february 2012 human impact partners advancement project .../media/assets/2012/02/rental...february...

R A D : H E A L T H I M P A C T A S S E S S M E N T 1

HOU S I N G Q U A L I T Y

MANAG EM EN T

S O C I A L C A P I T A L

A H E A L T H

I M P A C T

A S S E S S M E N T

T H E

R E N T A L

A S S I S T A N C E

D E M O N S T R A T I O N

P R O J E C T

F e b r u a r y 2 0 1 2

H u m a n I m p a c t P a r t n e r s

A d v a n c e m e n t P r o j e c t

N a t i o n a l P e o p l e ’ s A c t i o n

H U M A N I M P A C T P A R T N E R SKim GilhulySanetaDeVuono-powellLili Farhang

A D V A N C E M E N T P R O J E C TAlexiNunnFreemanAnita Sinha

N A T I O N A L P E O P L E ’ S A C T I O NLiz Ryan Murray

A C K N O W L E D G M E N T S HumanImpactPartners,AdvancementProject,andNationalPeople’sActionwouldliketothankthefollowingorganizationsandtheirmembersforparticipationinthisHIA’sscopingprocess,focusgroups,andsurveys:CausaJusta::JustCauseinOakland,CommunitiesUnitedforActioninCincinnati,CommunityVoicesHeardandGoodOldLowerEastSideinNewYorkCity,PeopleOrganizedforWestsideRenewalinLosAngeles,andtheRighttotheCityAlliance.Theinsightandaccesstheyprovidedenabledthisreporttoconveythevoiceandexpertiseofthosemostimpactedbyfederalpublichousingpolicies. WethankLeconteDill,LauraGottlieb,MarniePurciel-Hill,SaraSatinskyandMarenSpolumforresearchandwritingsupportandCarolineFichtenbergandMeganGaydosfortheirthoughtfulreviewandfeedbackofthisHIA.Finally,wethanktheSanFranciscoFoundationandTheCaliforniaEndowmentforfundingprovidedfortheproject.

S U G G E S T E D C I T A T I O N HumanImpactPartners,AdvancementProject,andNationalPeople’sAction.TheRentalAssistanceDemonstration(RAD)Project:AHealthImpactAssessment.February2012.

For more information, please contact:

Kim Gilhuly, Human Impact Partnerswww.humanimpact.org510.452.9442

AlexiNunnFreeman,AdvancementProjectwww.advancementproject.org202.728.9557

LizRyanMurray,NationalPeople’sActionwww.npa-us.org 312.243.3035

P R I M A R Y A U T H O R S


W H A T I S T H E I S S U E ?

Today,thereare2.3millionpeoplelivinginfederally-fundedpublichousingprojectsaroundthecountry,overhalfamillionfamilieswhoreceiverentalvoucherassistance,andoveronemillionpeopleonpublichousingandrentalvoucherwaitlists.Whilethedemandforhousingassistancehasincreasedovertime,fundingforpublichousinghasdecreasedsubstantially.Localpublichousingauthoritiesaroundthecountry,facedwithmassivebudgetshortfallsandadeterioratingpublichousingstock,areunabletoaccommodatetheneedforsubsidizedhousing,andvariouslocalitieshavebeguntoclosetheirwaitlistsaltogether.

Inresponsetothesesignificantchallenges,multipleproposalstore-organizethefundingandmanagementofpublichousingandtobringforwardadditionalfundshavebeendebatedatthefederalleveloverthepastfewyears.ThemostrecentresultofthesedebatesistheRentalAssistanceDemonstration(RAD)project,whichisapilotprojectapprovedinNovember2011thatmayleadtoasignificantre-structuringofAmerica’spublichousingstock,suchthatthe“public”aspectofpublichousingmaynolongerapply.Specifically,RADcouldallowprivateandnon-profitentitiestotakeoverleaseandmanagementresponsibilitiesandwouldallowforprivateinvestmentresourcestobeputdirectlyintopublichousing.Inaddition,itislikelythatRADwillpromotemovementfrompublichousingintotheprivatemarketthroughrentalvouchers.Additionalcomponentsaredescribedinthesidebar.

Throughallofthesepolicydebates,healthisseldomdiscussed.GiventhatpublichousingresidentshavevulnerablehealthstatuswhosehealthmayfurtherbeaffectedbyRAD,andbuildingonabodyofevidence connecting housing and health, Human Impact Partners, AdvancementProject,andNationalPeople’sActionconductedaHealthImpactAssessment(HIA)onRAD.ThisexecutivesummarydescribesthebackgroundandfindingsoftheHIA,andproposesrecommendationstoimprovetheimpactsofRADsuchthatthehealthofpublichousingresidentscanbeprotectedandpromoted.

