Addressing Housing as a Cornerstone for Community Health

By Marjory Givens

Marjory Givens, PhD, MSPH is the Deputy Director of Data & Science at County Health Rankings & Roadmaps.

Jun 27, 2019 | Smart Cities | 2 comments

High housing costs can make a difference in how well and how long we live. This topic is the focus of this year’s County Health Rankings, an annual report on the many factors that shape health and opportunity, county by county, across the nation. This year, data in our Key Findings Report show us that too many communities are burdened by severe housing costs—when people must spend more than half of their income to secure a place to live for themselves and their families. 

This year’s findings are sobering, and they document an issue that is pervasive in counties across the country. Severe housing costs affect people of all backgrounds, but low-income families and households of color, including Black and Hispanic people—are more likely to suffer the burden and impacts of severe housing costs.

The high cost of housing affects every county in the nation, particularly urban communities. More than one in ten households live with the burden of severe housing costs. In other words, they spend more than half of what they earn on rent or mortgage payments. This is particularly true in larger urban metro counties, where the percentage of households that are housing cost burdened is higher than in smaller metro, suburban, or rural counties. In many communities, the increase in housing costs have outpaced increases in local incomes. Renters are also disproportionately burdened by high housing costs with one in four renters impacted. And low-income renters experience an even greater financial burden with one in two spending more than half their paycheck on rent.

  • Renters are disproportionately burdened by high housing costs—and low-income renters experience an even greater financial burden. One in four renters spends more than half of their paycheck on housing. For low-income renters, the burden is particularly harsh, with half spending more than 50 percent of their paychecks on rent. The severe housing cost burden also disproportionately impacts Black individuals and families, who are more likely to rent than own a home.
  • High housing costs prevent too many families from building wealth, especially Black families. Owning a home is an important vehicle for families to build wealth for their children and grandchildren, but not everyone has had a fair chance to pursue this valued American dream because of decades of discriminatory practices and lending policies. More than 70 percent of White households own a home compared to just over 40 percent of Black households—and this pattern of limited opportunity in homeownership holds true for other racial and ethnic groups as well.

The Connection Between Housing Cost, Health, and Discrimination

When a family must spend more than half of its paycheck on rent or the mortgage, there is little room in the budget for other essentials that contribute to good health, such as healthy food, medicine, or transportation to work and school. Across all counties, as the share of people experiencing the burden of severe housing costs increases, so does the number of children in poverty, the number of people who don’t know where their next meal will come from, and the number of people in poor or fair health

Discriminatory policies and practices such as redlining or banking practices that target people of color with subprime loans, have resulted in gaps between white communities and communities of color when it comes to education, employment, community connections and supports, and safe neighborhoods – all of which are fundamental to achieving long and healthy lives.

Communities That Are Making a Difference

High housing cost is a thorny problem, and there’s no single solution. However, there are many things that communities can consider, and several approaches to creating and preserving affordable housing to learn from.

Just north of St. Louis, Missouri, there are 24 small, contiguous municipalities formed the 24:1 Community. This group brings together organizations across municipal boundaries to address housing challenges. Governments and nonprofit organizations partner with residents to boost homeownership and build wealth. For example, two nonprofit organizations: Beyond Housing and the 24:1 Community Land Trust, work together to offer an affordable quality homes through a program that helps residents become homeowners. The program provides buyers with financial advice, connection to services after purchase, and reinvests back into the community. These efforts are helping to keep housing affordable, empower residents financially, and create healthier neighborhoods.

The community of Chelsea, Massachusetts, just outside of Boston, knows health and housing are inextricably linked. In 2018, a multi-agency organization called CONNECT helped more than 450 clients get back on their feet by stabilizing their income and/or housing. The Neighborhood Developers, a local community development corporation, was instrumental in the development of the Box District; a 248-unit development where half of the units were designated as affordable. Beyond building new homes, Chelsea is focused on the preservation, rehabilitation, and maintenance of existing affordable housing through an Affordable Housing Trust Fund.

