Proceedings of a Workshop—in Brief

Convened December 15, 2025

Exploring Relevant Policy Domains: Housing Policy and Population Health

Opening Remarks

The December 2025 Roundtable on Population Health Improvement workshop held in Washington, D.C., explored the intersection of housing policy and population health, including policy at different levels of government, and highlighting housing issues along the life course (e.g., from accessibility for older adults to environmental asthma triggers for children).¹ Mary Pittman, roundtable co-chair and former president and chief executive officer of the Public Health Institute, welcomed virtual and in-person attendees which included members of the roundtable, invited speakers, and others. Pittman explained that throughout 2025, the roundtable examined policy as a structural driver of population health, focusing on labor and employment, taxation, and housing. She said this workshop would examine how housing challenges such as affordability, access, quality, and neighborhood conditions have implications for physical health, mental health, well-being, and life expectancy across the life course. Pittman said speakers would highlight innovative and actionable solutions with a focus on sustainable, replicable, and scalable approaches, including public sector strategies, market-based mechanisms, public–private partnerships, financing, and systems-level change. She said the discussions would also explore narrative strategies for improving public understanding of the relationship between housing policy and health.

Current and Emerging Themes in U.S. Housing Policy

Howard Husock, a senior fellow in domestic policy studies at American Enterprise Institute and a member of the workshop planning committee, moderated an opening discussion with Salim Furth, a senior research fellow and director of the Urbanity Project at the Mercatus Center at George Mason University. Their conversation highlighted some of the key contemporary themes in housing policy at different levels of government, including the growing YIMBY (Yes in My Backyard) movement, the complexity of federal policy effects, and a growing range of zoning policies in different areas of the country.

Husock began by underscoring the important role of local government in housing policy and asked Furth about the significance of new housing supply in increasing overall affordability. Furth said it would be helpful to have a single housing market for all, rather than one bifurcated between those who can afford to purchase a home through the private housing market and low-income individuals who are forced into a secondary housing market that requires vouchers and

other public programs. He shared that if the housing supply in a metropolitan area is increased by 2 percent, it leads to a 3 percent decrease in rent. Husock asked about the barriers to increasing the supply by that percentage. Challenges arise from processes and regulations at the local level, particularly decisions around zoning, which can be rather subjective, Furth replied. For instance, he said, zoning is used to influence community factors such as class, ethnicity, and aesthetics and includes exclusions on where apartment buildings may be located.

Husock mentioned impact fees and their role in incentivizing local government to be less exclusionary in housing construction, noting it as an example of how YIMBY can work. Furth added that many people who support the YIMBY movement are young, urban professionals, who, if born in the previous generation, would have had more housing options but are now unable to afford a house. Husock asked for examples of where and how much YIMBY action is happening in the United States. The movement began in the San Franscisco Bay area, Furth noted, and has spread to many urban areas where supporters attend zoning board meetings. Providing a historical example, Husock explained that in 1947, developer William Levitt wanted to build 17,000 small, 750-square-foot homes on Long Island, and the proposal was rejected until veterans attended the next board meeting and said they would purchase these new homes due to overcrowding in their current living conditions. The homes were built in what is now known as Levittown, Husock said. Furth provided additional YIMBY examples, saying San Franscisco recently approved major citywide upzoning, which allows more types of households (e.g., apartment buildings, single family homes, small multifamily homes) and additional uses of existing infrastructure.

At the state level, Furth said his work has focused on tracking legislation aimed at increasing the housing supply and explained how consequential housing bills have tripled during the past three years. For example, he said, some states prohibit blanket single-family zoning, while others, such as Texas and Maine, allow housing lots to be subdivided into smaller areas to increase the number of homes within the same square footage. Furth noted that in Texas, these smaller subdivisions can cost 25 to 30 percent less than a traditional home, creating cheaper housing stock that increases affordability and access.

At the federal level, Husock said the previous administration introduced an initiative called Affirmatively Furthering Fair Housing,² which incentivized counties to create affordable housing for low-income people in suburban areas by providing financial aid in the form of community development block grants. He noted that the program faced political challenges and was short lived. Furth also emphasized that federal policies can affect housing in numerous ways and said he wished more attention was paid to that relationship. Husock added that one reason for the limited housing supply in the United States is the increased number of households due to both a larger population as well as more people living alone. Furth closed by stating that an effective housing market is one that provides opportunity for anybody along the income spectrum to afford housing that meets their needs.

How Housing Shapes Health and Well-Being

Tiffany Manuel, president and CEO at TheCaseMade and both a roundtable and planning committee member, moderated a panel on how housing shapes health and well-being, featuring Nick Graetz, assistant professor at the University of Minnesota, and Kiyadh Burt, director of Hope Policy Institute. The panel presentations and discussion highlighted the pathways through which housing affects health, the bi-directional nature of the relationship, the role of economic precarity as a factor both resulting from and causing housing instability, and the systemic and not merely individual-level causes of housing challenges.

Manuel said that in the years she has worked on public policy change, she has observed that people "mobilize when they feel momentum, when they can see that progress is possible, when there is something worth fighting for, not just something to fight against." She noted a few areas of momentum in the housing space. First, she mentioned, there are new opportunities to address housing challenges facing an aging population, particularly around the needs of baby boomers who are entering older age. Manuel also highlighted how over the past few years several local and state jurisdictions have passed minimum wage policies, driven by rising housing costs, which have helped people remain stably housed and gain the related health benefits. Additionally, there has been meaningful growth in cross-sector partnerships between health systems, housing developers, and community organizations, she continued, and these efforts are becoming a more widespread strategy to improve population

health. Lastly, Manuel noted, discussions on the evidence surrounding housing and health outcomes are becoming more actionable and focused on for whom this relationship matters, under what conditions, and at what scale.

Graetz introduced four pillars connecting housing and health: condition, context, cost, and consistency (Swope and Hernández, 2019). Condition, he explained, are factors easily recognizable as having direct health effects, such as plumbing, mold, and lead paint. Context includes aspects such as neighborhood and location and determines whether there is exposure to hazardous environmental conditions, Graetz continued. He noted that condition and context are commonly thought of when considering the relationship between housing and health, while the evidence on the pillars of cost and consistency is evolving. Regarding cost, he highlighted one major connection to health outcomes in that "the rent eats first," meaning tenants substitute several other costs (e.g., preventive health care, food) to afford rent. The constant threat of eviction and forced displacement, which has acute and long-term health consequences, often prompts tenants to prioritize rent over other basic needs, he continued.