R A D C O M P O N E N T S RAD would allow for the following:

• Investmentofprivateresources into what was formerly solely a public asset

• Potentialforownershipbyanon-profitorganizationorfor-profitorganizationusingtax credits

• Restrictionsonthepropertieslimiting what the property can be used for and for how long it must remain “affordable”

• Potentialforincreasedreliance on vouchers without any new vouchers created

• Potentialforincreased,andstricter, residency standards with new housing managers

• Noguaranteeofone-to-onereplacement of hard units if demolition and renovation takes place

• Limiteddiscussionofresidentorganizingandresidentorganizations

• Significantdiscretionleftto HUD Secretary and many aspects dependent on funding

E X E C U T I V E S U M M A R Y

4 R A D : H E A L T H I M P A C T A S S E S S M E N T

W H Y D O E S T H I S M A T T E R ?

The potential impacts of RAD are vast; 2.3 million people living in 1.04millionhousingunitscouldbeimpactedifthepilotprojectisimplementedmorewidely.Theinitialimpactwillbelesssincetheprojectapprovedtheconversionof60,000unitsofpublichousing.However,RADisapilotproject,whichmeansitisbeingimplementedtotestpoliciesforthepublichousingsystemoverall.Notonlywillthisprojectimpactthelivesofresidentsofpublichousing,theprinciplesincludedinRADmorebroadlycouldimpactthelivesofindividualsliving on the edge of economic insecurity. With recent studies reporting that one in six Americans lives in poverty, and as the need foraffordablehousingisontherise, proposals that re-structure the publichousingstockshouldbemeasuredinlightoftherealitythatmoreandmoreindividualsarelivingontheeconomicbrinkandneedthestabilityandaffordabilitythatpublichousingprovides.

In recent history, policymakers have focused intense resources on relocatingresidentsoutofpublichousinginattemptstoimprovetheir socioeconomic status and to deconcentrate poverty (e.g., Moving to Opportunity, HOPE VI, and the Gautreaux project). In all oftheseapproaches,publicagenciesandhousingadvocateshavegenerally not given much attention to the health impacts associated withsuchsignificantpolicyshifts.Currentdebatesfocusonthecostsandbenefitsofthesevariousapproaches;fewofthosedebates,however,adequatelyincorporatethehealthofresidentsandcommunities,mostofwhomarepeopleofcolor,aspartofthatcost-benefitanalysis.

This lack of attention to the potential health impacts is particularly strikinggiventhevulnerablehealthstatusofmanypublichousingresidentsandtherelationshipbetweenhousingandhealth.Scientificstudiesfindthatpublichousingresidentsreport:poorerhealth;increasedlevelsofasthma,hypertension,diabetes,obesity,depression, and smoking; decreased levels of physical activity; andexposuretopoorindoorairqualityandpests.Publichousingresidentsarenottoblamefortheseconditions.Varioussocial,economic, and environmental factors interact to create poor health in populations:income and employment, neighborhoodinvestmentandquality,andaccesstoretailgoodsandserviceshaveallbeenshownto determine health status and health disparities.


W H A T I S H E A L T H I M P A C T A S S E S S M E N T ?

Health Impact Assessment (HIA) is a public engagement and decision-support tool that can be used to assess the health impacts of planning and policy proposals, and make recommendations to improve health outcomes associated with those proposals.

The fundamental goal of HIA is to ensure that health and health inequities are considered in decision-making processes usinganobjectiveandscientificapproach,andengagingaffectedstakeholders in the process.


Policydecisionsthataffecthealthdeterminantssuchashousingquality,stability,andaffordabilitymustbeviewedinthecontextofhealthneeds.Withouttheconsiderationofhealthimpacts,publichousingreformeffortsmayexacerbateexistinghealthvulnerabilities.TheamountofdiscretioninRAD,aswellastoofewprotectionsforlong-termaffordability,hasraisedconcernsamonglow-incomeandpublichousingadvocatesaroundthecountry.Infusingprivateresourcesintoatraditionally-governmentrunprogrammaybringforthadditional(andmuchneeded)funding,butmayalsoincorporatetherisksassociatedwithprivatefinance,potentiallyjeopardizingthepermanentaffordabilityandstabilitythatpublichousingprovidestoitsoccupants.

Toensurethattheevaluationofthispilotprojectcomprehensivelyconsidersthehealthimpactsofpublichousing-relatedpolicydecisionsandtomakerecommendationsforhowtomitigatepotentialimpactsforboththepilotperiodandthelong-term,HumanImpactPartners,AdvancementProject,NationalPeople’sAction,andanetworkofcommunity-basedorganizationsconductedahealthanalysis,ora“HealthImpactAssessment”(HIA)ofRAD.

