This blog post was originally posted by American Public Health Association.

Author: Tia Taylor Williams, Director of APHA’s Center for Public Health Policy

The COVID-19 pandemic has brought more attention to the field of public health. Every day, people are seeing and hearing from epidemiologists, clinicians, laboratory scientists, researchers and more. While the spotlight is on the field, we should seize this moment to bring national attention to our greatest imperative: reducing health disparities and advancing health equity. 

The public health field has an opportunity to shape the discourse about COVID-19 inequities to ensure that the root causes of the problem are acknowledged and addressed within, and well beyond, the pandemic.

As calls for race and ethnicity data in COVID-19 morbidity and mortality are heeded, we’re learning more about the communities and populations being disproportionately impacted. The prevalence of preexisting conditions — such as hypertension, diabetes, obesity and cardiovascular disease — among people who are dying from COVID-19 is also being emphasized.

As public health professionals, we know these same chronic conditions plagued low-income and communities of color at alarmingly high rates for decades before the current pandemic. We also know that these health disparities are the result of years of intentional disinvestment in communities. Lack of access to basic services, living wage jobs and affordable quality housing, education and health care are all veiled by a system that assigns value and structures opportunity based on how a person looks, i.e., racism.

At the same time, we know that as a country we are reluctant to understand, acknowledge and address how America’s legacy of racism, discrimination and exploitation has created present-day conditions of racially segregated and under-resourced neighborhoods.

If history is a predictor, as the pandemic persists and more data are collected, our suspicions about who is being hit hardest will be further substantiated. We can also expect that there will be many different arguments used to downplay or detract from the real issues. 

As health equity champions, we have to be ready to redirect those diversions. By applying an equity lens, we can shift the narrative to focus on the root causes of COVID-19 disparities:

• Racism, not race. Yes, it is important that disparities in COVID-19 testing, treatment and death rates are identified so that resources are funneled to where they are most needed. However, it is not being black, Hispanic, American Indian, Alaska Native, Asian or Pacific Islander that causes poorer health outcomes; it is how individuals and communities are treated because of their race or ethnicity. 
• Social and economic factors, not genetics. There may be some genetic differences among those who are able to recover from COVID-19 and those who succumb to it. However, until the research is definitive, we should avoid overemphasizing the influence of genetics on COVID-19 outcomes and disparities.
  What we do know is that overall health status is heavily influenced by socioeconomic factors, including place of residence, educational attainment, income and wealth. While there’s not much we can do about genetics, we can change socioeconomic factors through policies and systems changes.
• Environment and neighborhood conditions, not just behaviors. Health behaviors are important. They are also shaped by environment and access. Asking communities to eat healthily is futile if there are no affordable options — or healthy options at all — in their neighborhoods. This may seem like a no-brainer to those of us who live and breathe this work, but it’s important that this message is conveyed to broader audiences. 

At a time when family resources are dwindling and being spread even thinner, we must avoid finger-pointing and placing the blame on the behaviors of individuals in marginalized communities. We know racism is a driving force for the social, economic and environmental conditions, i.e., social determinants that influence health. For example, black and Hispanic communities have higher rates of exposure to air pollution, which has recently been associated with increased risk of COVID-19 death. 

We are public health. Social justice is in our roots. We look upstream to identify the causes of the causes. It is critical, during the pandemic and after, that we bring attention and action to addressing systemic and structural factors that shape who has power, where and how people live and, ultimately, what access and opportunities they have for good health.

For more on health equity and COVID-19, visit APHA’s COVID-19 and Equity page.

(left to right) Gustavo Velasquez of Urban Institute, Ernst Valery of SAA | EVI and Nicky Goren of Meyer Foundation discuss the causes and consequences of redlining at HAND’s Annual Meeting & Housing Expo.

On the heels of HAND’s Annual Meeting & Housing Expo, the team under the How Housing Matters Initiative at Urban Institute was inspired to author a piece reflecting on some of the policy changes that would be needed to address issues of housing discrimination and equity. An excerpt from the piece titled, “Rethink Housing and Community Development to Advance Racial Equity and Inclusion” is as follows:

In the US, descriptions of housing affordability challenges and differences in wealth, health, and education need to include a racial equity lens, or the picture is incomplete. Legally authorized and mandated housing discrimination through federal lending and investment policies laid the cornerstone of complex socio-spatial issues that historically segregated communities continue to face. Many of the inequities within and between neighborhoods, particularly in large metropolitan areas, trace their roots to redlining.

Such discriminatory lending practices have left a legacy of disinvestment predominately in black and brown communities. Although the Community Reinvestment Act of 1977 sought to undo forced inequalities within neighborhoods by creating strong incentives for positive investment activity, the ramifications of housing segregation and economic exclusion will take additional policy attention to address…

…Meaningful and inclusive community revitalization can break down some of the barriers instituted through disinvestment and discrimination. This can be done through equitable development, but it requires intentional engagement and community input. Community development corporations (CDCs) and community land trusts (CLTs) have facilitated this engagement. While CDCs and CLTs usually have residents on their boards, CDC leadership often does not represent those they serve, which can leave residents feeling disengaged.

