Rebuilding a More Equitable Housing System Post-COVID

November 04, 2020|1:51 p.m.| J.T. Lane, MPH | ASTHO Chief Population Health & Innovation Officer

Well before COVID-19 hit, an increasing share of American households faced housing challenges. Last year, 18.2 million American households (renters and homeowners alike) were considered severely burdened, paying more than half their incomes for housing. This is a public health concern because stable, affordable, and accessible housing has a direct and well-documented impact on physical and mental health outcomes.

COVID-19 has further magnified barriers to stable housing. The job and income losses associated with COVID-19 have contributed to increasing economic and housing insecurity for Americans, especially among Black, Latino, and immigrant households. Renters are increasingly falling behind on rent, with about one in six renters indicating they are not caught up on rent as of Oct. 14. This rate is higher among households of color, with 23% of Black renters not caught up on rent compared to 10% of white renters.

The CDC issued a declaration on Sept. 4 that temporarily halts residential evictions for individuals who qualify based on income. Renters will still be required to pay the full amount of owed rent by January 2021. Therefore, this notice has effectively signaled a potential impending wave of evictions in the new calendar year. The window to act is now. Further, the high number of households with unstable housing and accumulating debt—as well as the stark racial disparities present—mean we must rethink how our systems and institutions operate.

It's time to get more creative
The billions of federal dollars appropriated for COVID-19 recovery efforts create an opportunity for new investments in the health and well-being of communities, including for the social determinants of health. There are a wide range of governmental agencies and organizations receiving supplemental funding that share a common goal with public health of ensuring people have healthy and safe living situations.

Congress appropriated at least $12.3 billion by way of the CDC to state and territorial health departments, largely from the Coronavirus Preparedness and Response Supplemental Appropriations Act, Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the Paycheck Protection Program and Health Care Enhancement Act.

In addition, Congress directed funds to the Administration for Children and Families, including approximately $985 million for the Community Services Block Grant and $900 million for the Low-Income Home Energy Assistance Program. The U.S. Department of Housing and Urban Development received appropriations of $850 million for the Tenant-Based Rental Assistance program, over $5 billion for the Community Development Block Grant, and $53.7 million for Housing Opportunities for Persons with AIDS, among other programs.

Key players in housing
State and territorial health officials have long served as “conveners” and advocated for health to be considered in all types of policies. Key partners to advance this ‘health in all policies’ approach include the state human services agencies, departments of energy, and housing authorities. Each of these agencies may have funding or programs that address housing and are ripe for partnership. An opportunity for partnership could be designing a cross-sector, place-based intervention with blended or braided funding contributed by each agency addressing local needs. Agencies could also explore how to best make referrals to or streamline enrollment in various programs.

In addition, health officials may build relationships with the community action agencies in their jurisdiction, which are the nonprofit and public groups funded by the Community Services Block Grant and have a mission to fight the causes and conditions of poverty. For example, Wayne Metro Community Action Agency has worked to design person-centered programs, including working with a tech firm to solicit community input and create a streamlined application for emergency services. Now, with support from the Kresge Foundation, Wayne Metro is providing residential plumbing repairs to families in Detroit experiencing emergency needs during COVID-19. The number of Community Services Block Grant recipients varies by the state, and there may be a state-level association of community action agencies who can serve as a point of outreach for a state health agency.

Finally, and critically, community-based organizations and the communities themselves should be consulted and engaged each step of the way to recovery. Community engagement is core to public health practice and a necessary component of achieving health equity. As state and territorial leaders consider how to best leverage new funding streams or reimagine how programs and services are delivered, community input and feedback will ensure that the underlying conditions of health are addressed and that services are resources are accessible to those who need them most.

Cross-sector partnership in action
The Delaware Department of Health and Social Services Division of Public Health launched the Healthy Delaware Communities initiative, in partnership with the University of Delaware Partnership for Health Communities and Delaware Community Foundation. The initiative provides flexible funding to 12 “opportunity communities” in the state, selected based on census tracks with low life expectancy and high school graduation rates along with high infant mortality and child poverty rates. The department of health and its partners then provide flexible funding to address community-driven priorities around the social determinants of health. Nine of the 12 communities have projects in place to address housing, which range from legal aid to home repairs to safe drinking water. This initiative has also provided an infrastructure for the state’s COVID-19 response: The state placed a funded COVID-19 coordinator position in each community to assist with contact tracing, as well as to make sure that people have access to housing and other resources necessary for self-isolation.

The COVID-19 pandemic has shaken American households—many with tenuous access to safe and affordable housing before the pandemic. However, the influx of federal resources and public attention also create a window of opportunity for state and territorial health officials to reshape our policies and institutions into a more equitable society. To learn more about how health officials can seize this opportunity for change, check out ASTHO’s Bounce Forward report and podcast on housing. Additional chapters will be released in the coming months exploring opportunities for investment and partnership in other sectors.


Anna Bartels, MS is the director of clinical to community connections at ASTHO