ThisisthefirstHIAeverconductedofafederalhousingproposal.

W H A T D I D W E S T U D Y ?

HumanImpactPartnersandAdvancementProjectdeterminedthataHIAwaswarrantedprimarilybecauseifRADcontinuesbeyondthepilotperiod,ithassignificantpotentialtoaffectthehealthofallpublichousingresidents(overtwomillionindividuals)aswellastheincreasingnumberofindividualsandfamiliesinneedofsubsidizedhousingacrossmanygeographicareas.Inaddition,RADcouldaffectexistinghealthdisparitiesgiventhatpublichousingresidentsexperiencepoorerhealthoutcomeswhencomparedtothegeneralpopulation.Becausemethodsexistedtodocumentthebreadthofpotentialhealthimpactsandnumerousorganizationswerereceptivetoananalysisofhealthtobeincorporatedintohousingpolicydebates,wewereabletocompletethisHIA.

Thereisnosinglecausalpathwayfortherelationshipbetweenpublichousingandhealth–healthisimpactedbyvariousdimensionsofhousing,includingconditionsandquality,affordability,location,andstability. In determining thescopeofresearch,partnersforthisHIAagreedthatimpactsonhealthwouldbeassessedbyexaminingimpactsonseveralmediatingfactors(or“healthdeterminants”),including:typeofmanagement,evictions,andresidentorganizing;housingaffordability,stability,andquality;andsocialcapital.Literaturereview,evaluationsofpriorhousingrelocationprograms,focusgroupsandsurveys,andavailablequantitativedatawereusedtoassessimpactsontheseelements.GiventhepotentialforthepolicytoimpactcitiesandcommunitiesacrosstheUnitedStates,partnersdecidedtofocusthisHIAinseveral“casestudy”cities,specificallyNewYorkCity,LosAngeles,Cincinnati,andOakland,asawayofgroundingthefindingsandillustratinghowcomponentsofRADmightimpactspecificpopulations.


W H A T D I D W E F I N D ?

Overall,thisHIAfindsthatRAD,ascurrentlywritten,willhavesignificantimpactsonthehealthofpublichousingresidents and communities, and the impacts are more negative than positive – especially if recommendations proposed in this HIA are not adopted. The areas of impact relate to type of management in public housing, evictions,andresidentorganizing;housingquality,affordability,andstability;andsocialcapital.

Theseimpactswillbemorefar-reachingifRADisexpandedbeyondthepilotperiod.Ascurrentlywritten,mostoftheimpactsonthehealthofpublichousingresidentswouldbenegative,eitherbyintroducingnewnegativeimpacts,suchasdecreasingsocialcohesion/socialnetworks,orbyexacerbatingalreadypoorhealthoutcomes,suchas increasing stress. Some positive impacts may result from RAD, particularly in the areas of crime and violence and housing maintenance.

Due to the lack of economic and social investment in many of these communities and the existing health vulnerabilitiesofmanypublichousingresidents,publichousingprovidesanimportantsafetynetandsourceofstabilitythatprotectsresidenthealth.ThisHIAfoundthatvariousdimensionsofRADwouldimpacthealthinbothdirectandimmediate,andindirectandlong-termways.Thefactorsatplayarevariousandnotmutuallyexclusive–changestoanyoneofthesefactorswillnecessarilyimpactotherfactorsthataffectphysicalandmentalhealth.Specificresearchfindingsandimpactanalyses(whatweanticipatetheimpactsofthepublichousingreformpoliciestobeonhealth)relatedtothehealthdeterminantsstudiedinthisHIA–typesofpublichousingmanagement,evictions,andresidentorganizing;housingquality,affordability,andstability;andsocialcapital–aredescribedbelow.Recommendationsonhowtomitigatenegativehealthimpactsfollowourfindings.

1 . R E S E A R C H F I N D I N G SBecauseRADprimarilytargetsthemanagementandownershipstructuresofpublichousing–andbecauseimpactsonevictionsandresidentorganizing;housingquality,affordability,andstability;andsocialcapitalareexpectedtoresultfromchangesinthosemanagementandownershipstructures–wediscussourHIAresearchfindingsandimpactsrelatedtomanagementfirst,andthenfollowwiththeassessmentoftheotherdeterminants.Overall,therearemanydifferentoutcomesthatRADcouldhave–somearepositiveandsomearenegative–andthey,attimes,mayseemtoconflict.ItisimportanttonotetheoverarchingcategoryofimpactandunderstandthatHIAoftenhighlightstrade-offsbetweencategoriesofimpacts.

T y p e o f M a n a g em e n t , E v i c t i o n s , a n d R e s i d e n t O r g a n i z i n g• Overthepastseveraldecades,publichousingbudgetshavedecreasedby48%whilefundingforvouchers

hasincreasedby403%.Moreandmore,thepublichousingstockintheU.S.isbeingprivatelymanaged.