Graetz noted that the connection between housing and health in the United States is driven by structural racism. He mentioned one of his studies, which found that one in four Black women living with children are threatened with eviction each year, compared with about one in 20 White women living with children (Graetz et al., 2023). Graetz also noted "informal evictions" which include landlords locking renters out of their homes, increasing rent, or failing to provide rental renewals, all of which increase eviction-related stress and fear. Understanding the challenges around housing and health requires seeing the issues as structural and multifaceted and placing a focus on creating broad cross-sector solutions, Graetz said. He emphasized that everyone might have less housing security than they realize, and one medical or life emergency can trigger financial hardship, eviction, and foreclosure.

Burt introduced the role of Hope Enterprise Corporation and Hope Credit Union, a community development financial institution (CDFI) located in six states with a mission to strengthen the financial health and wealth of under-resourced communities. He echoed Graetz's remarks that access to safe and affordable housing is historically and deeply rooted in structural racism. Reflecting on the history of the United States, Burt noted that the counties with the largest concentration of enslaved populations historically now have the highest rates of persistent poverty, referring to a poverty rate of 20 percent for the past three decades.³ He said Hope serves areas that include these counties of deep poverty, noting that populations living in these areas have the highest rates of high-cost mortgage lending and poor health outcomes. As a credit union and mortgage lender, Burt said Hope aims to serve the needs of these communities. For example, in 2024, 87 percent of the organization's mortgage lending went to first-time homebuyers and 77 percent went to people of color. Homeownership improves the health of these populations by providing stability, Burt continued.

Manuel emphasized the idea that housing can be viewed as a communal issue, not just an individual one, and asked both speakers to elaborate on that. In his conversations with communities, Burt said, he distinguishes between personal accountability and institutional responsibility. He said the most recent data on mortgage denials showed that Black mortgage applicants with an income of $150,000 or more had a 29 percent denial rate, which was similar to the denial rate of White applicants with an income of $50,000 or less. Burt noted the reason not necessarily being individual unpreparedness but rather systemic factors that disadvantage Black homebuyers. Burt spoke about structural racism in the context of homeownership, specifically noting the racial homeownership gap, which has increased since 1960 and limits the economic mobility of Black populations who are less likely to have opportunities to pursue buying a home. Hope provides services that help people overcome structural challenges, he added.

Graetz shared his view that the broader financialization of housing is a major issue at the interface between housing and health. He said there is a large amount of capital focused on generating returns through continuously appreciating property values and stated this profit model is rooted in systemic inequalities. Addressing the communal aspect of housing, Graetz shared that over the past five years, he has observed more organizing around the collective framing of housing as a human right rather than commodity and creating long-term stability and affordability, for example, in the form of tenant unionization (formation of the Tenant

Union Federation⁴), campaigns, and the National Tenants Bill of Rights.⁵

Manuel acknowledged the importance of sharing personal experience to illustrate the relationship between housing and health. She reflected on how as a highly educated, African American woman from a low-income neighborhood she has several times experienced challenges obtaining housing and said these were stressful experiences that negatively impacted her emotional and mental health. For example, as a young Ph.D. graduate, she observed her White colleagues who could afford to buy homes because their parents paid the down payment, while she was denied apartment leases, lived in a U-Haul for several days, and felt unwelcome in certain neighborhoods.

Building on this, Burt noted that Hope serves states where large percentages of the population are Black and live in rural areas, presenting unique homeownership challenges. He said families lose ownership of homes due to older generations not having wills in place. In response to Manuel's remark about certain groups being unwelcome in particular neighborhoods, Burt stated it is important to build institutions and infrastructures that do not push people out—and to create incentives to do this. He highlighted a member survey Hope conducted in April 2025, which showed that 53 percent felt that the current economic conditions have reduced their confidence in their future. With decreased financial well-being comes decreased health, Burt emphasized.

Graetz spoke about his personal experience and motivation for getting involved in housing policy work. He acknowledged that he has reaped health and wealth benefits from his grandfather who benefitted from the GI Bill,⁶ which allowed him to buy an affordable home in a suburban area. However, Graetz noted the pervasive narrative growing up that his family was "financially responsible," not that they benefitted from a federal welfare program that primarily served low-income White veterans. The program had huge generational public health benefits, he continued.

Reflecting on her experience living in neighborhoods that were thoughtfully planned to improve health, Manuel asked for insight into actively planning and developing housing that promotes health. Burt highlighted innovation as an important component of inclusive housing policy. He shared an example of a Hope-led innovation called Y16 that creates homeownership opportunities for tenants, where they can purchase the home they rented responsibly for 16 years.⁷ Burt also emphasized the essential function of innovation in improving public health, since housing and financial stability enhance people's ability to perform at work, in communities, and with their families. Access to safe and affordable housing can also address issues such as quality of schools, crime, and the success of small businesses. Graetz agreed and added that shifting ownership models to more collective and communal structures can help people feel like there is public investment in the place they live.

Transitioning to open discussion and questions, Megan Sandel of Boston Medical Center and Boston University asked about the "capital remedies" to addressing historical issues of housing and health, including community-level wealth building. Burt stated that, to him, the solution is simple—it involves compensation and making amends for the challenges of homeownership for certain communities. More specifically, he said the capital strategy at Hope focuses on creating accessible products while also recognizing the importance of change within the entire mortgage lending system and a holistic approach to the problem. Lastly, Burt emphasized that building strong institutions that value inclusion will help everyone be able to buy a home where they want to live.

Roundtable member Lorna Thorpe of New York University asked Burt if Hope works with middle-income as well as low-income families and to discuss the distinct strategies. Burt said they work in collaboration with other community advocacy organizations, such as those providing resources to previously incarcerated individuals, to help them open a bank account. Other examples included collaborating with institutions like Wells Fargo and NeighborWorks America to provide first-time homebuyers with down payment assistance and partnering with Delta Regional Authority to renovate thousands of homes damaged by fires.

Manuel closed the panel by elevating the point Graetz made earlier about substitution effects and noted how if people have stable housing and more disposable income, it allows them to invest in themselves, their children, their families, and their community.

Innovations in Housing Affordability and Access to Build Communities of Opportunity

Anusha Venkataraman, a consultant to the Rhode Island Health Equity Zone (HEZ) Network, moderated the next panel discussion on innovations in housing affordability and access to building communities of opportunity. The speakers included Dan Gilmartin, executive director and CEO at Michigan Municipal League, and Tony Pickett, CEO for Grounded Solutions Network. The panel explored the role of local and state policies in increasing housing affordability, such concepts as shared equity⁸ and housing as wealth-building, and economic issues that affect people's ability to pay for their housing.

