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Opinion: Home Is Where the Heart Is (and the Lungs and Liver)

We’ve learned that housing shapes our health. Now it’s time for HHS and HUD to work together

Rene Conant packs up his camp in Los Angeles on Jan. 24, 2017. As we discover more about how housing shapes our health, the Department of Housing and Urban Development and the Department of Health and Human Services need to work in tandem, Ho and Ventimiglia write. (Justin Sullivan/Getty Images file photo)
Rene Conant packs up his camp in Los Angeles on Jan. 24, 2017. As we discover more about how housing shapes our health, the Department of Housing and Urban Development and the Department of Health and Human Services need to work in tandem, Ho and Ventimiglia write. (Justin Sullivan/Getty Images file photo)

Young or old, if you live in unsafe housing, or live without housing, you’re more likely to get sick or injured. A growing body of evidence has made it perfectly clear — our housing affects our health.

Now we need to act on that knowledge. While efforts over the years have tried to link up Housing and Urban Development programs with Health and Human Services, the two agencies still aren’t in sync. And neither can tackle this alone.

Housing shapes the health of our children. Homes with lead — from the paint on the walls, from the pipes, or even from the surrounding soil — can increase the risk of behavioral and learning problems. Children living in substandard housing are also more likely to develop asthma, which can then be triggered by allergens, dust and mold. Each year, more than 11.5 million children and adults suffer an asthma exacerbation. Of those, 1.6 million visit an emergency room and nearly 440,000 end up hospitalized.

Housing shapes our health as we age. With older adults spending much of their time in their homes, those sites are increasingly important for delivering health care services and must be able to accommodate their needs. Railings, grab bars, no-step entries and other basic structural features dramatically reduce the risk of costly and life-threatening falls. Yet today, only 3.8 percent of housing units are suitable for those with moderate mobility difficulties.

And regardless of age, simply having a place to live is fundamental to our health. Living without a home is not only traumatic, it also means coping with exposure to the elements, overcrowding in encampments or shelters, and limited facilities for hygiene and food preparation. Homelessness frequently results from, aggravates or causes serious health problems. Those experiencing homelessness are more likely to experience severe and frequent mental and physical illnesses — and use the most expensive health care interventions, such as emergency rooms, to treat them.

Joining forces

Today, the Bipartisan Policy Center released a blueprint to improve existing collaborations — and launch new ones — between HUD and HHS. Our recommendations account for the Trump administration’s priorities laid out in the agencies’ 2018–2022 strategic plans, along with the White House’s fiscal 2019 budget requests.

First, HUD and HHS should strive to connect at-risk populations with available resources by developing a national data-matching initiative. Efforts to collect, match and share data should be expanded between the two departments, specifically linking local housing and homelessness data with state Medicaid data.

Second, the agencies should integrate housing and behavioral health resources to provide a better platform for treatment and long-term recovery. Evidence shows that the combination of stable, affordable housing with individualized social services best supports health, particularly for those dealing with severe mental illness and substance use disorders. Homeless people are at high risk of dying from an overdose, and people with addiction are more likely to become housing insecure.

Third, creating more healthy homes to reduce lead poisoning and asthma triggers should become a shared goal. Both HUD and HHS already have separate programs dedicated to preventing these two conditions, but a more targeted, collaborative approach could make a serious dent in the problem.

Fourth, the agencies should align their disaster-related housing and health services so communities can better help residents after a natural disaster. Last year, an estimated 25 million people in the United States were affected by natural disasters, and they appear to be growing in both severity and number.

And finally, HUD and HHS should support healthy aging by better coordinating their existing supportive services and home modification programs. The Centers for Medicare and Medicaid Services’ recent announcement that Medicare Advantage plans may add benefits such as simple home modifications for those most in need is a good first step. With 10,000 Americans turning 65 every day, the need for suitable housing for healthy aging is only increasing. Most seniors are living with multiple chronic conditions, and 70 percent will, at some point in their lifetimes, be unable to fully care for themselves without assistance.

By more tightly linking federal health and housing policies, HUD and HHS can improve health outcomes and quality of life for vulnerable Americans, while more efficiently allocating limited federal resources.
Our housing and our health are intertwined, and that principle must be reflected in how our federal government works.

Jennifer Leimaile Ho served in the administration of President Barack Obama from February 2010 through January 2017, first as deputy director of the U.S. Interagency Council on Homelessness, and then as senior adviser on housing and health to two secretaries of the Department of Housing and Urban Development.

Vince Ventimiglia is chairman of the Leavitt Partners board of managers and vice chairman of Leavitt Partners board of directors. Previously, Vince served as the assistant secretary for legislation at the Department of Health and Human Services in the administration of President George W. Bush.

The Bipartisan Policy Center is a Washington, D.C.-based think tank that actively promotes bipartisanship. BPC works to address the key challenges facing the nation through policy solutions that are the product of informed deliberations by former elected and appointed officials, business and labor leaders, and academics and advocates from both ends of the political spectrum. BPC is currently focused on health, energy, national security, the economy, financial regulatory reform, housing, immigration, infrastructure, and governance. Website | Twitter | Facebook

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