Built Environment & Housing
The built environment includes all of the physical parts of where we live, work, play and age. Whether it’s our homes, office buildings, streets, schools, or parks, good physical and mental health depends on having homes and built environments that are safe, affordable, and hazard free [1, 2].
In contrast, poor quality, unaffordable, and inadequate housing and environmental factors contribute to health problems such as chronic diseases (e.g., asthma, hypertension, cancer) and injuries, and can have harmful effects on childhood development. The built environment also impacts and is impacted by broader socioeconomic factors such as ownership and wealth-building, location, neighborhood stability, and community safety.
The DC Healthy People 2020 goals related to housing and the built environment include:
1. Achieve health equity by addressing social determinants of health and structural/system-level inequities.
2. District residents experience a healthy environment.
3. People live free from negative health outcomes due to environmental factors.
Housing Conditions and Affordability
The cost of housing in DC is among the highest in both the nation and the world. A 2017 study reported that the average cost of renting an apartment in DC was the fourth most expensive in the United States, and sixth most expensive worldwide . Housing affordability relative to income is critical in determining how much households have left over to meet other basic needs. Severely cost-burdened households—those spending 50% or more of income on housing expenses—endure frequent financial strains and must make difficult tradeoffs between essentials such as food, utilities, and medical bills.
The availability and affordability of housing shapes families’ choices about where they live, often relegating lower-income families to poor quality housing in neighborhoods with higher rates of poverty and crime and fewer health-promoting resources . Inadequate housing conditions are known to contribute to adverse health outcomes, especially in children, who are most susceptible to poor air quality and circulation. Homes with issues such as water damage and mold are likely to have poor indoor air quality, while insect and rodent infestations as well as the chemicals used to treat them, may also cause health problems. The financial burden of unaffordable housing can further prevent families from accessing other basic needs including nutrition and health care .
I don’t think there’s any doubt that the housing crisis is the biggest challenge and the people we serve would say the challenge is to find affordable housing and to be able to stay in it, and that sort of then ripples… across everything else.
—Key District Stakeholder Interview, July, 2018
Housing Security and Homelessness
Secure and stable housing is out of reach for many DC residents, many of whom have lived in the District for their entire lives and are finding themselves priced out of a rapidly gentrifying city . Housing insecurity encompasses a number of challenges, including being severely cost-burdened and unable to afford rent, having to move frequently, or ‘doubling up’ with friends and family, with homelessness as its most severe form. In 2018, the Lab at DC surveyed 20,000 households at random aiming to identify the main housing challenges facing District residents. The reasons for moving across or out of DC varied by ward, but the main drivers included high housing costs and a desire for more space. In a competitive market with a limited number of large units, households that are large, low-income, or live in Wards 7 or 8 are most likely to be burdened by housing costs and say that they need to move as a result.
Many individuals, families, and households are one unforeseen event—an illness, job loss, or reduction in hours at work—from losing their housing. The risk for homelessness is especially high for low-income families spending more than half of their household income on housing costs . The Interagency Council on Homelessness developed the Homeward DC plan with the goal of ending long-term homelessness, whereas homelessness is a rare, brief, and non-recurring experience in DC. In 2018 there were 6,904 persons experiencing homelessness in the District–1 in every 100 residents in the District, a 7.6% decrease from 2017 . Among all adults experiencing homelessness, 88.4% of individuals are Black/African American.
While homelessness is decreasing in the District, in 2018 there were 924 homeless families (resulting in a total of 3,134 individual family members) of which children make up 61%. Clearly, the need for affordable housing remains critical for many.
Racial and Economic Residential Segregation
Across the US, more segregated communities have higher rates of severe housing cost burden for everyone, but especially for households headed by Black and Latinx residents. The effects of residential segregation are often stark: Black and Latinx individuals and families who live in highly segregated and isolated neighborhoods have lower housing quality, higher concentrations of poverty, and less access to good jobs and education . As a consequence, they experience greater stress and have a higher risk of illness and death.
The District of Columbia’s geographic distribution by race and ethnicity can be measured by its racial dissimilarity, with the Racial Dissimilarity Index (RDI) being the most commonly used measure of segregation between two groups (i.e., Black/White) within a geographic area such as a city. A score of zero indicates no racial dissimilarity and complete integration, while a score of 100 indicates a completely segregated geographic area.
Though most discriminatory policies and practices promoting segregation, such as separate facilities or services based on race, have been illegal for decades, residential racial segregation remains prevalent in many areas of the country, including the District. Areas where people of color live have historically lacked investment and revitalization of neighborhood amenities and services. Gentrification can, by definition, bring more opportunities to communities that have experienced severe disinvestment, but absent policies that mitigate displacement and preserve affordable housing options, have the same detrimental effects to a community by continuing to deny access to improved neighborhood amenities to low-income residents and people of color.
Opportunity Zones is a recent federal program that provides tax incentives for investments in new businesses and commercial projects in low-income neighborhoods. The evidence is mixed as to how designated opportunity zones will impact current residents living in these communities. In 2018, District leadership identified 25 census tracts to be designated Opportunity Zones.
Neighborhoods are dynamic community networks that are influenced both by public policies and private investments. Gentrification, the term often used to describe rapid urban development and the subsequent displacement of residents from their original communities, has been used to describe trends in the District of Columbia (DC) for over a decade. The results of gentrifying neighborhoods commonly focus on the socioeconomic consequences; however, population health outcomes are also affected.
