Do Simple Structural Home Repairs Improve the Health of Low-Income Philadelphians and Their Neighborhoods? An Evaluation of Philadelphia’s Basic Systems Repair Program
Background: The places where people live, work, and play can be significant sources of poor health and persistent health disparities. Housing is one such place. Affordable and high quality housing has long been recognized as a key social determinant of health. Deteriorating housing conditions are associated with a range of poor health outcomes, including injuries, respiratory disease, mental illness, and lead poisoning. Asthma, for example, is associated with the presence of mold and cockroaches, which are the result of excessive moisture from leaks.1 Depression is associated with poor exterior and interior housing quality.
Over 6 million houses in the US are considered substandard by the Department of Housing and Urban Development (HUD). The majority of these houses are occupied by already vulnerable populations, including children, the elderly, and low-income families and individuals. HUD defines a healthy home by the following eight principles: dry, clean, safe, well-ventilated, pestfree, contaminant-free, maintained, and thermally controlled. These conditions are determined by both interior and exterior home quality. For example, a deteriorating facade may permit water into the home, allowing mold to grow. An inefficient heating or cooling system or poor housing weatherization may lead to an excessively cold or hot home.
A small but growing body of evidence supports the impact of a number of housing interventions to improve health. For example, integrated pest management and elimination of mold reduces asthma morbidity, and preset safe temperature hot water heaters reduces burns. Few interventions, however, are deemed to have sufficient evidence for widespread implementation. We also know little about the most effective way to target housing interventions. Additionally, little is known about the impact that housing interventions may have on the health and safety of the surrounding neighborhood. For example, improving the condition of several houses on a block could improve neighbor connectedness and decrease stress, leading to a reduction in crime, or may spur improvements to other blighted spaces on the block.
The broad objective of this proposal is to further elucidate the links between substandard housing, housing repair, and health and safety outcomes for individuals and neighborhoods. Specifically, we will evaluate the City of Philadelphia’s Basic Systems Repair Program (BSRP), which provides low-income residents with grants to repair electrical, plumbing, structural, and heating systems emergenies.