Venkataraman introduced the HEZ Network, noting its establishment 10 years ago as a place-based approach to address health inequities by investing in community leadership and systems change. She noted her experience working as an urban planner at the intersection of housing, land use, and community power-building and said, "the most impactful solutions arise out of the communities that are most impacted by inequities."

Gilmartin spoke about the work at Michigan Municipal League, which represents community leaders throughout the state and works toward community wealth building and resilience. He said they focus on such issues as arts and culture, sustainability, financial security, infrastructure, lifelong learning, public health and safety, trust, and belonging. In particular, trust and belonging play a critical role in community flourishing, Gilmartin said, noting that investing corporate capital gains in the poorest areas is an intervention that has been proven to work. Gilmartin also spoke about the MI Home Program⁹ and its use of best practices to improve access to housing and build more homes by investing government funds into the community.

Pickett discussed innovation in community ownership of housing and the role of Grounded Solutions Network. The network, he said, consists of about 300 member organizations throughout the United States (e.g., community land trusts, nonprofit organizations, other community-based organizations, local municipalities, individual practitioners) interested in solving affordable housing issues. They focus on "shared equity housing models," which limits the amount of equity that can be taken out of a home once it sells, keeping the home affordable for a new family, he continued. For example, Pickett said, a long-term ground lease allows the nonprofit to maintain ownership of the land after a house sells, with only the physical structure being sold and mortgaged. He shared that a 2022 census showed a total of 314 community land trusts and shared equity programs throughout the country, marking a 30 percent increase since 2011.

Pickett said the shared equity approach is used for rental housing as well, such as the Champlain Housing Trust¹⁰ located in Burlington, Vermont, which has over 1,000 homes for both rental housing and single-family homeownership options. He spoke about the Island Housing Trust¹¹ in Martha's Vineyard, Massachusetts, which serves 277 residents by providing affordable housing, and the Maggie Walker Community Land Trust¹² in Richmond, Virginia, which acquires tax-delinquent property to develop affordable homeownership opportunities. The Bon Secours Richmond Health System also invested $1 million to help the Maggie Walker group acquire properties and reposition them for affordable housing, Pickett continued. Pickett noted the findings of a 30-year study conducted by Grounded Solutions Network and Lincoln Institute of Land Policy, which showed that the median shared equity household accumulates $14,000 in earned equity, with a median initial investment of $1,875. Additionally, he said, 6 out of 10 shared equity homeowners used their earned equity to eventually purchase a traditional market-rate home. He continued that the study also found the share of minority households living in shared equity homes increased from 13 percent in 2000 to 43 percent in 2018.

Venkataraman asked speakers to elaborate on the role of the public sector (local, state, or federal government) in implementing, shaping, or incentivizing housing solutions. Pickett noted the importance of a policy environment that supports the shared equity approach, including inclusionary zoning. Gilmartin added that a unique aspect of the housing issue is that "nobody owns it," meaning no one level of government has the ultimate responsibility to solve it. He said he thinks of houses as community assets that contribute to a collective vision that informs the decision of people buying homes in the area. Government subsidies such as down payment assistance and mortgages make people spend more on homes, not less, he continued.

Bringing up the concept of systems change, Venkataraman asked how to shift the mindset around what is possible and collectively own the problem of housing instability to create the possibility of change. Pickett said Grounded Solutions Network works with marginalized communities across the country to facilitate community ownership of assets (e.g., homes and businesses). He also noted the origin of the community land trust model, in which civil rights leaders in the 1960s who were not allowed to own property pooled their resources and purchased land, which they then used as a communal farm. Pickett explained that collective ownership provides everyone with the opportunity to build wealth. Gilmartin shared his view on the importance of shifting the narrative around investment in a home, what a home looks like, and zoning, especially because homeownership for the baby boomer generation does not reflect the opportunities for later generations. He also said Michigan Municipal League provides education to local governments about the community benefits of using land trusts.

Venkataraman asked how these strategies and innovations vary in large, urban areas versus smaller, under-resourced communities. Gilmartin shared his view that good public policy should have the same positive effects across different geographic regions, and the important issue to address is narrative change around what constitutes housing and neighborhoods. Pickett agreed and said progress can come from focusing on community-based and social housing innovations.

Speaking about displacement, Venkataraman said the Rhode Island HEZ Network is working to address this issue. In central Providence, for example, a neighborhood-level displacement risk analysis helps inform the city's policy decisions. She asked speakers how the interventions they have shared address displacement. Pickett noted how several organizations identify those most at risk of displacement and give them priority for any newly developed affordable properties. There are also tenant purchasing opportunities and efforts to protect potential development sites around transit projects, he continued.

During the question-and-answer period, Robyn Stone, advisor to LeadingAge, asked about the increased number of older adults living alone and the associated challenges. She asked how the connection between health and aging creates new pressures on housing, such as the need for communal housing models and access to transportation and social services. Pickett responded that community land trust models can promote interaction between residents, due to a requirement that about one-third of residents participate in community decision making and governance. In some cases, health care facilities may be incorporated within a building or community as well. Gilmartin spoke about building a "village model" with recreational, health care, and communal eating opportunities. He said the strongest communities offer opportunities where a person can live and be fulfilled at any stage of life.

Stone emphasized the importance of housing across the life course, highlighting how the United States could learn from other countries that view housing first as shelter and critical to public health. She asked speakers how to shift the mindset around housing being primarily viewed as an opportunity to build wealth and instead create housing policy that supports the entire lifespan. Gilmartin said it is important for home building to be viewed as a public good but acknowledged that he thinks this narrative shift is a future goal and may not be possible now. Venkataraman characterized the American opinion on public housing as an approach that is not financially viable and not worth the investment. She said shared equity models can move the country toward viewing housing as collectively owned, invested in, and operated. Other forms of investment in lifelong wealth building can be used such as baby bonds, she continued.

Manuel brought up the affordability issue and mentioned a few ideas that have been proposed to address it (i.e.,

extending mortgages from 30 to 50 years and dismantling child labor laws so youth can improve the family's ability to afford housing, among other needs¹³). She asked how to take advantage of the overwhelming recognition that affordability is a problem and develop more positive solutions that improve health. Pickett stated his work focuses on ownership economy as a solution and shared that he thinks a social movement is important to propel change. He also said community power-building and policies compelling the use of available funds are important to drive better policy decisions and improve health outcomes.

