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The Health Impact Project, in partnership with the Oregon Public Health Institute and the Metropolitan Area Planning Council, conducted a health impact assessment (HIA) to inform an update by the U.S. Department of Housing and Urban Development (HUD) of its designated housing rule, which allows housing authorities to allocate certain public housing properties, or a portion of them, for occupancy by senior families, disabled families, or a mixed population of senior and disabled families.

The HIA sought to identify the possible health implications that could stem from changes to the designated housing rule and to illustrate the potential for incorporating health data into federal decisions. The HIA team conducted the assessment before the rule-making process to provide HUD with data to inform the development of the rule. The HIA examined two scenarios, developed in consultation with key stakeholders, that HUD could pursue.

What is the designated housing rule?

The designated housing rule is one of many tools used by public housing authorities (PHAs) to allocate scarce resources and provide housing for seniors and people with disabilities who live in the PHAs’ jurisdictions. HUD is planning to update the rule to align with statutory changes made in 1996 and to clarify and streamline the procedures by which PHAs designate housing for these populations.

One hundred twenty-eight PHAs in 37 states and the U.S. Virgin Islands have designated about 63,800 units—less than 6 percent of all public housing nationwide. Of these, approximately 91 percent are designated for senior families, 4 percent are designated for disabled families, and 5 percent are designated for a mixed population. The majority (96 percent) of designated units are one bedroom or studio apartments.

How does the designated housing rule relate to health?

The HIA focused on six factors important to health that could be affected by designated housing rule-making: housing affordability, housing discrimination and choice, housing as a platform for supportive services, resident social environment, housing infrastructure and accessibility, and neighborhood characteristics. The team selected these factors based on strong evidence of their effects on health outcomes and on stakeholder priorities. Because one of HUD’s goals is to clarify and streamline the procedure that PHAs must follow to designate housing, the analysis also considers the implications of this regulation for PHA administration and financing.

Key recommendations

Based on the HIA findings, HUD could take a number of actions to optimize the health effects of the designated housing rule-making, including:

1. Expand efforts to use housing as a platform for supportive services. Housing that is coordinated with supportive services can benefit health and help state and local governments contain public service and health care costs. For many seniors and younger people with disabilities living in designated housing, supportive services help facilitate mental and physical health and the ability to meet lease requirements and maintain housing.
2. Promote fair housing initiatives to support choice in integrated community living. People with disabilities have significant unmet affordable housing needs and face barriers to transitioning out of institutions and segregated settings into community-based housing. Despite federal fair housing laws and policies, these individuals are likely to experience discrimination in their attempts to find housing.
3. Improve data availability and accuracy. Affordable housing needs have risen significantly over the past few years, but they are underestimated because current data sources do not capture those who are homeless or living in institutions such as nursing homes or assisted living facilities. Additionally, data on senior and disabled households’ ability to successfully use Housing Choice Vouchers to rent a unit, known as success rates, are limited.
4. Equip PHAs with data to inform strategies and actions to improve neighborhood resources. PHAs that use the designated housing rule are typically located in urban areas that are more densely populated and more diverse and have higher poverty and crime rates than PHAs that do not use the rule. Easily accessible data regarding neighborhood resources and service needs for designated housing residents (e.g., transportation, medical clinics) could inform PHAs as they develop designated housing plans.

These recommendations could be used more broadly to support the health of the more than 1.6 million senior and disabled families that PHAs assist through the public housing and voucher programs. Designated housing rule-making offers substantial opportunities for HUD to support PHA efforts to facilitate more choices in integrated community living; expand the supply of housing linked to supportive services; and help seniors and people with disabilities remain in their homes and communities as they age.

Download the issue brief.

Download the full health impact assessment.