• Sincethe1980s,anti-crimelawshaveerodedprotectionsforpublichousingresidentsandthosereceivingvouchers.Forexample,residencystandardshaveresultedinthedenialofresidencyforlower-incomepopulationswhoarehardtohouse,includingtheelderly,largefamilies,peoplewithdisabilities,andthosewhohavebeenarrestedorincarcerated,havepoorcredithistories,orareunabletomeetworkand/orschoolrequirements.



• Thereisadearthofstudiesevaluatingthequalityofprivately-managedpublichousingandthereisnonationalorreadilyavailablelocal data on the evictions resulting from implementation of residency requirements.

• OurHIAfocusgroupparticipantsoverwhelminglystatethatevictionisamainreasonwhypeoplemoveoutofpublichousing.Theseresidentsstatethattheriskofeviction,beingcaughtbreakingarule,orachild/visitingfriend/familymemberbreakingaruleandriskingevictionforthewholefamily,wasstressfulintheirlives.

• Researchshowsthatresidentparticipationinpublichousingaffairshas resulted in improved physical and living conditions, improved qualityoflife,greatersenseofcontrol,andincreasedcommunitybuilding.Participationisgreatestamongthosewhohaveresidedinpublichousinglonger.

• Historically,publichousingresidentshavebeenabletoorganizeandadvocatethroughresidents’associations.However,mechanismstoensure that residents have a meaningful voice in decision-making couldbestronger.

H o u s i n g Q u a l i t y , A f f o r d a b i l i t y , a n d S t a b i l i t y

H o u s i n g Q u a l i t y • Decadesofinadequateinvestmentinpublichousinghavetranslated

intomanyunitsbeingindisrepair. AU.S.HousingandUrbanDevelopment(HUD)inventoryestimatedthecapitalneedsas$21billionfortheentirepublichousingstock.

• Substandardhousingconditionscausestressandcontributetoavariety of health impacts including respiratory disease, neurological disorders, chronic disease, and mental health.

• Resultsareconflictingwithrespecttowhetherresidentrelocationviahousingmobilityorrelocationprogramshasledtohealthimprovements.

Feelings about management are summed up by a focus group participant who stated,

“The stress levels residents face dealing with managementisunbearable.”

H I A F o c u s G r o u p P a r t i c i p a n t

“……‘cause it just has been run into the ground and not by just the folks that live there, but by not having money to keep it up. It feels like a project failed and the people in it feel that way, too. I think that’s the reason no one takes pride in it anymore.”



H o u s i n g A f f o r d a b i l i t y• Lackofincomewithwhichtopayforadequatehousingcanlead

toadversehealthoutcomesassociatedwithhomelessness,overcrowding,and/orlivinginsub-standardhousing.Housinginsecurityhasbeenassociatedwithstressandtherearesignificantassociationsbetweenhighhousingcostsandhunger,inadequatechildhoodnutrition,andpoorchildhoodgrowth.

• Therearenumerousobstaclesforpublichousingresidentstotransition into the private market, including discrimination against andexploitationofvoucherholders,difficultypayingforandadjustingtoutilitybills,andlackofunderstandingaboutprivatemarkets,rentcalculations, and security deposits.

• ArecentHUDstudyfoundthat7.1millionhouseholdswerefoundtohave“worstcase”housingneedsin2011–anincreaseof42%since2001.Thesehouseholdsarecomprisedofverylow-incomerenterswhoeither(1)pay more than one-half of their monthly income for rent;or(2)liveinseverelyinadequateconditions,orboth.The crisis is exacerbatedbythelargedisparitybetweenavailablepublichousingunitsandthenumberofhouseholdsonwaitlists,andthefactthatfairmarketrentsaresignificantlyhigherthanwhatpublichousingresidentscanafford.

H o u s i n g S t a b i l i t y• Publichousingisfoundtoprovideresidentialstability.Becauseofthis

stability,livinginpublichousingduringchildhoodhasbeenassociatedwithincreasedemployment,raisedearnings,andreducedwelfareuse. Also, utilization of preventive health services among those living inpublichousingequaledorexceededthoseofothercityresidents.Thisstabilityalsofacilitatesdevelopmentofsocialrelationships.

• Studiesdocumenthighlevelsofresidentialinstabilityamongvoucherusers. HUDdataindicatesthatpeoplewholiveinpublichousingresidetherefornearlytwicethelengthoftimethanvoucherusersreside in their housing.

• ParticipantsinthisHIA’sfocusgroupscitedstressabouthousingstabilityandpermanenceasamajorconcern.