At the annual meeting of HAND, a membership organization for housing providers in Maryland, Virginia, and Washington, DC, Ernst Valery, founder and president of EVI Equity, addressed this challenge. He said, “We think so much about renovating the building, we need to also renovate the people.” EVI purchased Essex Village, an apartment complex in Henrico County, Virginia, that was far from providing its residents with a platform for success in life; according to Valery, it has been deemed the county’s worst apartment complex. EVI and the property manager CAPREIT quickly formed a tenants’ association to ensure that Essex Village residents were involved early in the planning process. Residents expressed excitement that the new owners wanted to hear their voices and to collaborate on creating lasting change in the housing development. When tenants are offered a seat at the table, they are eager to get involved, but developers need to provide the space to be heard.

You can read the article in full here.

Photo courtesy of Alexis Lewis

By Lisa A. Sturtevant, PhD

Nearly 400,000 renter households in the Washington DC region—about half of all renters—are cost burdened, spending 30 percent or more of their income on housing costs. For many individuals and families paying high housing costs can mean there is too little for other essentials, such as food and health care. In the Washington DC area, more than 12,000 homeless individuals were identified in this year’s point-in-time homelessness count, though we know the number of people without stable housing is much higher. Despite the efforts of countless housing advocates, non-profits, and local governments, the housing affordability challenges in the DC region continue to grow. What can local jurisdictions do to stem the rising affordability challenges?

Housing is a growing concern in the region. According to data from the U.S. Census Bureau, in 2000, about 220,000 renter households in the Washington DC metropolitan area were cost burdened. In 2015, that number had grown to about 380,000, an increase of 160,000 households. In 2000, 33.2 percent of renters were cost burdened. In 2015, that share was 48.5 percent. The overall number of cost burdened renters has increased in jurisdictions throughout the region. For example, there were about 25,600 more cost burdened renters in DC in 2015 than there were in 2000. In Montgomery County, the number of cost burden renters grew by more than 31,000 over the 15-year period between 2000 and 2015. Fairfax County added 24,200 new cost burdened renter households over the same period.

These increases are not because local jurisdictions have ignored the problem. Just in the last few years, DC has dedicated $100 million to its Housing Production Trust Fund. Montgomery County has increased efforts to use public land for affordable housing. The City of Alexandria continues to look for opportunities to partner with developers to expand mixed-income housing. Fairfax County has made housing affordability a key component of its Strategic Plan to Facilitate Economic Success. Arlington County is working to adopt at Notice of Funding Availability (NOFA) process to more efficiently and effectively allocate local housing resources.

But, as the cost burden numbers show, it hasn’t been enough. And things probably are not going to get easer in 2017. Even without specific affordable housing proposals, the new Presidential administration could weaken key Federal programs that local jurisdictions have come to count on for the production and preservation of housing affordable to lower-income individuals and families.

Tax reform. No specific proposals have been discussed by the incoming Trump administration related to the Low-Income Housing Tax Credit (LIHTC) program. It seems very unlikely that the credit itself will be eliminated since there is generally broad bipartisan support for the program. However, there has been a lot of talk about the likelihood of tax reform under the new Trump administration. Some affordable housing finance experts have suggested that there could be “substantial” indirect effects of proposed tax reforms on the LIHTC, making the tax credit less valuable to investors. Reduced capacity of the LIHTC could mean a growing need for local resources to fill financing gaps and to make projects feasible.

Cuts in Nondefense Spending. President-elect Trump has indicated that he intends to cut nondefense spending, at one time saying he wanted cuts of one percent every year. This would mean cuts to key HUD programs that serve some of the lowest-income and most vulnerable individuals and families in our communities—programs like the Housing Choice Voucher Program and CDBG and HOME. Historically a target of cuts, these programs could be at significant risk under a President who has indicated little interest in supporting HUD programs. Even now, federal housing programs currently serve only about a quarter of eligible households. Reductions in federal funding would means that local jurisdictions will lose critical resources to support a wide range of housing and community development programs and the losses would disproportionately impact the lowest-income and potentially the most vulnerable households.

Rising housing challenges and declining federal resources are not new phenomena; local jurisdictions have been taking on increasingly active roles in housing policies and funding for decades. However, in 2017, the role for local action on housing will be even more critical in our region. What can local jurisdictions to do differently to move the needle?

Communication is key:

Make the case. Throughout our communities we need to continue to make the case for why housing is important. And there is not just one argument. Whether it’s because increasing housing supply is good for the local economy. Or that education and health outcomes are better for families with access to safe and affordable housing. Or that poor children who live in higher-opportunity neighborhoods go on to make more money—any pay more taxes—than those left behind.

Document the need. At the local level, it is important not only to quantify housing needs in the community, but also to relate those numbers to actual people. Combining hard data with descriptions of hypothetical—or real—individuals and families is important for demonstrating the need.

Explain how housing finance works. Make sure that the community understands why government is necessary when it comes to building housing affordable to lower-income households. Tools like the Urban Institute’s affordable housing simulator can help show in black and white that gap that often needs to be filled by public resources.

Communication can be hard but other important steps are even harder:

Prioritize housing. Public resources are limited and local jurisdictions have competing demands on those resources. In general, however, local communities have not been explicit about prioritizing housing, and then about prioritizing particular goals within housing programs and policies. Prioritization—linked to specified and dedicated funding sources—seems especially important to having an impact.

Innovate on the funding side. To meet housing needs when federal resources are on the decline, it is going to be necessary to identify new sources of funding. Local jurisdictions need to commit to looking for innovative funding sources and partners.