Stories from the Field

Supporting Safe and Affordable Housing in Alameda County, CA

The Alameda County Public Health Department in California recognizes the links between health and safe and affordable  housing, and offers data and policy expertise to inform community advocates and public officials.

Highlights

1

In close partnership with advocates and policymakers, the Alameda County Public Health Department (ACPHD) addresses housing from two angles – habitability and affordability.

2

To reduce high rates of asthma among low-income residents, the health department partnered with city and county officials to talk about code enforcement, landlord accountability, and regulatory loopholes related to mold.

3

The health department served as a bridge between Causa Justa, a grassroots organizing group that favored a ballot initiative to protect tenants’ rights, and researchers studying its impact on health. Causa Justa and ACPHD also jointly published two reports documenting the health impacts of displacement.

4

ACPHD has informed efforts by The Utility Reform Network (TURN) to reduce utility shutoffs and TURN has trained health department staff in the availability of resources to which they can refer clients who are at risk of a shutoff.

We understood that we needed to get the support of an institution that really cared about this to help us make the case. We started this partnership very intentionally. The health department could provide the data on what conditions were and how people were being impacted, data that we could use to lobby elected officials and present to the public.” Camilo Zmora, Causa Justa

When stakeholders come together to talk about housing habitability, residential displacement, and skyrocketing rents in the San Francisco Bay Area, the Alameda County Public Health Department (ACPHD) is usually at the table. ACPHD, which serves Oakland, Calif. and other East Bay communities, provides data and analytical support to community-based advocates for healthy housing and informs elected officials and local government agencies about the health implications of housing policies.

Linking Public Health and Housing

In close partnership with advocates and policymakers, the Alameda County Public Health Department addresses housing from two angles– ensuring that existing housing is habitable and safe, and informing efforts to protect affordable housing and prevent displacement.

As a data powerhouse, the health department is especially well placed to gather and share evidence. When a ballot initiative designed to safeguard tenants’ rights was put to voters in Oakland, for example, the department evaluated the nexus of housing and health to inform decision-making.

“We worked with our epidemiologists to put together health data specific to Oakland,” explained Tram Nguyen, policy coordinator at the health department. “We cut the data by severe housing cost burden and overcrowding, and compared that to emergency room use, asthma and hypertension rates, and mental health emergency visits. We could show very strong correlations between hospital data and how housing is affecting folks.”

The department became a bridge between the community advocates who favored the ballot measure and researchers studying its impact. Without crossing any partisan lines, the head of the public health department presented research findings at a press conference.

“The health officer is a key part of our tool belt because that is where we have some political independence. It is his role to speak about health impacts.”

– Tram Nguyen, Alameda County Public Health Department

Costly or Overcrowded Housing: Health Consequences in Alameda County

  • Renters who pay more than half their income for rent are more likely to be hospitalized for hypertension. In communities where more than 35% of households pay at least half their income in rent, the hypertension hospitalization rate is about 1,500 per 100,000; where fewer than 25% of residents shoulder that burden, the rate falls to about 800 per 100,000.
  • Renters paying more than half their income for rent are more likely to visit the emergency department for mental illness. Where 35% or more renter households carry that load, the rate of emergency department visits for a severe mental disorder approaches 1,000 per 100,000 households. Where fewer than 25% of residents pay such rents, that rates drops almost in half.
  • Overcrowding increases emergency department visits for asthma. In communities where more than 13% of residents live in overcrowded housing, the rate of emergency department visits for asthma is 1,136 per 100,000, compared to 266 per 100,000 where fewer than 3% of households live in overcrowded conditions.

Alameda County Public Health Department data, 2016

Habitable Housing: Reducing Asthma

Among other activities in the area of habitability, ACPHD is heavily involved in efforts to reduce rates of asthma among low-income residents. “From the health department point of view, the link to housing policy is very clear,” explained Nguyen. “We are working with clients who are poor, their children are repeatedly hospitalized with uncontrolled asthma and their housing conditions are contributing to that. But they won’t complain because they are afraid of being evicted or may be undocumented. We see all of this come together in our client’s stories.”

