A man walks through a vacant lot in the Northern Liberties neighborhood of Philadelphia. Matt Rourke/AP

The features of urban decay can have a powerful effect on the overall wellness of a community. But these health impacts are often left relatively unexamined.

In the spring and summer of 2011, researchers from the University of Pennsylvania strapped heart monitors onto test subjects and set them loose on the side streets of Philadelphia. The subjects strolled around two clusters of vacant lots. Some of the lots had received a “greening” treatment from members of the Philadelphia Horticulture Society, who’d removed debris, planted grass and trees, and installed a low wooden post-and-rail fence. The other lots were untreated as a control. After analyzing GPS data from the subjects walks, before and after greening, the scientists found that walking in proximity to a greened space decreased subjects’ heart rates, compared to a non-greened vacant lot.

It’s just one example of how directly the city affects the bodies of those who live in it. “What I think is magical is that urban greening interventions are pretty simple,” says Joseph Schilling, a senior research associate in the Metropolitan Housing and Communities Policy Center. “It's not as if it takes tremendous improvement to the landscape, and yet you still see this health benefit.”

Schilling co-authored a new report by the Urban Institute that delves into the latest research on how urban blight—defined here as substandard housing, abandoned buildings, and vacant lots—functions as a social determinant of health. The research on this is relatively sparse, he says; while there’s lots of data on housing policy and public health, the two fields are not studied together much. With co-author Erwin DeLeone, Schilling has identified cities where the efforts to rid neighborhoods of abandoned buildings and vacant lots could be studied specifically for their public health impact.

“Public health folks don't necessarily think about blight when they're looking at their range of actions or intervention in housing,” Schilling says. “Housing officials are often narrowly focused on their responsibilities and don't think about what the public health impacts are.”

A community garden in Philadelphia. (Rob Cardillo/Philadelphia Horticultural Society)

Unhealthy homes can be pretty easy to spot. The report’s scan of the academic literature catalogues how broken windows or leaks, insect and rodent infestation, lead paint and pipes, defective appliances, and poor ventilation translate to direct health harms such as elevated blood lead, respiratory ailments, and exposure to cancer-causing toxins. And most housing policy focuses on these interior public health concerns. Earlier studies show that people spend about 69 percent of their time each day inside homes and only 8 percent outside. “If you think about families that live in or near substandard housing,” Schilling says. “There’s a huge cost in terms of impacts on asthma and other health conditions. If you can remove those agents of bad health, you would have greater cost savings—from direct health care costs, to higher property values, to better balance in a city budget.”

There’s evidence for the public health benefits of programs such as the Department of Housing and Urban Development’s Healthy Homes, an initiative that uses a mix of education and incentives for landlords and tenants to improve substandard housing.

(Braveman et al. 2011/Robert Wood Johnson Foundation)

Schilling argues we need to research models across different markets in cities with an eye towards a more holistic understanding of how an entire ecosystem of housing—such as neighborhood conditions and housing affordability—help or hurt public health.

“When you think about substandard housing, it’s easier to see the direct connection to the effect it has on the tenant or occupant,” Schilling says. “But when you think of an abandoned building or a vacant lot, there’s cumulative impact. In neighborhoods, we often see concentrations [of a problem]. It’s not a particular building—it’s how that collection of buildings is playing into the health of people.”

Even though much U.S. housing policy emerged with the idea of improving health, Schilling says that we lose sight of that aim when we measure blight elimination solely by property values and poverty rates. “Most housing documents measure output, like the number of spaces they inspected, the number of property fines collected,” he says. “We haven't dug deep enough to really understand the health impact.”

Working from a model created by the Robert Wood Johnson Foundation, Schilling will tackle that question in Memphis, Tennessee, with a two-year health impact assessment by the University of Minnesota’s Interdisciplinary Research Leaders project supported by the foundation. The project will investigate substandard homes and determine how housing policy can influence public health. “We’re going to work with a wide variety of the players in Memphis—local hospitals, the local Healthy Home working group, schools of public health, schools of urban affairs and planning, housing officials,” says Schilling. “We’re looking at what interventions work, from environmental courts to housing code enforcement, so we can learn what we can also apply to other cities.”

Housing’s role in public health is about more than lead contamination, pests, or broken windows; it’s also about whether the neighborhood itself encourages exercise, eases the stress of daily living, and deters crime. “We don’t see a lot of research that connects people’s physical activity and how a neighborhood operates,” Schilling says. “Someone living in a place with a lot of abandoned buildings is going to be less inclined to walk, exercise, go to the park.”

For decades, Baltimore, Maryland, has struggled to deal with tens of thousands of vacant homes. The impact on health outcomes for those living nearby, however, remains understudied. (Kevin Lamarque/Reuters)

What abandoned houses and vacant lots demonstrate is how little things can add up to a drain on public health. Schilling points to a 2015 study where the Ohio Education Research Center at Case Western Reserve University looked at how housing influenced kindergarten readiness in the Cleveland Metropolitan School District. Children who grew up within 500 feet of a distressed property had lower literacy scores.

Similarly, abandoned houses that become havens for crime have a host of indirect health impacts on neighbors; as Schilling puts it, the harm from crime “radiates” throughout a neighborhood: “If someone lives next door to vacant and abandoned property that is used for criminal activity, that wears on them psychologically—it’s a creator of stress.”

Abandonment can also speed the spread of disease via rodents or from the dumping of waste. “The effect might be localized but multiply that again and again,” says Schilling. “There’s a cumulative impact. If you've got ten, fifteen, maybe thirty vacant properties on a block, that concentration becomes a health hazard.”

Blight’s ground zero: A 2014 map of land recommended for structural removal and vacant lots in Detroit. (Detroit Blight Removal Task Force)

The report also outlines policy tools to combat blight, such as land banks and housing code enforcement, along with programs that allow cities with limited resources to target their efforts. “Baltimore had done a great job with its Vacants to Value initiative, which is more of a neighborhood-driven strategic approach to code enforcement,” Schilling says. “But it's only around for about four and a half years. We're seeing positive impacts on property values, but we don't know yet what the public health impacts are. The same thing is happening in places like Cleveland and Detroit.”

Implementing housing policy in a way that doesn’t endanger the health of neighbors and residents involves more than just code enforcement, Schilling says. “It really does put housing officials in this precarious position. If you don't enforce the code, we allow tenants to live in really unhealthy conditions. If you enforce the code too strictly without thinking about alternatives, you displace residents. You’re sort of given a Hobson’s choice.”

Visual fixes: Examples of exterior transformations from the Philadelphia Vacant Property Strategy that enforced a “doors and windows” ordinance. (Michael Maenner/City of Philadelphia Department of Licenses & Inspections)

One example: Philadelphia began to enforce a doors and windows policy to address vacant properties, particularly those left unkept by land speculators. When the city launched the program, it took the time to open a docket on the court for people to appeal their fines to avoid punishing residents who needed help installing working doors and windows for their properties. A 2015 study found the policy had a statistically significant effect on reducing gun-related incidents, assaults, and nuisance crimes.

In other words, rather than wielding code enforcement as a way to punish offenders or extract revenue, Schilling argues that the wellbeing of residents ought to be restored as housing policy’s central purpose. “We need to return housing back to its roots,” he says. “Housing codes were initially framed as a way to protect public health. While there’s still some of that, it’s so often become secondary.”

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