Friday Jun 02

Spring 2023

COMMUNITY DEVELOPMENT CORNER - Inclusionary Zoning:  One Key to Better Health

Inclusionary zoning (IZ) has become an increasingly popular tool as jurisdictions attempt to respond to the growing unaffordable housing crises.  Over 800 IZ policies are currently in place in at least 25 states and the District of Columbia.  These policies provide developers various incentives (tax reductions, expedited permitting, density bonuses and more) when selected shares of the units to be built are made available to families with incomes below various thresholds.  The objective is to help low-income families move from high poverty to low poverty neighborhoods, giving them access to safer streets, better schools, cleaner air and water and other amenities middle-class families take for granted.  Recent research also shows specific health benefits that result from the implementation of IZ policies.

My colleague Antwan Jones and I published peer-reviewed articles in the medical journal Circulation and the public policy journal Housing and Society in which we found that residents in communities that had adopted IZ policies, compared to those in areas without such policies, experienced lower rates of coronary heart disease (still the number one cause of death in the US), lower prevalence of high blood pressure and high cholesterol, fewer people on blood pressure medication, and fewer people reporting physical and medical health problems in the previous month.  These relationships held after controlling on median income, poverty rate, crime rate, labor force participation and other socio-economic factors.

There is great variability in the specific elements of IZ policies.  We found the strongest effects with policies that were mandatory as opposed to voluntary, focused on rental properties rather than homeownership, and required larger shares of affordable housing units in developments covered by the policies. 

The connections between health and housing generally have long been known.  Homes in poor neighborhoods are more likely to have peeling lead paint, be located near environmental hazards polluting the air and water, offer less access to healthy food, provide less green space and opportunities to exercise, educate children in failing schools, and create greater stress from a variety of factors that undermine health.  To the extent that IZ policies help some low-income families escape these conditions, better health outcomes should be no surprise.

We were unable to directly address the issue of causation.  But there is evidence that these associations are not just statistical flukes or spurious relationships.  Some of the nation’s largest financial institutions and health insurers see the connection.  UnitedHealthcare and Humana are working with Wells Fargo on initiatives that combine construction of affordable housing with on-site health care in what all parties see as profitable developments.  Fewer health care problems lead to fewer claims and missed housing payments resulting in higher profits for the insurer and lender.

The impact of IZ policies specifically was spelled out by Katherine Schreiber in her Psychology Today editorial when she concluded: 

The improved heart health of individuals living in areas that have adopted more inclusionary zoning policies could be a reflection of the greater access such residents have to healthcare, education, and employment, as well as how greatly reduced their stress levels are as a function of having stable housing, not living in fear of violence or exposure to other crimes, and experiencing a greater level of empowerment. Stress—from economic insecurity, proximity to crime, lack of employment, and inability to afford necessary medications or medical care—is known to take an enormous toll on heart health. Reducing the chronic stress of housing insecurity through inclusionary zoning policies is a fundamentally impactful way in which towns, cities, and states across the country can improve the physical, financial and emotional health of their residents.

Moving poor families is certainly not the only way to address urban poverty and IZ policies are not the only means to address housing affordability issues.  But mobility is certainly one approach and IZ is one of the tools that can ameliorate what has long been a problematic connection between housing and health.

Gregory D. Squires is a Research Professor and Professor Emeritus in the Department of Sociology at George Washington University