Healthy living begins in the home. Secure, affordable housing is critical to living long and well.
That’s according to the recently released 2019 annual County Health Rankings, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.
Ranking the health of nearly every county in the nation, the report’s authors write that their findings “illustrate how where we live affects how well and how long we live,” and underscore “what each of us can do to create healthier places to live, learn, work, and play – for everyone.”
The focus of this year’s report is housing. Health outcomes, the authors continue, “are shaped by a range of factors that are heavily influenced by where we live,” including our behaviors, access to care and nutrition and social and environmental factors.
If housing costs exceed 30 percent of monthly household income, that household is considered severely cost burdened. Nationwide, according to the report, more than one in 10 households spend more than half of their income on housing. This burden is associated with food insecurity, child poverty and self-assessments of poor health, according to the authors.
Communities across the country are rising to this challenge with comprehensive strategies that include housing rehabilitation loans and grants, rapid rehousing initiatives, mixed-income development and civic engagement.
One such is the Appalachian community of Garrett County, Maryland, where affordable-housing initiatives are not only meeting immediate needs but promoting economic development.
One ‘Unforeseen Event’ from the Street
For Aliana Havrilla, a community coach with the County Health Rankings and Roadmaps program, the single-most disturbing statement in this year’s report is that hundreds of thousands of households are but one unforeseen event – an illness, a job loss or even just a drop in hours – from losing their home.
According to the report, in 2016 nearly 900,000 households faced evictions.
That so many families and individuals have such a tenuous hold on secure housing, Havrilla asserted, “is a conversation that we don’t often have, but that we should be having.” It’s a conversation this report aims to advance.
For those who are able to remain in their home, struggling to meet a mortgage payment often means foregoing medical care or extending a few groceries beyond their capacity to nourish, triggering a cascade of health concerns.
While no region or demographic has been immune, the researchers determined that half of all rural counties have experienced an increase in severe housing cost burden since the housing crisis of 2006 to 2010, and that nearly one in four black households spend more than half of their income on housing.
Garrett County is Maryland’s westernmost county, abutting the state’s West Virginia and Pennsylvania borders. According to the County Health Rankings, it ranks 15th among the state’s 24 counties in health outcomes, health behaviors and clinical care, and 17th in quality of life.
The Garrett County Community Action Committee is a private nonprofit agency that works to build economic security for lower-income families and households. Affordable housing has been an area of concerted focus.
Duane Yoder, the agency’s president, said that while the home-ownership rate in the county is high, much of the housing stock is mobile homes that are in poor condition.
“One of the things that’s happened is that the community has been successful in creating jobs,” Yoder said. The county’s unemployment rate was once three times that of the state and the nation; it’s now roughly equal to those rates. But many of those jobs are in the services industry, and the pay is moderate to low.
“What that does in terms of housing,” Yoder explained, “is that it has created what our economic-development people and the business community are saying is an absence of affordable workforce housing. That’s become the big economic-development issue in the county.”
Affordable workforce housing is housing that is considered to be reasonably affordable for moderate to middle-income workers.
A primary concern for Garrett County, like for so many rural Appalachian communities, is the aging of its population – young people leaving in search of more and better opportunities. A declining population has a ripple effect, with implications for a community’s health. It can make it more difficult to recruit health care professionals and result in the closing of the local hospital.
So the community asked itself, Yoder said, “Can we do something to promote affordable housing that is targeting workforce-level incomes, and see if that stabilizes the population – see if that creates a younger population with children and a new economic energy that comes out of the younger households.”
The county commission has appropriated more than a million dollars the past couple of years to the Garrett County Community Action Committee for a down-payment assistance program. The stipulation is that the house must be in Garrett County.
The community has also invested in mixed-income rental housing, with units available for different income levels.
So while striving to bolster its residents’ quality of life in the here and now, the community is aiming toward a healthier future.
“It’s an economic-development strategy trying to address the issue of the decline in our population,” Yoder said. “We’re using housing as a strategy to promote economic development.”
Reason for Hope
The County Health Rankings authors write that “when too much of a paycheck goes toward the rent or mortgage, it makes it hard to afford the doctor, cover utility bills, or maintain reliable transportation to work or school. Owning a home can help build savings, providing stability and wealth over time.”
This is the 10th year of the rankings, Aliana Havrilla notes. “What gives me hope, broadly, is that we have knowledge and understanding of what drives better health.” That knowledge is now being coupled with practical strategies, she said. “We see a lot of these promising approaches and ideas across the country.”
“We’re really starting to understand both the drivers and the opportunities. That’s what gives me hope.”
Taylor Sisk is 100 Days in Appalachia’s health correspondent.