Physical Environment - Built Environment - Improve housing quality

Housing rehabilitation loan & grant programs

Health Factors:	Built Environment
Decision Makers:	Government - Local, Government - State
Evidence Rating:	Scientifically Supported
Population Reach:	50-99% of WI's population
Impact on Disparities:	Likely to decrease disparities

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Description

Housing rehabilitation loan & grant programs provide funding primarily to low or median income families to repair, improve, or modernize their dwellings, and to remove health or safety hazards from those dwellings.

Expected Beneficial Outcomes

Improved health
Reduced utilities costs (heating/cooling)
Improved housing safety

Evidence of Effectiveness

There is strong evidence that housing improvements generate health benefits, especially when improvements focus on increasing warmth through insulation and energy efficiency measures (Cochrane-Thomson 2013, Gibson 2011, Howden-Chapman 2007, NICE-Taske 2005). The effects of more general housing refurbishment initiatives on health are less certain (NCHH-Jacobs 2009).

Housing improvements targeting warmth have shown consistent positive effects on physical and mental health including general, respiratory, and mental health outcomes, as well as measures of well-being such as self-rated general health. Such improvements have also been shown to reduce children's absences from school, adult absences from work, doctor's visits, and hospitalizations (Cochrane-Thomson 2013, Howden-Chapman 2007). Low income housing rehabilitation complying with green standards can also improve health; green standards use sustainable building products and healthy housing features to reduce moisture, mold, pests, and radon, and improve ventilation (Breysse 2011).

Housing rehabilitation efforts in poor and declining neighborhoods may also have positive effects on neighborhood quality and neighborhood stability (Smith 2011, Helms 2012).

Implementation Examples

United States

Housing rehabilitation loan and grant programs are in place at the federal and state level and are available in all states. The US Department of Housing and Urban Development's Section 203(k) program is the primary federal program for the rehabilitation of single family homes. Section 203(k) can be used in combination with programs like the Community Development Block Grant and the HOME Investment Partnerships program (US HUD-Housing rehab).

Wisconsin

The Wisconsin Department of Administration, Division of Housing operates the Homebuyer and Rehabilitation Program with funds from the HUD HOME Investment Partnerships Program (WI DOA-HHR) and the WI Community Development Block Grant program for housing rehabilitation (WI DOA-CDBG).

Citations - Evidence

Breysse 2011 - Breysse J, Jacobs DE, Weber W, et al. Health outcomes and green renovation of affordable housing. Public Health Reports. 2011;126(Suppl 1):64–75. Accessed on March 11, 2013
Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072905/

Cochrane-Thomson 2013* - Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socio- economic outcomes. Cochrane Database of Systematic Reviews. 2013;(2):CD008657. Accessed on March 11, 2013
Webpage: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008657.pub2/abstract

Gibson 2011 - Gibson M, Petticrew M, Bambra C, Sowden AJ, Wright KE, Whitehead M. Housing and health inequalities: A synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health & Place. 2011;17(1):175–84. Accessed on March 11, 2013
Webpage: http://www.sciencedirect.com/science/article/pii/S1353829210001486

Helms 2012* - Helms AC. Keeping up with the Joneses: Neighborhood effects in housing renovation. Regional Science and Urban Economics. 2012;42(1-2):303–13. Accessed on March 11, 2013
Webpage: http://www.sciencedirect.com/science/article/pii/S0166046211001001

Howden-Chapman 2007 - Howden-Chapman P, Matheson A, Crane J, et al. Effect of insulating existing houses on health inequality: Cluster randomised study in the community. BMJ. 2007;334(7591):460. Accessed on June 20, 2012
Webpage: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1808149&tool=pmcentrez&rendertype=abstract

NCHH-Jacobs 2009 - Jacobs D, Baeder A. Housing interventions and health: A review of the evidence. National Center for Healthy Housing (NCHH). 2009. Accessed on June 20, 2012
Webpage: http://www.nchh.org/Portals/0/Contents/Housing Interventions and Health.pdf

NICE-Taske 2005 - Taske N, Taylor L, Mulvihill C, et al. Housing and public health: A review of reviews of interventions for improving health - Evidence briefing. NHS National Institute for Health and Clinical Excellence (NICE). 2005. Accessed on June 20, 2012
Webpage: http://www.nice.org.uk/nicemedia/pdf/housing_MAIN FINAL.pdf

Smith 2011* - Smith MM, Hevener CC. The impact of housing rehabilitation on local neighborhoods: The case of small community development organizations. American Journal of Economics and Sociology. 2011;70(1):50–85. Accessed on March 11, 2013
Webpage: http://onlinelibrary.wiley.com/doi/10.1111/j.1536-7150.2010.00763.x/abstract

Citations - Implementation Examples

US HUD-Housing rehab - US Department of Housing and Urban Development (US HUD). Rehab a home w/HUD’s 203(k). Accessed on June 19, 2012
Webpage: http://portal.hud.gov/hudportal/HUD?src=/program_offices/housing/sfh/203k/203kabou

WI DOA-CDBG - Wisconsin Department of Administration (DOA). CDBG-Small cities housing program. Accessed on September 4, 2012
Webpage: http://doa.wi.gov/category.asp?linkcatid=1066&linkid=212&locid=173

WI DOA-HHR - Wisconsin Department of Administration (DOA). Homebuyer and rehabilitation program (HHR). Accessed on June 18, 2012
Webpage: http://doa.wi.gov/category.asp?linkcatid=1071&linkid=212&locid=173

* Journal subscription may be required for access.

Comments from Users about this Policy/Program (Cost, Feasibility, Lessons Learned)

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Health Factors

Health Behaviors

Tobacco Use

Diet & Exercise

Alcohol Use

Sexual Activity

Clinical Care

Access to Care

Quality of Care

Social & Economic Factors

Education

Employment
Income

Income

Family & Social Support

Community Safety

Physical Environment

Environmental Quality

Built Environment

Decision Makers

Businesses & Employers

Community Organizations

Government - Local

Government - State

Government - Federal

Healthcare Organizations

Individuals

Schools

Evidence Rating

Level of effectiveness based on a scan of academic literature and key recommendations of leading organizations.

Scientifically Supported Numerous studies or systematic review(s) with positive results
Some Evidence Research suggests positive impacts; further study may be warranted
Expert Opinion Recommended by credible groups*; research evidence limited
Insufficient Evidence Evidence limited or unavailable; further study warranted
Mixed Evidence Evidence mixed; further study warranted
Evidence of Ineffectiveness Research consistently shows program is detrimental or has no effect

Although many policies and programs are recommended by credible groups, we apply the rating ‘expert opinion’ only when policies are recommended but limited scientific evidence of effectiveness is available.

* The American Heritage Dictionary defines credible as 'capable of being believed; plausible.' and 'worthy of confidence; reliable.' To be considered an 'expert recommendation,' policies and programs must be recommended by one or more organizations that are recognized for their impartial expertise in the area of interest and have limited evidence available.

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

	<1%			20-49%
	1-9%			50-99%
	10-19%			100%

Potential Population Reach

	<1%			20-49%
	1-9%			50-99%
	10-19%			100%

Potential Impact on Health Disparities

Likely impact of a given policy or program on racial/ethnic, socioeconomic, geographic or other disparities in Wisconsin based on its characteristics (e.g., target audience, mode of delivery, etc.) and best available evidence related to disparities.

Likely to decrease disparities
No impact on disparities likely
Likely to increase disparities