maintenance practices appear to vary and impact their ability to identify health-related housing quality issues in the absence of inspections.
• During interviews, property managers and residents identified physical inspections as an impetus for reporting housing maintenance issues.

Based upon these findings, the following recommendations were developed to minimize the negative health impacts of the proposed policy:

• Implement a single standard across agencies, which is most likely to find health-related quality and safety problems to optimize health. A standardized physical inspection tool will increase consistency in reporting and noncompliance remediation, which will improve health.
• Establish ongoing training to increase the quality of physical inspection reports and to raise awareness of housing-related health issues among inspectors.
• Develop and implement a risk-based inspection agenda that focuses resources, streamlines inspection schedules based on housing and tenant characteristics, and is protective of adverse exposures and health.