Trump’s Housing Cuts Put Americans’ Health at Risk

Americans spend an average of 69% of their time at home. The connection between housing and health is well known – unsafe structural and environmental factors at home contribute to disease, disability, and injury. If Congress enacts the Trump administration’s 2019 proposed budget cuts to housing, then we may observe greater inequities in the physical and mental health of Americans.

Proposed cuts

For the second year in a row this administration has proposed dramatic cuts to non-defense spending. For fiscal year 2018, the administration proposed reducing the Department of Housing and Urban Development (HUD) budget by 13.2% or $6.2 billion. Deeper cuts to HUD, to the tune of 18.3% or $8.8 billion, were originally proposed for fiscal year 2019. However, as a result of increased spending caps following the enactment of the Bipartisan Budget Act of 2018, the administration proposed an additional $1.7 billion investment in HUD. One billion dollars was recommended to offset rent increases among elderly and disabled HUD-assisted households from proposed rent assistance reforms, and the balance was recommended to restore Tenant-Based Rental Assistance funding for housing vouchers.

Despite these modest funding revisions, the 2019 budget still calls for significant cuts to HUD programs. Legislative reforms to rental assistance programs would require able-bodied individuals to work and to pay a higher percentage of their income toward rent. These reforms are consistent with broader administration goals to encourage work and self-sufficiency among families dependent on welfare programs. Programs for public housing capital development and modernization (Public Housing Capital Fund), community and economic development (Community Development Block Grant program) and affordable housing production, buying, and rehabilitation would be eliminated. And, funding to reduce lead exposure for low-income children would remain unchanged.

Importance of healthy homes

The quality of the structure and environment of a home and its immediate surroundings is linked to health. In 2011, the Surgeon General’s Office highlighted the public health impact of housing when it issued a call to action to promote healthy homes. The Acting Surgeon General pointed out that the “leading preventable causes of death, disease, and disability are asthma, lead poisoning, deaths in house fires, falls on stairs and from windows, burns and scald injuries, and drowning in bathtubs and pools.” And unlike the declines for the other leading causes of death such as cancer, stroke and heart disease, there has been no change in potentially preventable deaths related to poor housing such as chronic lower respiratory diseases (such as asthma, bronchitis, and emphysema), but a 23% increase from unintentional injuries.

This call to action summarizes evidence-based research related to housing and health, and recommends steps that might reduce poor health, which include improving air quality and reducing allergens, preventing exposure to elevated lead levels, improving housing structure and design, and preventing overcrowding by ensuring an adequate supply of housing.

Health consequences of cuts

Funding cuts to rental assistance programs, and affordable and safe housing may lead to poorer health on multiple fronts. Approximately 4.6 million households receive HUD rental assistance. According to the Center on Budget and Policy Priorities, two-thirds of working age, non-disabled HUD households are already working or are subject to work requirements, however 60% of them have below-poverty earnings. Non-working HUD households are either looking for work, in school, have a condition that makes it difficult to find and sustain employment, or are full-time caregivers. Rather than encourage work and self-sufficiency, rent increases may drive more HUD households into poverty and further hardship. Furthermore, housing cost burdens, common among low-income renters, are known to result in less money being spent on basic needs such as food, health care, and transportation.

Diane Yentel, president and chief executive of the National Low Income Housing Coalition, highlights that there is already a $40 billion backlog in public housing capital needs. If structural deficiencies in housing increase as a result of increasing unmet capital needs, there may be an increase in asthma, injuries and poor mental and physical health. Lead exposure results in lasting developmental and behavioral disorders and the percentage of children with elevated blood levels has recently increased across America. However, stagnant funding for lead exposure mitigation may not be able to meet these increasing needs. Furthermore, an inadequate supply of housing may lead to overcrowding and homelessness, both of which are associated with poorer mental and physical health.

Limited research has assessed the casual effects of housing and housing policy on health. The aforementioned research is largely observational, where the correlational but not causal effects of housing on health can be inferred. A review of studies on housing mobility policy found that the use of housing vouchers to move from high- to low-poverty neighborhoods, may contribute to better physical and mental health in adults and children. Even the Task Force on Community Preventive Services recommends the use of housing voucher programs to move to safe neighborhoods to improve health. Additional funding to evaluate well-designed housing policy experiments is warranted.

Rather than propose the deepest cuts to housing since President Reagan decreased HUD funding by almost 60% from $36 billion in 1980 to $15 billion in 1998, the Trump administration should consider how its low- and middle-class voters will react at the polls to cuts that will likely exacerbate current levels of unaffordable and unsafe housing. Rather than enact this proposed budget (which they may not do), Congress should consider whether maintaining or increasing housing funds directed at the lowest rungs of the economic ladder may increase economic mobility and lead to cost savings in other areas, such as health. For example, children from low-income families receiving housing assistance are less likely to have poor growth and potentially poor nutritional status, compared to those not receiving housing assistance. And the reimplemention of policies that encourage homeownership, such as accessible and affordable mortgages, may allow families to accumulate wealth and mitigate health inequities. Finally, rather than display poor stewardship of taxpayers’ money by spending $165,000 on redecorating the HUD headquarters, Dr. Carson, the Secretary of HUD, should spend time advocating for housing funds that address the housing and health inequities in America.

Renée Mehra is an ISPS Graduate Policy Fellow and a doctoral candidate in the Department of Chronic Disease Epidemiology at the Yale School of Public Health.