Gentrification trends have the potential to improve or worsen population health among the original residents who are displaced, those left behind, and new/incoming residents. Gentrification is a housing, economic, and health issue that affects a community’s history and culture and reduces social capital . A recent analysis from the National Community Reinvestment Coalition found that the District experienced the greatest intensity of gentrification of US cities between 2000 and 2013 . The study determined that approximately 40% of gentrification eligible neighborhoods in the District were found to be gentrified, resulting in 20,000 Black residents being displaced from their communities.
Current homeowners in rapidly growing neighborhoods in the District fear displacement in anticipation of community revitalization efforts that drive property appreciation and, therefore, higher property taxes and cost of living. Several District government programs are already available for property tax relief, including caps, tax credits, deductions, abatements, and deferrals for certain eligible property owners.
In addition, many programs exist that could help a homeowner reduce the cost of owning and operating a home (such as programs to reduce the cost of utilities and repairs, or to help homeowners generate revenue such as by allowing room rentals or the construction of accessory dwelling units). However, as noted in the Resilient DC Strategy, these programs are not packaged or marketed to cost-burdened households.
Cost-burdened renters also struggle to afford to live in DC and often accept substandard housing conditions to remain close to their jobs and social support. The District already has strong protections for renters but the fear of retaliation or loss of affordable units adds complexity to this issue. Fear is compounded for undocumented immigrants.
There are several tools and best practices communities and governments can use to prevent, mitigate and address the harms of displacement, including housing and community land trust funds, community benefit agreements, inclusionary zoning program, participatory budgeting and prioritzations. In response to these emerging housing challenges in the District, the Resilience DC initiative will work to identify reasons for current relief program underutilization and create new programs to fill gaps for current homeowners, protect renters from displacement and retaliation, and expand programs to strengthen pathways to home ownership for District residents who want to become homeowners .
Opportunity Zones is a recent federal program that provides tax incentives for investments in new businesses and commercial projects in low-income neighborhoods. Similar to the challenges development challenges described in this section, the evidence is mixed as to how designated opportunity zones will impact current residents living in these communities. In 2018, District leadership worked with residents and businesses to identify 25 census tracts to be designated Opportunity Zones.
New development is occurring rapidly in the District. Developers need to abide by policies such as the Green Area Ratio zoning regulation and requiring green building certification for both public and private sectors in order to ensure that building designs incorporate appropriate green space and energy-efficient technology to reduce the impact on the environment. Other regulations include that certain thresholds of affordable housing be available in new residential developments to improve access for low-income individuals and families.
Climate change continues to be an increasingly serious threat with 75 percent of emissions in the District coming from buildings. The District’s buildings —both new and existing—must become more energy efficient to reduce the amount of greenhouse gas emissions they are contributing to the atmosphere . Through District-wide plans such as Sustainable DC 2.0 and Climate Ready DC, collaborative actions aim to ensure that the built environment is sustainable and equitable in how new development accommodates the District’s population growth.
Safe green spaces, open spaces and recreational spaces such as parks, sports fields, recreational centers, community gardens, and waterfronts represent an essential piece of a thriving and healthy urban ecosystem . Spending time in a natural and outdoor environment has been shown to have a protective effect – those who spend more time in well-maintained and accessible “green” spaces can expect more positive physical and mental health outcomes.
DC has a wealth of natural and outdoor resources, including National Park spaces owned and maintained by the federal government and 905 acres of green space like parks, gardens, recreation centers, athletic fields and more. However, these spaces are not evenly distributed across the city, and there are still large areas within the District where more parkland may be needed.
Assets and Resources
Short-term family housing program guide by ward
Lead-testing in homes and/or of children (Department of Energy & Environment)
IMPACT DC: Improving Pediatric Asthma Care in the District of Columbia Program (202-476-3970)
DC Citywide Plans
• Homeward DC
• Climate Ready DC
• Sustainable DC 2.0
Urgent Wellness– An innovative collaboration between a new healthcare organization, Urgent Wellness, and the District of Columbia Housing Authority is providing medical services to the residents of Benning Terrace in their homes.
Promising Practices & Policies
• Developing a more effective crisis response system
• Increasing the supply of affordable and supportive housing
• Removing barriers to affordable and supportive housing
• Increasing the economic security of households in our system
• Increasing prevention efforts to stabilize households before housing loss occurs.
• Eliminate environmental health threats such as mold, lead and carbon monoxide in atleast half of the District’s affordable housing.
• Conduct health impact assessments for new developments and renovations.
• Green industrial areas and create green buffers between industrial use and residential neighborhoods.
• Medical-legal partnerships to bring supportive housing to vulnerable patients
• Equitable Investment in Opportunity Zones in Washington DC
Citations & Additional Data Resources
1. CDC. Impact of the built environment on health. 2011.
2. RWJ. Issue Brief 2: Housing and Health. 2008.
3. Rental Affordability Index. Nested 2017. Accessed June 27, 2019.
4. County Health Ranking Report 2018
6. DC Point-in-time Count 2018
7. Residential and Segregation and Health, 2016
8. WHO. Urban Green Spaces, 2019
9. DC Health Equity Report 2018
10. CDC. Health Effects of Gentrification. 2009
11. National Community Reinvestment Coalition. Shifting Neighborhoods: Gentrification and cultural displacement in American cities. 2019
12. Resilient DC Strategy 2019
13. DC Office of Energy and Environment. Greenhouse Gas Inventories. 2016
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