Home: A Pathway to Health Equity Through Housing An Assessment of the Connection Between Housing & Health In Pinellas County, Florida Rusty Bennett, CEO Collaborative Solutions, Inc. A special thanks to: Bon Secours, the Shimberg Center, Pinellas County Government, and the National Low Income Housing Coalition for their research and efforts that helped us develop this report As Randy said… 1) This is a journey and the beginning of deeper exploration of the interconnection between housing and health

Social & Economic Factors Health Behaviors Drugs Smoking Drinking Safe Sex Diet & Exercise Clinical Care Access to Health Care Quality Care Social & Economic Factors Income Education Family Employment Community Support Physical Environment Air Quality Water Quality Transportation Housing Medical treatment alone will not create the impact needed to achieve health equity – must include social determinants of health lens, particularly the Physical Environment: Housing SOCIAL DETERMINANTS OF HEALTH – IMPROVING OUTCOMES TO ACHIEVE HEALTH EQUITY

HOUSING AS A BASIC HUMAN RIGHT HOUSING AS A HOME HOUSING AS HEALTH Key belief: Housing is critical to achieve health equity - Housing is the mechanism through which larger systemic inequities get realized (Aidala & Sumartojo, 2007). 1) National movement – moving beyond just housing, to a fuller understanding that housing – that a home has in the life of individuals and families This work is systems-level and a home is the centerpiece – this is where we begin to see the intersectionality of other things… Stable housing is intrinsically linked to health (next slide...Housing is Health Care)

HOUSING IS HEALTH CARE Research demonstrates that stable housing is a crucial determinant of physical and mental health Improves Access to and Retention in Care Ensures Better Health Outcomes Improves Mental Health Environmental Safety Improves Health Cost Effective Adults living in unaffordable housing are more likely to describe themselves as being in “fair” or “poor” health compared to individuals living in affordable housing (Maqbool, Viveiros, & Ault, 2015) Stable and affordable housing may help individuals living with chronic diseases increase their rates of medical care, maintain their treatment regimens, and achieve better health outcomes (Aidala et al., 2016)

Health equity means that every person, family and community has a fair opportunity to live a long, healthy life, regardless of race, ethnicity, income level or gender identification. Achieving Health Equity requires removing obstacles to health, such as poverty and discrimination and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care. HEALTH EQUITY

Areas in Pinellas County with a higher percentage of non-White households show higher rates of mortality. Pinellas County ranks 38th among the 3,007 counties in the United States for the gap between the average income of the top 1% of the population and the average income of the bottom 99%. Poverty has a disproportionate impact on persons of color in Pinellas County - nearly 30% of those living in poverty identify as African-American, 19% identify as bi- or multiracial, and 20% identify as “other race.” Pinellas County is significantly more segregated than other Florida counties. Based on our research, poverty, race, and geography are all connected to access and an ability to maintain safe, decent, and affordable housing in Pinellas County. INEQUITY FACTORS

THE 4 A’S OF HOUSING Affordability – Households pay no more than 30% of their adjusted income toward rent and utility costs. Availability – Units of housing affordable and currently ready for occupancy. Accessibility – Housing that is accessible to needed community amenities. Adequacy – Safe and decent housing, including the physical condition of the property, as well as its location.

THE 4 A’S OF HOUSING - AFFORDABILITY Affordability – households pay no more than 30% of their adjusted income toward rent and utility costs Workers earning 80% Area Median Income (AMI) or below (approximately $50,000 for a family of four) in Pinellas County experience an affordability gap in housing, which increases in proportion to decreasing income. Pinellas County rents have increased nearly 22% in the last six years. A minimum-wage worker earning $8.25 has to work 148 hours per week (or 3.7 full-time workers) to afford the estimated median market rate rent of $1,405 per month. Workers who rent property in Pinellas County must make an hourly wage of $26.93 – nearly 4 times the federal minimum wage – to not spend more than 30% of their income on housing costs. If asked: median market rate rent were assessed using longitudinal data through Zillow’s rental database for Pinellas County Continues to be a lack of affordable units for extremely low-income households; those households continue to disproportionately be persons of color

THE 4 A’S OF HOUSING - AFFORDABILITY 1 in 2 South Pinellas households are cost-burdened and live in areas with high concentrations of low- to extremely low-income residents. The concentration of cost-burdened households in Pinellas County is predominately found in minority neighborhoods. The affordability gap is highest among Black/African-American residents in Pinellas County – $490 compared to $60 for White residents. Lower income households disproportionately pay higher percentages of their income toward housing in Pinellas County. Affordability gap/race data – sourced from analyzing race/ethnicity, AMI, and rent burden from the Census Bureau and Zillow Rent Index Time Series

THE 4 A’S OF HOUSING – AVAILABILITY It is estimated that there is a deficit of 19,820 units for extremely low-income households at 0-30% AMI ($25,100 for a family of four) and nearly 34,000 for households at or below 50% of AMI ($31,950 for a family of four). Only 27 of every 100 renter households living at 0-50% AMI ($31,950 for a family of four) have access to affordable and available rental units. There is only 1 unit of public housing in Pinellas County for every 100 people who qualify. Three out of four low-income seniors do not have access to affordable housing units in Pinellas County. Not only about affordability but do we have units available for low-income residents; subsidies alone won’t get us there

THE 4 A’S OF HOUSING – ACCESSIBILITY Consider Proximity to Community Resources Jordan Park Average Commute Score – 55/100 Greater Pinellas Point Average Commute Score – 36/100 Lake Maggiore Average Commute Score – 46/100 Need to better understand physical access and livability concerns Need to explore potential policy barriers Unfair Screening Processes NIMBYism Persons with Disabilities Commute scores: A measure of accessibility is a community’s walk score. The scores are based on a scale of 1-100, with 100 being the best – the most walkable, best public transportation, or the most bikeable. For communities with higher numbers of households living with lower incomes, these scores are lower – meaning they are more car dependent (whether they can afford a car or not) and have fewer transit options – this significantly limits their access to needed community resources such as employment, health care access, healthy food options, etc. Among the top ten most accessible neighborhoods in South Pinellas County, only two contain assisted housing developments.

THE 4 A’S OF HOUSING – ADEQUACY Pinellas County contains a larger stock of older housing when compared to other areas throughout the State of Florida Estimated that over 177,000 of the County’s housing units were built prior to 1970 – the largest concentration being in St. Petersburg Housing adequacy problems (lack of utilities, overcrowding, cost burden) disproportionately impact low-income, Pinellas County residents Part of strategy needs to connect housing to the importance of health THE 4 A’S OF HOUSING – ADEQUACY

PLACES TO BEGIN Preserve existing affordable housing Increase Collaboration Increase housing especially for extremely low-income Preserve existing affordable housing Create data-driven strategies Eliminate housing inequities

Peggy Bailey Director Health Integration Project Center on Budget and Policy Priorities Diane Yentel President and CEO National Low Income Housing Coalition Fred Karnas Senior Fellow Kresge Foundation Please Welcome our panel of advocates, funders and distinguished national housing experts