“I have a great deal of medical expenses. So really, to have to pay $1500 or $1600 or $2200 a month in rent anywhere else…I couldn’taffordit.Iwouldbehomeless.”



“I have lived in public housing for 50 years … grew up here. That’s where I intend to die. My choice. Iloveit.”



S o c i a l C a p i t a l

S o c i a l C a p i t a l / S u p p o r t a n d S t r e s s• Socialsupportprovidesabufferinstressfulsituationsandprevents

feelingsofisolation.Neighborhoodsinwhichresidentsfeelsocialcohesivenesstowardtheirneighborstendtohavelowermortalityratescomparedtoneighborhoodslackingstrongsocialbonds.

• Relocationoutofpublichousinggenerallyhasnegativelyimpactedsocialcapitalandnetworksbycreatingphysicalisolation,diminishingface-to-faceinteractions,andmovingresidentsawayfromsupportsand services.

• Residentsofpublichousingarelivingwithhighlevelsofstress.Most focus group participants in this HIA indicated that they or their neighborsexperiencedhealthissues,amongstthemostcommonlycitedwasstressassociatedwithhousinginsecurity.

R a c i a l a n d E t h n i c S e g r e g a t i o n a n d P o v e r t y C o n c e n t r a t i o n

• Livinginraciallysegregatedneighborhoodshasbeenassociatedwithhigher infant mortality, overall mortality, and crime rates that cause injury and death. The concentrationofpovertyhasbeenassociatedwithhighunemploymentrates,highschooldropoutrates,andcrime and violence. These are often reasons cited for demolishing publichousing,eventhoughmanyoftheseneighborhoodsalsolackcritical social services that may ease these health risks and other consequences.

• Segregationiscommoninpublichousing.Nationally,therearethree times as many African-Americans and one and a half times as manyLatinoslivinginpublichousingascomparedtothegeneralpopulation.

• Publichousingrelocationprogramshavehadmixedresultswithrespect to achieving stated goals of racial and ethnic integration and poverty deconcentration. Residents often re-concentrate into segregatedand/orpoorcommunities,andthereislittleimprovementin individual income levels.

“Closeness to family and friends are important to ourcommunities.”

“Iknowmyentirefloorand at least somebody on everyfloor,[and]Ihaveaninvestment and connection. All the old folks tell me hello, and they are invested andwanttoseemegrow.”

H I A F o c u s G r o u p P a r t i c i p a n t s

“I don’t want to leave whereIlive;Iwantthemto just take better care of it as if we lived with rich peoplenow.”


1 0 R A D : H E A L T H I M P A C T A S S E S S M E N T

C r i m e a n d V i o l e n c e• Crimeandviolenceareoverwhelminglystatedasaconcernamong

publichousingresidents.Crimeisoftendiscussedintandemwithcommentsaboutthecommunitiesinwhichpublichousingislocatedinandtheinabilityofmanagementtointervene.

• Housing relocation programs have, overall, reported positive impactsoncrimeandviolence.Researchassessingwhethercrimeis displaced to other communities illustrates that crime decreases overall.

• However,thesocialcohesionpeoplefeelinpublichousingactsasabuffertoperceivedcrime,andthisperceptioncanhaveaprotectiveeffectforresidentswithrespecttocrime.

S t r e s s• BoththeliteratureandourHIAfocusgroupfindingsconfirmthat

theresidentsofpublichousingarelivingwithstress.Mostofourfocusgroupsparticipantsindicatedthattheyortheirneighborsexperiencedsomehealthissues,themostcommonlycitedbeingstressassociatedwithcrimeandhousinginsecurity.

2 . I M P A C T A N A L Y S I S F I N D I N G S A N D S U M M A R Y T A B L EPredictionsofimpactsweremadebasedontheresearchfindingsincludedinthereport,andonthe“determinantsofhealthoutcomes”–i.e.,typeofmanagement,evictionsandresidentorganizing;housingquality,affordability,andstability;andsocialcapital.ThroughouttheHIA,wedemonstratetheconnectionsbetweenthesedeterminantsandhealthoutcomes,andwherepossibleweincludefutureimpactsonhealth.PredictionsofhowRADwillimpacthealthdeterminantswerequalitativelymadeusingfindingsfromtheliterature,existingconditionsdata,andfocusgroup and survey results. Given the lack of detail in RAD, the predictions belowreflectourbestinterpretationofthecomponentsofRAD.


“I feel stressed at times, cause it feels like things ain’t getting better, they are getting worse. Also they are always talking about the projects are gonna be sold soIworryaboutthat.”


