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Can Affordable Housing Improve Heart Health?

Study links inclusionary zoning policies to improved cardiovascular outcomes.

Key points

  • Municipalities with more affordable housing tend to see better heart health among their residents.
  • Improved access to stable and affordable housing has been shown to lower crime and improve access to education and healthcare.
  • Inclusionary zoning policies are associated with greater income and racial integration.
Photo by Pavel Danilyuk from Pexels
Source: Photo by Pavel Danilyuk from Pexels

Over 126 million Americans are affected by heart disease—the number one cause of death in the United States. Heart disease is a catchall term for several heart-related conditions, many of which can be fatal, including atherosclerosis (the buildup of cholesterol in arteries), stroke, coronary heart disease (a disease of the vessels supplying blood to the heart), and various heart rhythm disorders (like atrial fibrillation).

Some populations face a greater risk of heart disease than others: Individuals living in poverty, for example, are much more likely to suffer from heart disease and heart failure than individuals hailing from higher socioeconomic statuses. Poorer nutrition, limited access to treatments and life-saving medicines, the chronic stress of being unable to make ends meet, and living in unsafe or unstable housing conditions have all been shown to contribute to this disparity.

So too have the more health hazardous conditions of homeless shelters and public or low-income housing (think: poorer ventilation, greater exposure to secondhand smoke, peeling lead paint, crowded living spaces, and closer proximity to pollutant-producing sites like chemical plants). That many individuals living at or below the poverty line lack access to green spaces and areas affording opportunities to exercise—both of which improve cardiovascular health—is yet another reason they face such elevated risks of heart disease.

Keenly aware of these disparities, George Washington University researcher Antwan Jones, Ph.D., and colleagues set out to see whether the availability of affordable housing in a given area correlated with improved heart health among that area's residents. Jones et al. did this by looking at the correlation between various heart health measures in certain municipalities (think: diagnoses of cardiovascular disease and high cholesterol as well as use of prescription medications to lower blood pressure) and these municipalities' adoption (or not) of inclusionary zoning policies.

What Are Inclusionary Zoning Policies?

Inclusionary zoning policies refer to housing policies that increase the number of affordable housing units in a given area either by requiring developers to set aside a certain percentage of units in new developments for families living below certain income thresholds; incentivizing developers to do so via expedited permitting, construction fee reimbursement, and density bonuses (whereby developers may increase the square footage or number of units in their buildings, provided they reserve a certain number of units for lower-income tenants); or levying fees on developers creating market-rate real estate that is used to finance affordable housing.

Photo by Jonathan Borba from Pexels
Source: Photo by Jonathan Borba from Pexels

Jones' team was interested in this link because of the correlations between affordable housing and other known benefits, which include improved access to schools and job opportunities as well as increased safety. At least one other study by researcher Courtnee Melton-Fant, Ph.D., at The University of Memphis, Tennessee, found that in states whose laws prohibited local governments from regulating rents through inclusionary zoning policies, individuals living in those jurisdictions rated their health as poorer and tended to delay seeking medical care due to cost concerns. (The effects were particularly pronounced for Black individuals).

What the Study Found

Jones et al. looked at demographic data from the U.S. Census Bureau obtained between 2011 to 2015 and the 500 Cities Project: a joint study conducted in 2017 by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation that estimated 27 chronic disease risk factors and health outcomes for 500 of the largest municipalities in America. Inclusionary zoning data came from a 2015 survey conducted by the Lincoln Institute for Land Policy.

They found that cities without inclusionary zoning policies had more residents with cardiovascular issues (as measured by rates of high blood pressure, high cholesterol, blood pressure medication consumption, and diagnosed coronary heart disease) than cities with inclusionary zoning policies. They also found that cities lacking inclusionary zoning policies had fewer insured adults while cities that implemented more inclusionary zoning policies saw a greater proportion of their residents employed and a lower proportion living in poverty.

More specifically, Jones’ team found that some inclusionary zoning policies predicted better heart health outcomes than others. The most impactful policies were mandatory, avoided incentives for developers, increased the percentage of affordable housing units in new developments, required the collection of fees from market-rate developments (to build affordable housing), and ensured the ability to preserve and rehabilitate housing.

This is a fascinating study (recently published in the journal Circulation: Cardiovascular Quality and Outcomes) that sheds further light on the already known benefits of affordable housing. Among them are increased racial and income integration, which has been shown to reduce inequities in access to healthcare, stable employment, and education. Increased access to affordable housing—via the Low-Income Housing Tax Credit, or LIHTC, which subsidizes the procurement, building, and/or rehabilitation of affordable rental units—has also been shown to reduce crime rates, in part because such developments often include 24/7 security and local police may set up outposts within LIHTC developments. If more residents have access to affordable housing, the incentives to engage in crime may also decrease, as being able to make ends meet decreases pressure to resort to violence or theft in order to procure needed resources like money and food.

Photo by cottonbro from Pexels
Source: Photo by cottonbro from Pexels

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.

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