Breaking down housing equity policy in the US

While the United States (U.S.) has recognized housing as both a fundamental human right and a social determinant of health, current housing policies perpetuate housing instability and inequity. This is most evident within the context of racial disparities and the ways in which racial disparities in turn lead to health care disparities. Furthermore, lack of access to stable, affordable housing also contributes to poor health care outcomes in general, highlighting the need for policy reform. The creation of housing policies that actively prevent further disparities and instead maintain healthy communities throughout the U.S. can decrease hospitalizations and health care costs while improving health care outcomes.

So begins the first draft of my first ever policy paper. As a current AOA Training in Policy Studies (TIPS) fellow, one of my program requirements has been to identify a health care policy issue and provide policy recommendations for it. We’re given a blank slate and the opportunity to choose any topic that we feel passionate about, so I was excited to write my first policy draft.

I’m not sure that anyone really thinks health policy is easy, but I definitely imagined this being an easier task than it was. That’s the thing about policy though—it’s a skill that has to be practiced, just like any other. I always thought I had a lot of experience in health policy, but I also knew that, having never written a formal policy paper before, there was a gap in my health policy expertise. Being a TIPS fellow has helped me to address that.

Taking action

So, when it came time to write my first policy paper, I selected a topic that my experience as a family medicine resident in New York City had fostered interest in—housing inequality in the United States. If you research this topic, you will find a lot of information. Housing inequity exists at every level in the U.S., from the municipal to the federal, and as a social determinant of health, it’s intricately tied to health care. U.S. housing policy has been tethered by racial segregation and ongoing systemic and institutional racism, by unjust financial and infrastructure practices, and by limited policy, despite the existence of the U.S. Department of Housing and Urban Development, which was actually a policy intervention itself—an act passed in 1965 under President Lyndon B. Johnson.

Given this, I’m still working to narrow the focus of my paper for the final draft, but my literature review has been enlightening as to the history of housing policy in the U.S. and the ways in which policy recommendations begin. In my policy draft, I wrote a few of my own, advocating for actions such as:

• The creation of a federal advisory council tasked with: 1) Reviewing existing housing policies in place that promote or do not protect against housing inequity and instability; and 2) Providing solutions for addressing these potentially discriminatory and health-disruptive policies.
• The preservation of existing communities and neighborhoods rather than their dismantling through government projects, such as highways.
• Support for S.98, the Neighborhood Homes Investment Act, which has been read twice and referred to the Committee on Finance, and “calls for the creation of a new federal tax credit that will produce new equity investment dollars for the development and renovation of family housing in distressed urban, suburban and rural neighborhoods.”
• Investment in racially segregated communities that experience housing disparities.

Next steps

My conclusion so far is as such: For decades, structural and systemic racism in the U.S. has led to housing inequity. Policy recommendations have the potential to address many of the inequities still experienced by individuals and families today and to contribute to the overall goal of health equity. Without policy changes that can both address the historical damage done and prevent future damage to the health of people seeking affordable, sustainable and equitable housing, this gap in health care outcomes will never be addressed.

My next step as an AOA TIPS fellow is to get from first draft to the final policy paper. The program is teaching me to think about policy from a new lens and ask questions, such as “Is this solution specific enough or too vague? Is it doable? Is it even relevant?” Similar to my residency’s qualitative improvement curriculum, I realized that many of the tenets of a policy paper are the same as those of our QI projects, for which we adhere to our SMART aims. SMART stands for Specific, Measurable, Attainable, Relevant and Timely.

I’m excited to see what my finished policy paper will look like and to generally think about the next steps that follow those in the health policy world who have had to learn how to get from recommendation to implementation.

Related reading:

A housing and real estate guide for physicians and medical trainees

Taking a holistic approach to voting in the 2024 election