R A D : H E A L T H I M P A C T A S S E S S M E N T 1 1

Wepredictthatchangesinthetypesofmanagement,ascurrentlywritten,are likely to lead tothefollowingimpacts:

• Improvedhousingconditionsduetomoreresponsivemaintenancepracticesbecauseofincreasedfundingavailablefromconversions.Healthbenefitsincludefewerinjuriesandimprovedmentalandphysicalhealth(e.g.,respiratoryhealth).However,iffundingisallocatedtorepairtheleastdistressedhousingstock(e.g.,failingtoprioritizethehousingthatismostinneedofrepairs)and/orifrenovationsarenotcompletedusinghigh-qualitystandards,healthbenefitsassociatedwithimprovedmaintenancemaybelimited.Furthermore,ifongoingfundsarenotcommittedtomaintenanceoverthelong-term,anyhealthbenefitsmaynotlast.

• Improvementsinsafety,crime,andviolence.Ascrimeandviolencedecrease,healthimpactswouldincludefewerinjuriesanddeaths,aswellasdecreasedstressandstress-relatedhealthconditions.

• Increasedstressamongthosewhofaceincreasedhousingcosts,havefewersocialnetworksandsupport,experiencehousinginstability,and/orareevicted.

Wepredictthatchangesinthetypesofmanagement,ascurrentlywritten,may leadtothefollowingimpacts

• Moretenuousrelationshipsbetweenresidentsandmanagement,andstressassociatedwithdisrespectfultreatmentbymanagement.

• Decreasedstrengthofresidentorganizingprotections,therebylimitingimprovementsinthephysicalconditionsofhousing,anddecreasesinqualityoflife,communitybuilding,andsocialcapital.

• Decreasedhousingstabilityiffinancialimpactsandtimeanduserestrictionsplacethelong-termpermanenceofthepublichousingstockatrisk–leadingtostress,housingcostburden,andthedisruptionofsocialnetworksandsupport.

• Increasedresidencystandardsand/orrequirementsthatwillleadto:

• Increasedevictionsduetonewrulesandone-strikepolicies.

• Housingdeniedtofuturetenantswhocannotmeetresidencyrequirements,includingthosewhohavebeenarrestedorincarcerated(orhavearelativeinthissituation),havepoorcredithistories,orwhoareunabletomeetworkorschoolrequirements.

• Decreasedsocialcohesionandsupportnetworksthrougheviction,relocation,and/ordisplacement.

• Increasedhousingcostburdenforresidentsrentingatlessaffordableratesintheprivatemarket.


Potentialpromotionofmobilitythroughtenant-basedvouchersis likely to leadtothefollowingimpacts:

• Improvedmentalhealthandperceptionsofneighborhoodsurroundingsamongadults.

• Housinginlessraciallysegregatedandpoorcommunities,thoughnotsignificantlyless.

• Increasedhousingcostburdenandassociatedhealthimpacts(e.g.,havingfewerresourcesforotherdailyneeds,poorqualityhousingconditions,overcrowding,andhomelessness).

• Decreasedhousingstabilityandincreasedthreatofevictionwhenrentingthroughtheprivatemarket,causing negative health impacts.

• Decreasedsocialcohesionandsupportnetworksthroughtherelocationprocess.

• Decreasedabilitytoorganizeforbetterconditions.

Thereareseveralimportantcaveatstoconsiderinrelationtotheseimpacts:

• Anychangesinpublichousingwillhaveadisproportionateimpacton“hardtohouse”populations–e.g.,theelderly,largefamilies,peoplewithdisabilities,andthosewhohavebeenarrestedorincarcerated,havepoorcredithistories,orareunabletomeetworkorschoolrequirements.

• ThereiscurrentlynofundingforvouchersoradditionalvouchersbeingcreatedthroughRAD.Therefore,mobility-basedimpactswilloccuroverthemedium-to-longtermonlyifmorevouchersareprovided.

• Theimpactsdescribedabovewillvaryovertheshort-to-longterm.Someimpactswilltaketimebeforemanifestinginvisibleways,whileothersmayoccurimmediately.Furthermore,impactsthatmayinitiallybepositive may change over time, and vice versa.

• Manyofthefindingsassessedinthereportareinpartbasedonevaluatingpasthousingrelocationprograms, including MTO, HOPE VI, and the Gautreaux project. Research from these programs demonstrates limited positive impacts on health and health determinants. RADdifferssignificantlyfrompastprogramsinwaysthatcouldfurtherlimitpositiveimpactsonhealthandhealthdeterminants.Inparticular,MTOprovidedextensivefundingforvoucherswherenoneisprovidedhereandunderHOPEVI,manypublichousingcomplexesweredemolishedandrebuilt,whichisnotanticipated in RAD.



ThetablebelowsummarizestheimpactsofRADonhealthdeterminantsprioritizedinthisHIA.Includedisinformationonthedirection,magnitude,andseverityofimpacts,whichisdefinedbelow,aswellasthestrengthofthe evidence and any uncertainties regarding predictions.

