With nearly 40 community partnerships across the country, the BUILD Health Challenge strives to identify learnings that can be applied more broadly to address the root causes of our country’s most persistent health challenges. We’re working with communities to tackle big issues that are inextricably linked to health, such as food insecurity, transportation, early childhood development, and safety, alongside dozens of other issues.

Recently, several of the BUILD communities approached us with a seemingly straightforward question about how many housing inspectors other cities have to enforce their rental codes and protect residents from unsafe housing. They intended to use this information to better understand the role housing inspectors play within different communities, since they are often a major stakeholder in identifying and addressing building related issues that directly impact the health of residents (e.g., chronic asthma). With several BUILD communities working on the issue of housing across the country, we were able to gather this information and discuss the results—which ended up revealing more than we had anticipated. We realized the right question to ask was not, “how many do they have?” but rather, “how many inspectors do they need to make sure housing actually contributes to health instead of fueling health crises?”

Housing is just one focus area for BUILD and this statistic is just one metric among hundreds that play out in an incredibly complicated environment. But it’s definitely one worth considering. Here’s what we found. (Download the Infographic)

The BUILD Approach

The BUILD Health Challenge Housing Infographic

As a first step, we asked the six BUILD-supported community-based partnerships in our current cohort with a housing focus about how poorly maintained rental properties impact health and how their community enforces health and safety protections. While they uniformly found substandard rental properties associated with higher rates of chronic conditions, especially childhood asthma and lead poisoning, their responses varied widely with respect to how many inspectors their cities used to enforce the rental code.

We realize that these cities differ tremendously in many respects—size, location, budget, and so on—so there is no intent to compare them to one another. We share these findings only to provide a snapshot in time and demonstrate the stark contrast in the ratio of rental properties to housing inspectors that exists in these cities. If you take Cleveland, OH, for example, you will see that there is a total of 11 rental inspectors for all 84,000 rental properties. This means that there is 1 inspector for every 7,636 rental properties. Through this exercise we saw within our own cohort the challenge of maintaining existing safe, affordable rental housing while building more to accommodate an influx of residents.

Housing is Hard to Get Right

These data alone hardly answer the question that started us on this path— “How many housing inspectors do cities need and what sort of policy support do inspectors need to protect their residents as the communities grow?”

Over the past decade, many other cities and suburbs alike have also experienced a population boom that pushed up housing costs faster than incomes. It’s a dynamic that has forced local policymakers and stakeholders in BUILD communities and across the country to grapple with questions about how communities evolve while serving the needs of old and new residents alike. While more novel issues such as Airbnb rentals, inclusionary zoning, and transit access demand attention, more traditional questions, such as how to best identify unsafe housing conditions and hold landlords accountable for addressing them before these issues create long-term health impacts, can’t be taken for granted either.

Looking at these communities we see that with more information in hand, cities can begin using the data to inform their public policy efforts, community engagement strategies, and healthcare delivery. Recent efforts by BUILD-supported partnerships have focused attention on this very issue and resulted in improved health and housing outcomes. Namely, more inspectors (Cleveland, Des Moines, and Trenton), a citywide rental registry (Cleveland and Trenton), and regular, proactive inspections (Cleveland) that will systematically improve the quality of housing across the community. BUILD communities aren’t stopping there either. Collectively, we are looking ahead at what’s next and working on exciting new programs that address the traditional challenges in new ways.

For BUILD, and the communities we work with, issues at the intersection of health and housing are top of mind. Our goal is to strengthen partnerships between community-based organizations, hospitals and health systems, local health departments, and others, to cultivate a shared commitment to moving resources, attention, and action upstream to drive sustainable improvements in community health. It’s questions like these discussed above that BUILD and the communities it supports will continue asking as we contribute to our nation’s understanding of health and wellness farther upstream from healthcare to the root causes of our most persistent challenges.  We invite you to join us in this conversation and share what you’re thinking about in housing and beyond.

(Download the full size infographic here.)