In South Carolina, Spartanburg County’s Northside Neighborhood—a place once plagued by blight, unemployment, and poverty—is being transformed to expand affordable housing and set community residents on a path to better health. The Northside Development Group, in collaboration with community partners, is working to increase educational and recreational opportunities, and expand community services. So far, they’ve created a healthy food hub, new green spaces, and a community center.

Four Solutions for Communities to Explore

Fortunately, there are many strategies that communities can use to develop and secure more affordable housing—and ultimately realize better health—for residents, and particularly for low- to moderate-income residents.

1. Communities can become more inclusive and connected by:

  • Adopting inclusionary zoning laws
  • Engaging all residents, including youth, in public governance and community development decisions
  • Passing and enforcing fair housing laws
  • Creating housing mobility programs
  • Developing mixed income communities
  • Ensuring access to living wage jobs, quality health care, grocery stores, green spaces and parks, and public transportation systems in all communities

2. Facilitate access to the resources that residents – particularly low to moderate income families need to secure affordable housing, such as housing choice vouchers or housing trust funds.

3. Implement policies that provide capital resources that create and preserve affordable housing, such as:

  • Acquisition, management, and financing of land for affordable housing
  • Tax credits, block grants, housing trust funds, and other government subsidies or revenues to advance affordable housing development
  • Zoning changes that reduce the cost of housing production

4. Provide the services that help those who struggle with safe and secure housing. These strategies could include:

  • Rapid re-housing programs, supportive housing, service-enriched housing, and rental assistance
  • Eviction prevention services
  • Income supports, like living wage laws, paid family leave, or Earned Income Tax Credits

Our Homes, Our Communities, Our Health

Where we live—our homes and our neighborhoods—influences our health. Safe, secure, and affordable housing is a basic cornerstone of building a healthy life for ourselves and our families. And when more people in a community have access to safe, secure, and affordable homes, we all benefit. The question is, how can we work together to make this a reality for everyone in our communities?


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  1. We have been promoting the development of a more structured, distributed work center architecture that is focused upon greater inclusion and security throughout expanded metropolitan areas. We have yet to create a more appropriate and functional work location model for major employers. Current economic incentive policies only reinforce a single location mentality in an age of digital transformation. This has vast repercussions for the growing inequality of proximity to jobs (opportunities) and the costs of housing. We would like to submit a proposal on distributed metropolitan design and creation of enterprise centers but have not found the appropriate contact in your organization. Can you help us connect? Thank you.

  2. Well, Maslov’s pyramid is always valid in this area, if the house contains in itself a series of primary needs and if we add others such as food and energy together with more transcendental satisfactions like living in a place related to myself from the form that has the housing from my forms and utilities, this implies something very healthy, a community that meets around these terms is an ideal that crosses the social limits.
    On the other hand, in these times the value of a home is more related to the mortgageable mortgage valuation that for its benefit and favor in life, this way we have arrived at almost nonsense stock aspects where those who take care of their investment limit those who need to have a house constituting a pressure that has illicit overtones against the rights to life.
    From this angle this concept of housing, is a place where everyone solves their life and their basic needs are satisfied to be able to transcend in life, that is then my refuge, a factor that significantly affects the other points mentioned in this article. However, there are many barriers on the part of those affected, one of the most important is a traditional cultural aspect, which in turn in many young people, in the main, is changing and property for some is rather an anchor unsustainable, being them professionals who aspire to optimum quality of life, informed and mostly vegetarian. This change of cultural habits is a reality that increases, and will surely change the profile of the matter within a few decades, the solution mentioned then adapts to both and education is the catalyst.
    The proposal generally affects the last paragraph of point one mentioned here, however, if other users who are not part of the affected acquire this type of life, they always reorganize and in some way to those who are part of this affected population because in this real estate movement the old solutions move to this sector where these benefits and incentives can be applied from the first house in a traditional way. It should also be considered that everyone lives in some way subsidized directly or indirectly, this aspect should decrease from the self consumption.
    We have an architecture that delivers this solution.


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