E x p l a n a t i o n s :Impact referstowhethertheproposalwillimprovehealth(+), harm health (-),orwhetherresultsaremixed(~).

Magnitude reflectsaqualitativejudgmentofthesizeoftheanticipatedchangeinhealtheffect(e.g.,theincreaseinthenumberofcasesofdisease,injury,adverseevents):Negligible,Minor,Moderate,Major.

Severity reflectsthenatureoftheeffectonfunctionandlife-expectancyanditspermanence:High=intense/severe;Mod=Moderate;Low=notintenseorsevere.

Strength of Evidence referstothestrengthoftheresearchandevidenceshowingcausalrelationshipbetweenmobilityandthehealthoutcome:•=plausiblebutinsufficientevidence;••=likelybutmoreevidenceneeded; •••=causalrelationshipcertain.Acausaleffectmeansthattheeffectislikelytooccur,irrespective of the magnitude and severity.

H E A L T H

D E T E R M I N A N T

I M P A C T M A G N I T U D E

( H O W M A N Y ? )

S E V E R I T Y

( H O W B A D ? )

U N C E R T A I N T I E S

Type of Management

Eviction

Resident Organizing

Housing Quality

Affordability

Stability

Socialcohesion/ Socialnetworks

Segregation

Concentration of poverty

Crime

Stress

~-~+--- ~~ +~

Minor- Moderate

Moderate

Minor

Moderate-Major

Moderate-Major

Moderate-Major

Major

Minor- Moderate

Minor- Moderate

Moderate-Major

Moderate-Major

Low-Moderate

Moderate

Low

High

Moderate

Moderate

Moderate

Low-Moderate

Low-Moderate

High

High

••

••

••

••

••

••

••

•

•

••

••

E V I D E N C E

S T R E N G T H

Abilitytoinformallyimplement stricter residency rules

Resident organizing protections

Strength of eviction protections

Assuming funds target the most distressed housing stock

Howtimeanduserestrictionswillbeimplemented

Uncleartheextenttowhichtenant-basedvoucherswillbedistributed


W H A T D O W E R E C O M M E N D ?

Asdescribedabove,whileRADislikelytoleadtosomepositivehealthimpacts,negativeimpactsarelikelytooutweighanypositiveimpacts–especiallywithoutmitigation.Furthermore,thereareanumberofmissedopportunitiestoimprovehealthviaRAD.Toaddressthesegaps,basedontheresearchfindingsandimpactsdescribed,weidentifyanumberofrecommendationstoimproveRADandanylong-termpoliciesthatmayresultifitiscontinuedbeyondthepilotperiod.Overall,thegoaloftheserecommendationsistomitigateidentifiednegativeimpactssuchthatresidenthealthcanbeprotectedandpromoted.

Recommendationsarewritteninsuchawayastobefeasible,actionable,measurable,andabletobemonitored.Becauseofthenumberofunknownsrelatedtoimplementationaswellasthelackofoverallpositivehealthimpactsthatwouldresultfromimplementation,wefirstproposeanumberofoverarchingrecommendationsfordecision-makerstoconsider:

1. Prioritizefundingtoimprovingexistingpublichousingstockratherthanonrelocatingresidentsoutofpublichousing.

2. Keepthe“public”inpublichousing–requirethatpublichousingalwaysremainapublicassetunderpublicownershipandcontrol,particularlyintimesofrisksuchasforeclosure,bankruptcy,ordefault.

3. Requirethepreservationofthepublichousingstockbyclarifyinglong-termsustainabilityplansforindividualPublicHousingAuthorities(PHAs),developedbyPHAswithoversightfromandincollaborationwiththeresidentorganizations,publichousingadvocates,andHUD.

4. Designateadequatefundingforservices,support,andprotectionsforthosewhoaretraditionally“hardtohouse.”(e.g.,theelderly,largefamilies,peoplewithdisabilities,andthosewhohavebeenarrestedorincarcerated,havepoorcredithistories,orareunabletomeetworkorschoolrequirements,etc.)

1. Developanassessment,monitoring,andevaluationprogramincollaborationwithresidentorganizationsandpublichousingadvocates,implementedbyanindependentthirdpartytotrackimplementationandeffectsofRAD,andtorecommendchangesthatwillneedtobemadeifRADiscontinuedbeyondthepilotperiod.1

6. Set up a Conversion Oversight Committee (COC) made up of existing leaders of PHA resident organizations, publichousingadvocates,andelectedofficials.TheCOCshouldbechargedwithreviewing:nationalresidencystandards;criteriaforselectingwhichpublichousingreceivesRADconversionstatus(includingspecialconsiderationforpublichousingsitesthatprovidehousingforthe“hardtohouse”);andnationalgrievancepolicies,andshouldberequiredtoprovidetwiceyearlyupdatesonimplementationprogressandevaluation program results.


