In our previous article, we explored the role that structural racism plays in shaping health disparities in the U.S. One of the most foundational platforms for health and well-being that is affected by structural racism is that of healthy housing.
Our homes are essential for our physical, mental, and social well-being. Homes are our most grounding spaces as we pursue goals in education, employment, community engagement, and beyond. Yet access to a healthy home environment is not equal among Americans, which has significant implications for health equity.
In this article, we explore the different ways that housing can affect our health; how Black households are disproportionately burdened by unhealthy housing exposures; and the role that structural racism plays in creating that unequal burden.
Physical Housing Conditions
Our indoor environments can affect our health in many ways, with housing being a prime example. Unfortunately, healthy housing features aren’t equally available to everyone. 7.5% of non-Hispanic Black households live in substandard housing — compared to only 2.8% of white households.
One well-known housing hazard, lead, can still be found in the paint and water of many households. Lead’s ongoing presence came into the national spotlight in recent years due to Flint, Michigan’s crisis of lead-contaminated water. Indeed, lead continues to be far too widespread: in 2015, 1,100 water systems serving 3.9 million people exceeded the action level established for lead under the Safe Drinking Water Act. A recent study showed that, non-Hispanic Black children aged 1-5 years old are twice as likely as white children to have elevated blood lead levels, demonstrating how toxic burden is disproportionately borne by Black homes.
Many other physical conditions also disproportionately affect the health outcomes of Black households. For instance, homes that are too hot or too cold can interfere with our ability to thermoregulate, contributing to cardiovascular and respiratory issues as well as depression. But Black households have a higher energy burden, spending a higher proportion of their income on energy costs – making it more challenging to maintain an appropriate temperature without additional stress over the bills. Black households are also more likely to live in multi-unit housing, in which secondhand smoke from a smoker in one apartment can spread to others. 67.9% of Black children are exposed to secondhand smoke, compared to 37.2% of white children, each year, with home being the primary exposure source.
Housing Affordability and Stability
The physical environment isn’t the only way that housing can affect residents’ health. In fact, unaffordability affects health in a range of ways. A higher rent burden is linked to poorer self-rated health and hypertension, and can contribute to stress and poorer mental health. Furthermore, paying disproportionately high amounts of one’s income towards housing drains financial resources that could otherwise be used for health-relevant expenses, such as health services, prescriptions, and food. And going without such necessities can also pose health risks. 54.7% of Black households are considered cost-burdened — meaning that they pay over 30% of their income towards their rent or mortgage — compared to 42.7% of white households.
At the far end of the spectrum, affordability often goes hand-in-hand with residential instability, which encompasses a range of adverse housing outcomes such as being behind on rent or mortgage payments, frequent moves, homelessness, eviction, foreclosure, and overcrowding or doubling up. Black homes are also more likely to be damaged, and Black households more likely to be displaced by, natural disasters, as demonstrated by Hurricane Katrina. Such instability can threaten people’s health and well-being. For example, it’s associated with poorer health, lower weight, and developmental risks among young children.
The Role of Structural Racism in Creating Housing Disparities
Why do Black households bear a disproportionate burden across such a range of unhealthy exposures? A major reason, as previously researched by this author, is the legacy of segregation, which limited the housing options available to Black households to the poorest-quality ones — i.e., the most unhealthy — on the market. Segregation also reduced the opportunity for Black households to build wealth through homeownership, which would have facilitated access to healthy housing for future generations. Racial discrimination in housing is less prevalent than it used to be (although it still exists), but segregation is still entrenched in many cities, and racial inequity continues to affect Black households’ economic ability to access healthier housing options.
Segregation, in turn, did not happen organically. As Richard Rothstein states in his bestseller The Color of Law, “Today’s residential segregation in the North, South, Midwest, and West is not the unintended consequence of individual choices and of otherwise well-meaning law or regulation but of unhidden public policy that explicitly segregated every metropolitan area in the United States.” Although such discriminatory policies have been abolished, their legacy is difficult to undo, and the patterns they created still persist.
For example, redlining — a process in the 1930s-60s by which government agencies rated neighborhoods’ riskiness for mortgage loans — explicitly used residents’ race as a factor. Neighborhoods with Black residents therefore had a harder time getting loans, and the loans they did receive were extended on less favorable terms. Similarly, urban renewal programs in the 1960s –which demolished Black neighborhoods to build new commercial centers, highways, and other developments — displaced and disrupted many vibrant communities.
While government policy helped entrench segregation in the U.S., private actions reinforced it. For instance, the code of ethics of the National Association of Real Estate Boards, the trade association for realtors, stated for more than 30 years, until 1956, that realtors should never introduce into a neighborhood “members of any race or nationality, or any individuals whose presence will clearly be detrimental to property values in that neighborhood” (perceived threats to property values were a common justification for segregation). And many households in the first half of the twentieth century put restrictive covenants into their home deeds on sales, specifying that the house couldn’t be sold to anyone Black in the future.
As we’ll explore in our next article, residential segregation is associated with many built environment factors outside of housing itself that can also pose risks to residents’ health.
What Can We Do?
It’s important to note that structural changes that promote equitable access to healthy housing are critical to reducing housing disparities. This includes actions to improve housing affordability for Black households — like increasing the supply of subsidized housing, making housing opportunities that are affordable to a wide range of income levels available in more neighborhoods, and thinking creatively about financial models—such as community land trusts–to reduce financial barriers to Black homeownership. And it also means ensuring that Black households have equal opportunity to enjoy healthy housing conditions. For example, government funding can support health, safety, and energy efficiency repairs and renovations for low-income homeowners and landlords. And affordable housing can be built, maintained, and/or renovated to reflect standards that promote resident health and abate any health and safety hazards.
Although structural change is paramount, there are still short-term steps residents can take to enhance healthier home conditions in the meantime. Our team has spent nearly 10 years researching strategies to make indoor spaces more supportive of occupants’ health, well-being, and performance. For some of our findings and suggestions related to housing, check out our white paper “The Science Behind Healthy Homes.”
Edited by Radhika Singh and Regina Vaicekonyte