Financing Housing and Health: Current Landscape and Evolving Approaches

Chris Krehmeyer, president and CEO of Beyond Housing in St. Louis, Missouri, moderated a panel with Andy Winkler, managing director of housing and infrastructure policy at the Bipartisan Policy Center, Michael Neal, senior fellow and practice area lead in the Housing Finance Policy Center of the Urban Institute, and Stockton Williams, executive director of the National Council of State Housing Agencies. The panel highlighted both national-level policy approaches and local level challenges (e.g., structural, financial, environmental) and some innovative solutions, and it also introduced some of the narrative issues (e.g., storytelling) related to housing that would be addressed at greater length by the final panel of the day.

Krehmeyer began with a nod to the fact that housing is a social determinant of health, sharing how components of his organization's work—staff embedded in school systems, community health workers on staff, a forestry unit that plants trees in the community, and investment in a grocery store—reflect a recognition of the interconnectedness of housing and health along with other factors.

Winkler spoke about three timely and bipartisan issues in housing that resonate with policy makers: growing the housing supply, preserving the stock of affordable housing, and providing demand-side support to help people afford housing. He added that there are some efforts to move the needle on all three fronts. The Renewing Opportunity in the American Dream (ROAD) to Housing Act in the U.S. Senate and the Housing for the 21st Century Act in the House of Representatives are both bipartisan bills, which are modest in nature because they do not include much new funding, but they illustrate a desire to bring about some changes. Neal outlined the housing life cycle—people living with their parents, renting, buying a home, and lastly, securing a forever home—but noted many factors that disrupt that life cycle, including homelessness. He mentioned several examples that illustrate the multiple ways in which housing is a social determinant of health, including energy costs and effects on health and well-being of housing occupants, but also noted that health can impact housing outcomes as well, including the effects of the COVID-19 pandemic on mortgage lending and on borrowers. Data on Federal Housing Administration lending show that a not insignificant percentage of mortgage delinquencies occur due to illness, Neal said, but he noted that the existing policy infrastructure may not fully recognize all of the connections between housing and health.

Williams said housing finance agencies serve low- to middle-income households, helping them to afford and preserve their housing. The housing finance ecosystem has paid attention to health outcomes for some time, Williams noted. Examples include

1. supporting construction (mostly multi- but also some single-family) affordable housing using healthy and environmentally smart building practices, materials, and techniques to try to set a reasonable standard for air quality;
2. weighing options for locating the housing, in some cases placing it in more resource-rich neighborhoods, or supporting people's desire to stay in place, which points to an important and complicated dimension of health and housing interaction; and
3. for existing housing, home repair of otherwise stable housing.

Krehmeyer shared that Beyond Housing leads an affordable housing program with 800 rental units and has rehabilitated 1,500 units in a neighborhood of 40,000 residents. The Federal Home Loan Banking system plays an important role in funding that work. New construction needs a subsidy, Krehmeyer said, and his organization formed a partnership with Missouri's largest homebuilder with help from a philanthropic organization. With the funding it secures,

Beyond Housing performs the first steps in new construction and then turns it over to the homebuilders. He asked the panelists if similar strategies are scalable and what else in the field looks promising. Making project "math" work can be challenging and requires a great deal of piecing together different sources of funding, Winkler observed, also noting regulatory compliance hurdles. He expressed optimism about the expansion of the Low-Income Housing Tax Credit (LIHTC) during the summer of 2025, as well as growing interest in finding new tax incentives to support new construction and preserve existing housing. Winkler also said he is seeing innovations at the state level and efforts to support local governments.

Neal said the federal government often drives expansion of effective models. One example is the Department of Housing and Urban Development (HUD) 203(k) program, which offers opportunity but has bureaucratic barriers related to the program setup, property appraisal, and identification of who will renovate a property. He also noted the importance of keeping the investor class engaged, for example, with GSEs (government-sponsored enterprises like Fannie Mae) offering cash-out financing loans (a type of refinancing that allows homeowners to take advantage of the equity in their home).

The Urban Institute is conducting an evaluation project in St. Louis, helping people in historically Black neighborhoods avoid displacement by providing 50 homeowners $20,000 to help them build wealth and remain in their homes, Neal shared.¹⁴ Some of these homeowners inherited their home from one or more previous generations of their family, but they do not have the financial means to make improvements to their homes, Neal added. Moreover, the 2025 tornadoes that affected St. Louis damaged many properties, which exemplifies another threat to people's ability to stay in place. When people are displaced, they not only lose the homes they own, but they also may lose opportunity when leaving a community undergoing economic development, particularly if they move to a neighborhood with less opportunity. Krehmeyer added that some of the affected homeowners in St. Louis lacked homeowners' insurance, underscoring both the importance of insurance and of helping people navigate various challenges to stay in place.

Williams spoke about the engagement of the private sector in housing investments, for example, as hospitals and health systems invest in housing and receive LIHTC through their state governments. Health care organizations can also engage with state housing finance agencies to fund community development and services for people in their communities. Williams shared how philanthropic funding has been used in partnership with state housing finance agencies (HFAs). Several state HFAs assembled net incremental resources and obtained additional incremental commitments to affordable housing development. A second conduit for health care engagement in housing involves Medicaid waivers to support housing, which has been challenged due to cuts to Medicaid. But by 2025, 30 states had received permission to use Medicaid flexibly for a wide range of housing-related purposes. In two states, that included rental assistance, Williams said, adding that HFAs have rarely been the direct recipients of state Medicaid funds, but they have partnered with state agencies that received and oversaw the use of those funds. Krehmeyer said BJC Health, the biggest health care organization in Missouri, was the lender in a recent deal in St. Louis.

Krehmeyer asked where the most exciting investment is taking place. Winkler highlighted the supply bucket (e.g., how to support preservation efforts), noting that the demand side is much more complex because it largely focuses on housing assistance. BPC has worked to strengthen collaboration between HUD and the Department of Health and Human Services (HHS). Innovation efforts, Winkler said, should also include Medicare through long-term services and supports, which can unlock health care dollars for housing solutions that will help improve health.

Neal spoke about the legal concept of "heirs property" and the challenges of fractional ownership (e.g., multiple owners of a property property). While homeowners are less likely than renters to live in homes in disrepair, people who inherit a home are more likely to live in a home in poor condition. The situation of heirs property makes them less likely to be able to obtain access to capital to improve the home or secure homeowners' insurance. Neal noted several data sources that inform work on these issues, including property records

and the Health and Retirement Study¹⁵ (e.g., which asks homeowners if they have a will or an estate plan).

Williams and Krehmeyer closed the panel discussion with comments about the national shortage of all kinds of homes for all kinds of people, with cost being the most significant hurdle. Williams spoke about fiscal sustainability, noting that HFAs run federal housing programs but primarily finance their own operations through bonds, which means that capital markets affect their work (e.g., debt, credit rating). A virtual audience member asked Williams to talk about LIHTC as a federal tax incentive allocated competitively by state HFAs to developers who want to build projects. The tax credit accrues to a developer when a property is sold. In recent years, a growing number of hospitals and other institutions have invested in development. Williams directed the audience to more resources about this work on the HFA website and suggested they look for H3C (Healthy Housing, Healthy Communities).¹⁶

Pastor George Nicholas of Buffalo, New York, and a roundtable member shared that two young children in his community recently died in a house fire, which stemmed from substandard housing. He asked how to raise the level of urgency around these issues. Winkler said that health care and other sectors partnering in housing have been raising the level of urgency in recent years. Although people may or may not see government as a solution, he said, there is a role for every level of government to help improve the quality of housing. Neal underscored the importance of narrative change—how can researchers share their findings more impactfully and less abstractly? Videos about homeownership and other strategies to share aspects of lived experience can help bring about change, as does traveling to places to equip people with data they can share with decision makers. Referring to the fatal house fire in Buffalo, Williams noted that there is some momentum—but not urgency—regarding the lack of justice in the system. Numerous entities in the system in Buffalo failed, Williams said, and continued advocacy and grassroots energy are needed. Nicholas said the housing crisis is based on "choices we are making as a country, and we are choosing profitability over keeping children safe in their homes." Williams acknowledged that some groups are asking whether affordable or government-supported housing should even be for-profit, or whether it should be social housing, seen as a public good, adding that there is a lot of frustration with the current system. Community land trusts and limited equity cooperatives are more likely the exception. Neal said he asks what his role is in the ecosystem, given that he is not a policy maker. A recent event in which Neal participated brought together academic researchers, and it showed that only expanding housing supply, though important, does not help "harmonize homeownership outcomes" for people of color. There is a need to ensure everybody benefits from improvements in the system, Neal said, and work such as his can help.

Pittman asked about the role of local media in highlighting the story of the two children killed in the Buffalo house fire. Nicholas said the media first cast blame on the parents (who were trying to save other children in the home). The challenge, he noted, is how to generalize the story of one landlord and one family to a broader conversation about the system. Roundtable member Rishi Manchanda of HealthBegins asked if there are power-building community organizations working to address housing and health care costs, both of which are too high and are linked. Neal said the Consumer Price Index (CPI) indicates that shelter (housing) costs have risen more quickly than health care costs, but the Personal Consumption Expenditures (PCE) indicator shows that health care costs have outpaced housing costs, primarily because the PCE also includes spending on behalf of consumers by insurance companies. Tearing down the silos is happening, for example, in the context of baby bonds, where investments in personal capital can yield dividends in health improvements. Robyn Stone from Leading Age added the example of an older adult falling in their home because of a lack of home modification, leading to higher costs to the Medicare program. Roundtable member Philip Alberti of the Association of American Medical Colleges (AAMC) shared early findings from an AAMC survey of 5,000 adults who were asked how important for community health and well-being it is to develop affordable and humane housing—and who is responsible for that. Overall, 87 percent of respondents said affordable and humane housing is very or somewhat important, with 60 percent saying it is very important. In a

final reflection, Williams said YIMBY advocates are seeing success in getting people elected at the state and local levels, and they need to be informed about the links between health and housing.

Integrating Health and Housing for All: Health Sector Approaches to Tackling Housing Challenges

Ruth Thomas-Squance, co-executive director of Build Healthy Places Network (BHPN) introduced a panel on promising practices that integrate health and housing and exemplify how the health sector is tackling the housing challenge. The panel included Megan Sandel, pediatrician at Boston Medical Center (BMC) Health System and a professor of pediatrics and environmental health at Boston University. Stefanie Seldin, president and CEO of Rebuilding Together Philadelphia, and Jack Tsai, regional dean and professor of public health at University of Texas Health. Panelists focused on the direct effects of housing access and quality to people's health, shared examples of approaches and outcomes, and underscored the importance of financial solutions and the benefit of narrative or storytelling in informing decision makers, both themes noted in earlier discussions.

Thomas-Squance said BHPN works at the intersections of community development, public health, and health care, and the organization endeavors to change how the sectors collaborate to address the social factors that shape health through investments in projects that are community-led and -owned, and through the creation of tools, resources, and communities of practice. Thomas-Squance grounded her remarks in the Vital Conditions for Health and Well-Being framework shared with participants.¹⁷ The framework provides a reference point for thinking through systemic approaches that consider the interconnected aspects of housing and health, including stable housing, neighborhood safety, housing affordability, and quality.

Sandel said her health system provides supportive housing and serves as an anchor institution engaged in place-based investing. All dimensions of the health care sector, including providers and payers, are looking at the housing issue, she said, and health care insurers, including for-profit ones, are increasingly invested in the LIHTC because it creates more housing and benefits their members.

The hospital owns a health plan and accountable care organizations—referring to financial arrangements where a hospital owns both sides (provider and payer). She said hospitals and health systems can provide capital and political will, which is the biggest tool in housing. Given that hospitals are increasingly paid in lump sums of money for services to keep populations healthier rather than operating fee-for-service arrangements, it matters if the hospital pays for the downstream effects of bad housing and lack of housing. Sandel added that the hospital is part of Children's HealthWatch, a non-partisan network of pediatricians and other experts that monitors economic conditions and public policies that affect children's health. In addition to hospitals and health systems, Sandel noted, health insurers are thinking about housing because they know it benefits their patients and they are investing in housing and claiming the LIHTC.

Seldin began with an acknowledgment that, in addition to the negative substitutions mentioned earlier in the day (such as the tradeoffs of paying for rent versus food), there are positive substitutions when people have secure housing and can then pay for health-related priorities. Rebuilding Together Philadelphia has a partnership with the Children's Hospital of Philadelphia, including a program focused on addressing housing issues that exacerbate asthma in children: moldy drywall, leaks, old carpeting, and other issues. Housing is really health care, she said. She shared how she explained to a health care provider that the high cost of fixing a broken hip can be prevented by adding low-cost interventions in homes, such as grab-bars in showers and handrails on steps. Rebuilding Together Philadelphia provides free repairs to income-eligible homes to make them healthy, safe, and energy efficient. Seldin noted the 25 goals of the National Center Healthy Housing as a guide for her organization's work of centering health and safety in homes for children, older adults, and all residents.

Seldin said Rebuilding Together Philadelphia is self-funding repairs and improvements in children's homes and saving health insurance companies money, but it is a challenge to persuade insurers to invest. What is needed are financing vehicles (e.g., social bond financing) and for capital to be structured with intentionality to improve housing health and safety. One difficulty in securing financing is patient churn

from one Medicaid provider to another and how to handle that issue, since providers will not realize savings from their investment if affected patients move to another provider. Sandel called this as a classic "wrong pockets" problem, noting the need for financing vehicles to solve this problem. She referred to a 2023 issue of Health Affairs that examined social bond financing. What is needed is for capital to show what a return on investment (ROI) would look like. She explained that the meaning of ROI needs to shift from helping a sick child with asthma to improve, to identifying the child early and preventing that asthma attack (by addressing the triggers in their home).

Tsai spoke about how the Department of Veterans Affairs (VA) has the advantage of having both funding and a comprehensive integrated healthcare system with a common data system. For instance, homeless and unstably housed residents have access to care, and VA often offers housing and health services that are co-located. In addition, social service providers can see the notes associated with a specific VA patient, which allows for better integration of services. VA's budget allows for a common funding stream for health care, social services (e.g., employment services), and housing, often offering all of the services together.

Thomas-Squance asked Sandel to explain the concept of "anchor institution." The term, according to Sandel, refers to institutions, like BMC, that are large, deeply rooted in community, and "using economic power to address economic inequities that we believe are tied to health inequities." Anchor institutions use the four "P's" of place-based hiring, place-based procurement (e.g., buying local good and services), place-based investing to affect the economic status of people in surrounding communities, and policy change. Sandel also noted that the term "population health" is used to refer to a pool of patients, but the focus for BMC and like-minded organizations is place-based population health, referring to people who are living in specific neighborhoods and communities.

BMC is a large health system and part of a health plan that serves 40 to 50 percent of the Medicaid market in Massachusetts. Across many neighborhoods in Boston a majority of residents receive care in the system and are in the health plan. Therefore, the health system has developed a "reasonable accommodation fund" to enable Boston Housing Authority to handle issues that affect the health of patients who live in its housing (e.g., install grab bars to prevent falls). Sandel shared that BMC approached the local community development corporation and asked them about a major need. For instance, they wanted to bring in a grocery store to the bottom floor of an affordable housing development but could not obtain bank financing. BMC was able to provide gap financing to make that happen. With a match from the Robert Wood Johnson Foundation, BMC also was able to provide 20-year, zero percent financing to build the largest supportive housing development in the city. This kind of financing makes the difference between a shovel in the ground now rather than 12 months later, Sandel said. She gave another example, illustrating how health care anchors can band together. In Boston, the mayor placed $5 million of ARPA (American Rescue Plan Act of 2021) funds in an acquisition fund to preserve affordable housing and keep it off the speculative market. In response, five local hospital systems matched that funding with another $5 million, and ultimately the funding was made available to community land trusts as a financing tool. The BMC housing effort was able to preserve 500 units of affordable housing in six months.

Thomas-Squance noted that there is not a single institutional solution, but rather, partnerships working jointly to address these issues. She asked Tsai to share about housing challenges in VA populations. Tsai said a common question is whether the research findings in VA populations are generalizable to the general population. Tsai noted that there are some differences—but also some commonalities. Care in VA is structured differently (e.g., many veterans get a mental health provider assigned to them). A quarter of veterans live in rural areas, so transportation support and telehealth are vital, he said, and added that although it is unclear whether telehealth care works for unsheltered veterans, it works better for those in permanent supportive housing.

Seldin shared that there are 120 Rebuilding Together affiliates nationwide. The problem of substandard owner-occupied housing can be challenging because it is not visible, Seldin said, adding that the Federal Reserve Bank of Philadelphia found $200 billion was needed to repair owner-occupied

housing nationwide, and the numbers are likely much higher for rental housing.¹⁸ At the same time, she added, the most affordable housing is the housing one is in right now. Building an affordable housing unit in Philadelphia costs $450,000, but in California, that number rises to $800,000, Seldin noted. Though production of new housing is a huge hurdle, updates and repairs can keep people who live in affordable housing in their housing. Working with a legal services provider, Rebuilding Together tells Philadelphia landlords that if they do not make repairs, Rebuilding Together will fix substandard housing and charge the landlords for the repairs.

Sandel shared the term "medico-legal partnership," which refers to legal assistance in health care settings that helps patients and families resolve pressing issues such as a threat of eviction or an unresponsive landlord, and reflected on the need for systems to be proactive. For example, tenants do not need an inspector to document what they can observe and report themselves. Seldin shared how a patient almost lost a Section 8 Housing Choice Voucher because her house did not pass inspection due to needed repairs, and she could not find a new place to live within the allotted time. After receiving housing-related help from Rebuilding Together, the woman called back to ask talk to the lawyer again because her child was not getting the special education they needed. "We need to create systems that help tenants take advantage of what their rights are," Seldin said. She shared another story of a 76-year-old woman receiving supplemental oxygen therapy, whose landlord wanted to evict her without following the necessary process, and cut her electrical wires. That led to a loss of air conditioning in August, and no access to oxygen, resulting in a three-day hospital stay. The woman was ultimately moved to better housing and won $37,000 settlement in court, and Rebuilding Together was repaid for the $2,300 repair they made to address the housing issue, which was less costly than the hospital admission.

Seldin shared that addressing home factors translates into fewer school absences for children and fewer work absences for parents and caregivers, noting that 25 percent of kids in the lowest-income neighborhoods in Philadelphia have asthma, and remedying conditions in the home makes a dramatic difference. A child named D'vine, for instance, was in his grandmother's care, suffered from asthma, and was admitted to the hospital for asthma attacks two or three times. After repairs were made in the home, D'vine has not needed to be taken to the hospital for asthma attacks, which has had a measurable positive impact on the family's lives, Seldin said.

Thomas-Squance asked panelists what could support promising practices and to infuse a sense of urgency for ecosystem changes. Sandel pointed to the third panel's mention of shared equity, saying "that the people closest to the pain should be closest to the power and that includes having an asset." With that in mind, she said, BMC focuses on place-based investing and requires an ownership component to be part of any investments. For instance, BMC helped the owners of a grocery store who did not want to get priced out of the neighborhood. To do that, BMC worked with the local community development corporation to create a rent-to-own model that enabled the grocery business to stay. In another instance, a business owner faced a steep increase in rent and considered a nearby warehouse space but had a gap in funding, so BMC created a recoverable grant, secured a Boston Children's Hospital match, and then also received a city match. The effort saved 150 jobs and created 75 more jobs, and for ROI, BMC asked the business to move toward the MIT (Massachusetts Institute of Technology) living wage,¹⁹ as well as make more employee stock options available. Ownership and shared equity must be part of any sustainable solution, Sandel emphasized.

Tsai said VA operates a continuum of housing assistance for different types of needs, from emergency shelter beds to permanent supportive housing. He added that VA works with community providers, such as a legal services program that helps veterans with problems related to landlord disputes and evictions. In addition to the continuum, VA programs recognize a range of clinical and psychosocial needs and different kinds of living arrangements. Seldin underscored a point highlighted by both Tsai and Sandel, namely the importance of listening to constituents (e.g., patients, homeowners, veterans). Seldin said the housing crisis is also a workforce pipeline crisis and that there is a dearth of workers in the construction industry both for new construction and for preservation. However, they need family-sustaining jobs and wages, and that issue needs to be elevated, she noted.

Thomas-Squance asked how to break down silos to respond to people's needs. Sandel said place-based investing works

like chapters in a book, where the characters learn as the book progresses. She spoke about the Boston Opportunity System, which is a broad coalition that starts by asking "What's your pain point?" Sandel also referenced the Capital Absorption Framework²⁰ from the Center for Community Investment, which emphasizes "articulating a shared priority, creating and executing an investable pipeline of projects, and improving the enabling environment." Sandel said she has heard community members say they have been asked repeatedly what they want, but nothing tangible happens as a result. That changes, however, if people ask for a grocery store and those working to effect change bring in a grocery store. BMC's partnership with different city agencies and grassroots organizations is working to build trust around the table, Sandel said, referencing Dan Gilmartin's earlier comments about the importance of trust in any efforts to facilitate community flourishing.

Thomas-Squance summarized the different ways in which health care anchors can get involved in housing: as influential community partners, sources of capital, or donors of land or initial dollars to legitimize a project. She agreed on the importance of trust, noting that trust is eroded each time a community need is not met by those who have asked what the community needs.

Robert Kaplan of Stanford University asked about the model described by Rob Kahn of Cincinnati Children's Hospital, which emerged after a landlord threatened to evict tenants for using air conditioning units to keep their children with asthma healthy. Sandel shared that this case was discussed in Pediatrics (Beck et al., 2012), noting that the housing units were in a HUD-funded development where the landlord was not keeping the housing to the legally required standard. When two families in a row came to the hospital with the same threatening letter, the health care team learned that it was the same landlord. Beck and colleagues also tested the reverse approach, Sandel noted (Samuels et al., 2022). They looked at the zip codes of children being admitted to emergency departments for asthma and found that those zip codes included areas with fewer pharmacies, higher density of housing code violations, and other relevant variables. This led to deploying housing inspectors as a proactive strategy to detect and address housing conditions that exacerbate asthma. Holding private landlords accountable is good, she said, but sometimes the landlords are themselves low-income homeowners, so capital investment is needed.

Mary Pittman asked about insurance and the challenges associated with it, particularly in the context of weather-related disasters, and the risk of insurance loss. Seldin added that people's credit scores are affected by whether they can get insurance. She shared that there are seven structural home fires each day in Philadelphia, and climate change will likely worsen disasters and displacement, making insurability a great concern. Disaster preparedness needs to be part of the considerations for homeownership, she said. People's credit scores being considered in insurance decisions are another means of redlining, of discrimination, Seldin noted. If one cannot get insurance, one cannot buy a home. Sandel shared the Housing Partnership Network created a captive insurance system that enabled them to self-insure (similar to the malpractice insurance BMC has for itself), and there are similar federal and group insurance solutions that can solve problems like these to avoid worsening inequities.

Monica Valdes Lupi asked how Sandel approaches housing at BMC in the context of cuts to Medicaid and the diminishing safety net. Sandel touched on the threats against continuum-of-care services, and in particular, people who rely on permanent supportive housing funding from HUD. The funding bill that pulled $1 billion from Medicaid will affect the care and services that can be provided, she noted. Medicare, which is largely privatized, has interesting supportive housing models, such as SASH (Support and Services at Home), which provides linkages to services and supports for older beneficiaries and those with disabilities who live in affordable housing, including through community health worker and part-time nursing services. Unlike Medicare, Medicaid is administered state by state, Sandel stated, and each state applies for its own five-year waiver, and each is different. For example, the Massachusetts waiver runs through 2027, when Medicaid work requirements²¹ will come into effect, and the state is already seeing the work requirements for the Supplemental Nutrition Assistance Program (SNAP) coming into effect in 2026. Sandel said that Massachusetts wants housing-related services to remain in the waiver, but it is unclear whether CMS will allow that. As a forward-looking idea, she suggested investing in public housing, as well as

holistic solutions across housing health and community development based on initiatives implemented in Boston. Housing is the bottom of Abraham Maslow's hierarchy of needs,²² Sandel added; people cannot show up at work or at school without housing. She said economic development is essential, and one function of safety net hospitals is to be economic mobility engines. For instance, BMC works with families to provide trauma-informed financial literacy training and helps the parents of their patients find jobs, she said.

Closing Dialogue

In sharing her reflections on the day, roundtable co-chair Ana Diez Roux, distinguished University Professor of Epidemiology and director of the Urban Health Collaborative at Drexel University outlined five key themes she synthesized from the day's presentations and discussion.

1. Housing is inextricably linked to health—echoing the four pillars outlined by Graetz (and the similar four dimensions mentioned by Thomas-Squance), highlighting the mechanisms through which housing affects health, along with the long-term and even intergenerational consequences of a lack of good housing. Moreover, good housing has implications for work, schooling, and the neighborhood, which in turn affects health. The relationship between housing and health is bidirectional, and housing is also a major domain through which social factors manifest and affect health, with multiple loops that connect the two domains.
2. Housing is a system involving many interrelated players and dynamics; when one intervenes on the system in one domain, effects can be observed on other outcomes. For example, there are multiple state and local policies that affect housing (e.g., taxation, zoning), and housing as a system is embedded in and is reinforced by preexisting societal inequities, contributing to health inequities. (Winkler, Williams, Pickett, Furth)
3. There are historical structural drivers of housing availability and inequities in housing. These characterize how structural racism and inequality affect the distribution, context, quality, and cost of housing; the financialization of housing and the consequences of housing as a money-making operation that is market driven and privatized; and the negative effects of those characteristics. (Graetz and Burt)
4. There are models and innovations in housing, such as community land trusts and other equity models; silo-breaking partnerships, including those with the health sector by leveraging community benefit and public insurance (e.g., Medicaid waivers), embracing the anchor role, and entering innovative partnerships that engage legal services and other sectors; and use of data to link housing and health and build the evidence base for what works. (Pickett, Gilmartin, Williams, Neal)
5. The housing paradigm can be transformed. Considering housing as a collective good calls on practitioners to take a life course approach to housing and how it shapes health at different ages, and to think of housing not only as shelter but also as a tool for wealth building. Effective housing policy would ensure adequate housing as a human right, recognize the urgency of the moment, and acknowledge the fact that this is a challenge of society's own making. (Diez Roux, reiterating points made by multiple speakers)

Robert Kaplan observed that there are three broad categories of actors in the housing ecosystem, as in the health care sector: people who need shelter and people who want to live long lives, the housing enterprise and the health care enterprise, and the government that must mediate between the different actors and their different motivations.

On Narrative Change Strategies

Thorpe reiterated that there is bipartisan interest in addressing the housing challenges so many people face and asked about the strategies to infuse narrative into conversations about housing. Pittman said the roundtable can play a role in lifting up the narratives. Alberti commented on "interest convergence" as a way to think about different and more inclusive narratives. Finding areas of agreement happens at the end goals, such as broad agreement on the vital conditions for health and well-being that include "humane housing." However, there is no convergence on the way to get there due to such factors as misunderstanding and misinformation, he said. New narratives can be helpful in addressing the lack of convergence on the processes for achieving the agreed-on goals.

Pastor Nicholas responded to the comment about the different categories of actors and emphasized that the needs of the people with the housing problem should be prioritized,

and that narrative change needs to be linked to power. The challenges to housing that create poor health outcomes happen because the interests of homeless or inadequately housed people are not prioritized over those of the actors with power—the health care system, the developers, or the banks.

Manchanda referenced Salim Furth's assertion that "zoning is a welfare system for affluent owners." Shared priorities that center the needs of those most affected require shared analysis, Manchanda noted, including power analysis, to answer the following questions: (1) if the existing structure does not work, who benefits more (i.e., see financialization and market fundamentalism); and (2) who is telling the story, whose stories are elevated? It will be important to invite more voices to the conversation, he said, including movement-building and power-building organizations.

Manuel added to the earlier remarks that it is not just a matter of narrative, but a need to understand how the systems that exist (e.g., housing, health care) are built. All people deserve better housing, better health care, and participatory and community-engaged education is needed on these issues, she said. As federal agencies relevant to health, housing, and living conditions were being dismantled, regular people did not know if this was something they should care about, she added. It was only when it became clear that Medicaid cuts would affect all communities, including rural communities and regular people everywhere, that the ramifications of changes to government structure and function began to come in focus. Practitioners and the field as a whole have done a disservice by not educating people about what exists in terms of the basic systems needed for health and well-being, she said.

Thomas-Squance added a reflection on narrative change and the fact that in the evaluation of success metrics, data about lived experience are often devalued and viewed as "anecdotal," yet it is necessary to capture the voice of those most impacted to assess impact. Neal added his final reflection on the tearing down of silos among trade associations, realtors, homebuilders, and others, and the importance of cross-disciplinary conversations.

Participants' closing remarks provided a round-up of some of many dimensions of housing policy discussed during the day-long event and were a reminder of the complex array of social, economic, and other considerations in the design and implementation of policy solutions at different levels of government.

References

Beck, A. F., M. D. Klein, J. K. Schaffzin, V. Tallent, M. Gillam, and R. S. Kahn. 2012. Identifying and Treating a Substandard Housing Cluster Using a Medical-Legal Partnership. Pediatrics November 130(5): 831–8. https://doi.org/10.1542/peds.2012-0769​​​​​​​​.

Graetz, N., C. Gershenson, P. Hepburn, S. R. Porter, D. H. Sandler, and M. Desmond. 2023. A comprehensive demographic profile of the US evicted population. Proceedings of the National Academy of Sciences120(41):e2305860120. https://doi.org/doi:10.1073/pnas.2305860120​​​​​​​​.

Samuels, E. A., R. A. Taylor, A. Pendyal, A. Shojaee, A. S Mainardi, E. R Lemire, A. K. Venkatesh, S. L. Bernstein, and A. L Haber. 2022. Mapping emergency department asthma visits to identify poor-quality housing in New Haven, CT, USA: A retrospective cohort study. The Lancet Public Health 7(8):e694-e704. https://doi.org/10.1016/S2468-2667(22)00143-8​​​​​​​​.

Swope, C. B., and D. Hernández. 2019. Housing as a determinant of health equity: A conceptual model. Social Science & Medicine243:112571. https://www.sciencedirect.com/science/article/pii/S0277953619305659.

Disclaimer: This Proceedings of a Workshop—in Brief was prepared by Alina Baciu and Stephanie Puwalski as a factual summary of what occurred at the workshop. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

PLANNING COMMITTEE:Mary Pittman (Chair), Public Health Institute; Howard Husock, American Enterprise Institute; Chris Krehmeyer, Beyond Housing; Tiffany Manuel, TheCaseMade; Ruth Thomas-Squance, Build Healthy Places Network; Lorna Thorpe, New York University. The National Academies' planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. Responsibility for the final content rests entirely with the rapporteur(s) and the National Academies.

REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Hae-Young Kim, NYU Grossman School of Medicine; Rishi Manchanda, HealthBegins; and Gregory Squires, George Washington University. Kirsten Sampson Snyder, National Academies of Sciences, Engineering, and Medicine, served as the review monitor.

SPONSORS: This workshop was partially supported by Association of American Medical Colleges, Blue Shield of California Foundation, Fannie E. Rippel Foundation, Nemours, NYU Langone Health, Robert Wood Johnson Foundation, The Kresge Foundation, and Thomas Jefferson University. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

STAFF:Maggie Anderson, Research Assistant; Alexandra Andrada Silver, Program Officer; Alina Baciu, Roundtable Director; Torrie Brown, Program Coordinator; and Stephanie Puwalski, Research Associate.

SUGGESTED CITATION: National Academies of Sciences, Engineering, and Medicine. 2026. Exploring Relevant Policy Domains: Housing Policy and Population Health: Proceedings of a Workshop—in Brief. Washington, DC: National Academies Press. https://doi.org/10.17226/29461.

For additional information regarding the workshop, visit https://www.nationalacademies.org/projects/CHPP-HCPH-25-P-716/event/45977.

Copyright 2026 by the National Academy of Sciences. All rights reserved.