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7. Localresidentassociationsshouldbeapartofreviewanddecision-makingprocessesontopicsincludingdevelopment and implementation of residency standards; development of disposition plans and relocation compensationandsupport;developmentandoversightofgrievancepolicies;sitemaintenanceworkplanstoaddressrepairneeds;newrulesimplementedwithinpublichousingcomplexes;anddistancelimitsofnewhousingidentifiedforresidents.

Thereportincludesabout35specificrecommendations.Belowwehighlighteightrecommendationstargeteddirectlyatimpactspredictedinthereportrelatedtotopicssuchasownership,management,eviction,tenantorganizing,andsocialcohesion:

1. Prioritizethatownersofconvertedpropertiesalwaysbeapublicentity,includingintheeventofforeclosure,bankruptcy,default,ortransferofcontract.

2. RequireenvironmentallysustainablerehabilitationusingstandardsfromLeadershipinEnergyandEnvironmental Design (LEED) or Enterprise Green Communities and ensure full implementation and enforcementofHUDSection3employmentrequirements.

3. Expanddueprocessprotectionsforpublichousingresidents,suchasbydevelopinggrievancepolicies.

4. Require100%waiversforallunitsinallproject-basedpilotsitestoensurethatincomemixingrequirementsand the resulting displacement do not apply.

5. Requirejustcauseevictionsofresidentsineffortstoprotectagainstretaliationforcomplaintsmadeabouthousingquality.

6. Limitdistanceofhowfarresidentsarerelocatedbasedonuniquecharacteristicsofthecity.Forresidentswhorelocate,providerelocationassistancepertheUniformRelocationAssistanceAct,includingmovingcosts,transportationcosts,andjobplacementassistance.

7. Ensure the protection, repair, and maintenance of hard housing units, especially the most distressed units andunitsfor“hardtohouse”residents.Limitthedemolitionanddispositionofpublichousingunitstothoseunitsthatarebeyondrepair,asdefinedbycriteriasetwithoversightfromaConversionOversightCommittee.

8. Requireone-for-onereplacementoflostordemolishedpublichousingunits(i.e.,hardunits).

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W H E R E D O W E G O F R O M H E R E ?

StakeholdersfromaroundthecountryhavebeenmeetingwithHUDandelectedofficialstoweighinonRADandits implementation both before and after it was signed into law in late November 2011. Our goals for this HIA are that:

1. HUDandotherofficialsresponsiblefortheimplementationofRADdirectlyincorporatespecificrecommendationsincludedinthisHIAinanefforttomitigateidentifiednegativehealthimpacts.

2. Stakeholders and decision-makers incorporate discussions of health impacts and health inequities as part of housing policy-making.

Numerousquestionsremaintobeansweredtoseewhetherthesegoalsaremetandwhetherhealthimpactswillbeallayed:Willpublichousingtrulyremain“public”?Whatwilltheconversionprocesslooklike?Whatrolewillresidentsandstakeholdersplayintheprocess?Whatsupportwillbeprovidedtoresidentsthroughsuchsignificantpolicyshifts?Whatinformationanddatawillbetrackedandmadepublicaboutconversions,residencychanges,andresidents’experiences?Willpublichousingremainapermanentsourceofhousingforthoseneedingitmost?Trackingtheanswerstothesequestionsovertimeisessentialandwillhelpusunderstandtheextenttowhichpublichealthcanlooktopublichousingasan“intervention”toprotectandpromotethehealthofvulnerablepopulations.

Repeatedly,researchhasshowntheimportanceofhighquality,affordable,andstablehousingtoindividualandcommunityhealthandwell-being–findingsthatresidentsandcommunitystakeholdershaveknownbothphysicallyandintuitively.Forfartoolong,housingpolicieshaveatbestminimized,andatworstexcluded,discussionsofhealthandhowpoliciesmayexacerbateorimprovehealthinequities,despitethefactthathousinggreatlyaffectshealth.ThisHIAwasconductedinanattempttoaddressthismajorgap.Thoughtherewereanumberoflimitations–includinglackofquantitativedataonpublichousingconditions,littleinformationregardinghowRADwillactuallybeimplemented,andmixedresearchwithwhichtocompare–webelievewearemakinganimportantandnecessarycontributiontoongoingdebatesonsubsidizedhousingpolicy,andinthefieldofhealthimpactassessment.WehopeHUDandotherofficialsdrawuponourfindingsandrecommendationstocarefullymonitorandmeasuretheimpactofRADaswellashelpdeterminethefutureofpublichousing.


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