The health department’s recognition that policy and systems intervention are essential to advance asthma control “synced well with community organizers” who were trying to get the city to respond to tenant needs, said Nguyen.  “Our interests lined up around the habitability issue.”

Early conversations at the grassroots level led the health department to reach out to Oakland city officials and the Alameda County’s Healthy Homes Department to talk about code enforcement, landlord accountability, and existing loopholes around mold regulation. “We encountered lots of cultural and institutional problems,” Nguyen acknowledged. But bumps in the early dialogue smoothed out over time, with monthly meetings now scheduled “to jointly troubleshoot code enforcement cases that affect children’s health.”

“We try to work together and learn one another’s areas better, and identify systemic issues together.”  – Tram Nguyen, Alameda County Public Health Department

In another partnership, health department officials participate in the Regional Asthma Management and Prevention (RAMP) project, which advocates for routinely scheduled rental building inspections, rather than complaint-based code enforcement, to detect pest infestation and mold at an early stage. “Communities where you see the most substandard housing are also where you see disproportionately high asthma rates”, says Brandon Katagawa, senior policy advisor at RAMP, echoing health department findings.

Affordable Housing: Combatting Displacement

With affordable housing and displacement at epic proportions in the Bay Area, the health department has also become an important voice in government for the health value of stabilizing rents, curtailing evictions, strengthening building code enforcement, and targeting housing development to the lowest-income households. Along with presenting research, the department helps to articulates the consequences of policy decisions in letters, presentations, and briefings for City Council members, state legislators, and other public officials.

“We help to reframe and expand the debate,” explained Nguyen. “These are not just tenant/landlord issues, but about what kind of community development we want to see, and what is driving up our health costs and leading to poor outcomes for children and their families.”

Recognizing ACPHD’s commitment to housing issues, Causa Justa (Just Cause), a grassroots organizing group, sought its expertise to inform its advocacy work. “We understood that we needed to get the support of an institution that really cared about this to help us make the case,” said Camilo Zamora, lead organizer for Causa Justa, who initially reached out to the health department for data. “We started this partnership very intentionally. The health department could provide the data on what the conditions were and how people were being impacted, data that we could use to lobby elected officials and present to the public.”

“Causa Justa specifically targeted the health department as a partner to provide some data and credibility and the institutional alliances they needed to move the issue to a different level.” – Tram Nguyen, Alameda County Public Health Department

Two joint publications grew out of that partnership. Rebuilding Neighborhoods, Restoring Health (2009) documented both individual and community health impacts of the foreclosure threat. The department also contributed health impact research and data and policy analysis to Causa Justa’s report Development Without Displacement: Resisting Gentrification in the Bay Area (2014).

Other Community Alliances

Utility shutoffs are still another example of how local partners have found an ally in the health department. Almost a million homes in California had their gas or electricity cut off at some point in 2016, creating significant health and safety liabilities. ACPHD helped to inform a policy briefing in Sacramento, where The Utility Reform Network (TURN) pushed California legislators to restrict utility shutoffs, an effort it eventually won.

ACPHD encouraged TURN to put forward an unusual argument to legislators – that people who had accumulated utility debt and couldn’t get utilities turned on could be barred from subsidized housing, causing municipalities to lose federal housing dollars. In their ongoing partnership, TURN now trains health department staff in the availability of resources to which they can refer clients at risk of a shutoff.

By contributing analytical rigor and institutional credibility, the public health department plays a crucial supporting role in community-based efforts. “This is about staying grounded in the research, staying grounded in the data, and applying a critical analysis,” said Alexandra Desautels, MS, program manager for strategy development and dissemination at the California Endowment, who was formerly with the health department. “If we understand the data and the literature in context, our analysis will lead in a direction that is very much aligned with those working more directly with the community.”

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