A doctor in the housing department? Why not? J. Scott Applewhite/AP

Maybe Dr. Ben Carson is not the best choice for HUD secretary, but the link between housing and health makes a medical professional a good pick for this Cabinet position.

Donald Trump’s choice to have his one-time rival Ben Carson head the Department of Housing and Urban Development has triggered a lot of head-scratching. Carson’s dilly-dallying* on whether to accept the job drove many into full excoriation disorder, wondering why a retired neurosurgeon with no housing policy experience was even being considered. CityLab’s Kriston Capps assembled a comprehensive set of opinions from housing experts on why having Carson lead HUD would be a huge mistake—not least of which is the doctor’s allergy to fair housing principles.

But if the critique is that a medical professional is unfit for the HUD position, then that doesn’t square with the research, which is increasingly convinced that housing is indeed a health issue. Dr. Megan Sandel, the former medical director of the National Center for Medical-Legal Partnership, calls housing a “vaccine” for protecting children against societal ills. And there’s global agreement on this. The World Health Organization states in its international guidelines for “healthy housing” that:

There is a clear need and opportunity for governments and others to promote health in the course of making investments in housing. International guidance on healthy housing–targeting construction experts, architects and engineers as well as housing agencies and local authorities–would enable action that is scientifically-based, and protects and advances public health.

“There are clear and obvious links between health and housing,” says Diane Yentel, president and CEO of the National Low Income Housing Coalition. “Whether Dr. Carson would use his position and his expertise to make that case in order to protect and expand proven affordable housing solutions remains unknown.”

A brain surgeon like Carson might not make that kind of connection. But another person with a public health background likely would. That wouldn’t be a bad prescription for HUD right about now, given the important discussions being held about, for example, toxic lead spewing from faucets and flaking from window frames in low-income communities.

Earthjustice staff attorney Eve Gartner agrees that it would be “extremely important” for the next HUD secretary to have a health background. She’s been involved in an effort to force the federal government to take stronger action on home-based lead poisoning—a campaign mostly aimed at the EPA, but which calls for HUD’s attention as well.

“Housing is not just about construction and bricks and mortar, but also about whether there is mold, or are their other substances in the housing that are causing or contributing to things like elevated asthma rates in kids,” says Gartner. “[It’s also about] really understanding that any exposure to lead puts a child at risk of having brain damage”

But as Yentel mentioned, there’s also tremendous health value in assuring that housing is affordable. Yentel points to the American Academy of Pediatrics’ recent advocacy for an expansion of the Section 8 voucher program into healthcare services as evidence of this. A summary of research on the impacts of affordable housing on health, published by the Center for Housing Policy in April 2015, attests to this:

Affordable housing alleviates crowding and makes more household resources available to pay for health care and healthy food, which leads to better health outcomes. High-quality housing limits exposure to environmental toxins that impact health. Stable and affordable housing also supports mental health by limiting stressors related to financial burden or frequent moves, or by offering an escape from an abusive home environment. Affordable homeownership can have mental health benefits by offering homeowners control over their environment. Affordable housing can also serve as a platform for providing supportive services to improve the health of vulnerable populations, including the elderly, people with disabilities, and homeless individuals and families. Safe, decent, and affordable housing in neighborhoods of opportunity can also offer health benefits to low-income households.

To see how this works, look no further than East Harlem, affectionately known as “Spanish Harlem,” which has lost nearly 2,000 affordable housing units since 2011. It’s slated to lose thousands more over the next ten years. Over half of the neighborhood’s population is rent-burdened, meaning a family pays more than 30 percent of its income on rent, leaving little for other needs like medicine. This is especially problematic given that East Harlem has some of the highest asthma rates in the nation.

For the New York Academy of Medicine, there is a clear link between the kind of financial suffocation experienced by East Harlem renters and the asthmatic kind. Which is why East Harlem leaders involved NYAM researchers when the city began scoping out the neighborhood under its new affordable housing plan. There was a desire from the community to prioritize the health conditions of East Harlem residents in the new rezoning process, so NYAM performed a health impact assessment of the neighborhood’s housing needs.

It’s a novel concept—planners and developers perform economic and environmental impact assessments, but usually not health-based ones. The East Harlem study was just the second ever done in New York City and it wrapped in September. Based on the data gathered, NYAM found that the city’s inclusionary zoning policy—requiring developers to preserve a portion of new housing units for families making well below the area median income—would be a “crucial part of maintaining a stable, health-supporting environment in urban communities.”

Other recommendations from the East Harlem Neighborhood Plan Health Impact Assessment include setting annual goals for reducing housing code violations, integrating active design and alternative green spaces, and reducing dust exposure and noise pollution during construction.

Lindsey Realmuto, one of the lead researchers on the health assessment, says that their study has been well received by planners in both the public and private sector, but there’s no telling how much of it will be incorporated into the actual redevelopment.

“Implementing what we know to be healthy design strategies sometimes takes longer and requires more community involvement, and as you can imagine, when developers want something built, sometimes that kind of community engagement and extra effort doesn’t get done,” says Realmuto, “but some developers, especially nonprofit developers, have been doing a really good job trying to make this an essential component of their housing plans.”  

Health advocates would no doubt like to see a program like this scaled up, used in communities and cities across the country as the urban landscape continues to transition. What would be helpful is a strong cheerleader or ambassador who holds tremendous sway over how homes and urban communities are developed in America—someone like a HUD secretary. Even better: a HUD secretary with health care expertise. Maybe someone like Ben Carson.

But it would also require someone who respects the roles of desegregation and civil rights in making cities stronger and lifting people out of poverty. So, given his aversion to these things, then maybe someone not like Carson.

“Given the complexities of the growing affordable housing crisis and the multitude of programs under HUD’s purview, an ideal candidate for HUD secretary would have some experience with and understanding of the programs he will oversee—Dr. Carson has little to none,” says Yentel. “However, if Dr. Carson accepts the position and chooses to use his leadership and his significant health expertise to better make the case for the importance of affordable housing solutions to the health of kids, families and communities, that could be very powerful.”

*This post has been updated.

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