Promoting healthy communities and reducing disparities through affordable housing policy: Applying Health Impact Assessment to the allocation of low income housing tax credits

There is a massive body of evidence indicating that health status is strongly influenced by an individual's home and neighborhood. Many references have been developed to describe healthy housing and healthy communities. Yet these resources are not consistently being applied in housing policy. The largest federal subsidy for rental housing is now the low income housing tax credit (LIHTC). It creates or preserves about 100k units nationally and about 2k in Georgia. Each state is responsible for setting its own allocation criteria. We used health impact assessment (HIA) to identify the most effective ways to promote health through Georgia's allocation plan that would be adopted by developers and policy makers. We selected 18 potential interventions based on the strength of evidence, leading causes of morbidity and mortality, and ease of implementation. Many were adopted into the policy, but one was controversial, and we learned that the health benefits or risks of particular behaviors and environments were misunderstood. Additionally, we conducted further study of two key elements that strike at the source of health disparities, access to quality education and access to healthy, successful communities. Education included locating in good school districts, increasing participation in early learning programs, and improving or creating educational resources. Healthy communities included locating in integrated, higher SES neighborhoods, supporting bridging social capital with the neighborhood, and promoting comprehensive revitalization of under invested neighborhoods. Our recommendations translated these health in all policies principles into standard policy language. The state housing agency adopted some recommendations and is studying others for future adoption.