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Health, Housing, and the Law
Abraham Gutman, MA
Center for Public Health Law Research
Temple University
Philadelphia, PA
2018 Annual Health Law Conference
Center for Health Policy and Law
Northeastern University
Boston, MA
1. Housing inequity is a wicked problem
2. Law has largely been neglected as a lever in
this complex system
3. A systems model can help us organize existing
legal levers and what we know about them
4. We know very little about some of the most
basic housing laws, we also see little innovation
5. A public health law research agenda for
housing equity is needed
A Wicked Problem
• Ill defined
• No definitive formulation
• Never fully solved
• Every attempt counts
significantly
Rittel, H.W.J. & Webber, M.M. Policy Sci (1973) 4: 155. https://doi.org/10.1007/BF01405730
The State of Housing
6,689,000
35 for every 100
83,000,00038.9 million18.8 million
4,000,000
Linchpin to Health
Safe
Housing
without any
Hazards
Stable
Housing
Affordable
Housing
Socio-
Economically
and Racially
Diverse
Neighborhood
with Amenities
Problem Definition?
• Rent too damn high or wage too damn low?
• Is there nowhere to build or is there too much
vacancy?
• Is housing an economic problem? A poverty
problem? A health problem? A legal problem?
Ill defined problem
Game Plan
1. Start from the end –
what is the
aspirational goal?
2. Break the problem
down to smaller
problems – what do
we know?
3. Fit them together in
a system
The Goal: Housing Equity
The Role of Law
• Recent works have
showed that law has
an instrumental role in
both creating and
perpetuating the
system of housing in
the United States.
“Soundboard” Approach
• Each law governing
housing could be
thought of as a lever
on a soundboard of a
sound producer.
• The goal is to balance
the levers to achieve
“the perfect sound” –
equity.
A Legal Levers Model
More people living
in quality housing in
socioeconomic and
racially mixed,
healthy
neighborhoods.
Maintaining
Existing
Housing
Affordable,
Stable, and
Safe
Increasing
the Supply
of New
Affordable
Housing
Affirmatively Furthering Fair Housing
Protecting and Enhancing Economic
Choice for the Poor
Governance
We find:
• A lot of law
• Little innovation
• Very little evaluation
Domain: Fair Housing
Lever: state fair housing laws
What We Know:
• There is a dearth of
literature on the
impact of state and
local fair housing laws
which shows modest
to no effect on
segregation.
Domain: New Housing
Lever: LIHTC
What We Know:
• The Low Income Housing Tax Credit Program
created 2.97 million housing units between 1987
and 2015 with an annual budget of $8 billion.
• Does LIHTC increase affordable housing
supply? Few studies
• Does LIHTC contribute to poverty concentration
or racial segregation? Few studies that are
conflicting.
Domain: Existing Housing
Lever: Code Enforcement
What We Know:
• Do housing code enforcement efforts increase
quality of housing or lead to evictions and rent
hikes?
• “A debate with no evidence” (Desmond & Bell,
2015)
Desmond, M., & Bell, M. (2015). Housing, Poverty, and the Law. Annual Review of
Law and Social Science, 11, 15-35.
Domain: Expanding Choice
Lever: Housing Vouchers
What we know:
• Assisting 2.2 million families, 1-in-4 qualified.
• In many cities, voucher holders are clustered in
high poverty areas, “voucher submarket.”
• The common thread to studies: in cities where
there is more affordable housing, the outcome of
the HCV is better and mobility is increased.
What Do We Know?
What Now?
Get “the whole system in the room” with “hope that
there is a better way of doing things, a recognition
that failure is possible, and a willingness to ‘trust
the process’ without guarantees of a particular
outcome.”
Nancy Roberts, Wicked Problems and Network Approaches to
Resolution, 1 INTERNATIONAL PUBLIC MANAGEMENT REVIEW (2014).
Public Health Law
Research Agenda
✔ Aspirational goal.
✔ Lever that could shape the system.
✔ A model that puts “the whole system in the room.”
✘ Evidence, experimentation, and deliberate
collaboration.
A clear public health law research agenda is a
start to tie what we have and what we are
missing.
1. Housing inequity is a wicked problem
2. Law has largely been neglected as a lever in
this complex system
3. A systems model can help us organize existing
legal levers and what we know about them
4. We know very little about some of the most
basic housing laws, we also see little innovation
5. A public health law research agenda for
housing equity is needed
What I promised to show:
