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Examining the Role of Inclusionary Zoning in Health


Authors of a Health Affairs blog post cite an initiative that rates how well cities are doing in making sure their laws allow for affordable housing, which is getting more attention as a factor in population health.

The shift to value-based reimbursement has forced health systems to pay more attention to social determinants of health, and studies show that one stands out: Housing, both the quality and the location, is one of the best-researched indicators of overall health. Health systems are even designing interventions to improve housing for patients who consume more than their share of health resources.

A blog post today on Health Affairs by Shelley Hearne, DrPH; Brian Castrucci, MA; and Loel Solomon, PhD, examines the role of local housing policy in shaping access to affordable housing. It follows the journal’s recent policy brief on housing and health.

Evidence points to the difference that housing quality and location make, if these can be addressed. Removing conditions like mold and infestation improves respiratory health, and housing instability is connected to mental health problems, addiction, and inability to stick with treatment regimens for chronic conditions such as diabetes.

Click to learn more about the ROI of social determinants of health.

The authors of the new blog post examine efforts by CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, to rate major US cities on 9 evidence-based criteria “that can create healthier communities that thrive.” Availability of policies that promote inclusionary zoning was among them, and the authors note that this kind of zoning has 3 purposes: (1) to protect low-income people from eviction, (2) to find places for new affordable units, and (3) to preserve existing affordable units.

CityHealth leaders were looking for 4 criteria for zoning policies: Is an inclusionary law in place? Is the program evaluated? Does it apply to projects of 10 units or more? And does the law require that at least 20% of the units are affordable?

The CityHealth rankings found that 13 of the 40 largest cities had policies worthy of a medal for 2018, including 3 worthy of a gold medal: Chicago, New York City, and Los Angeles. Laws have followed housing prices, and the authors note that there’s more work to do, since only about a third of cities have adopted such a law.

In the earlier policy brief, Health Affairs noted that 1376 affordable housing programs exist nationwide, with about half being in New Jersey, where a 1974 state Supreme Court ruling called for every local jurisdiction to provide its “fair share” of affordable housing.

The authors of the blog post note that CityHealth does not assess how well laws, rules, or executive orders have been implemented. “Limited budgets, enforcement, or political interventions can impact the effectiveness of any city policy,” they write.

New Jersey is a prime example of how politics can get in the way of implementing mandates: More than 40 years after the original ruling, a judge is still bringing towns into court asking them to demonstrate how they have met the requirements.

“There is no silver bullet when it comes to building health, but we know now that the status of one’s health has a lot to do with where a person lives,” the authors wrote. “The good news is that city officials have the power—and, indeed, the imperative—to help create healthier places that can help improve residents’ quality of life. Inclusionary zoning is one robust, viable option that can help city residents thrive.”


Hearne S, Castrucci B, Solomon L. Mapping out inclusionary zoning at the local level: city leadership, housing, and health. Health Affairs Blog website. healthaffairs.org/do/10.1377/hblog20180815.360578/full. Published August 20, 2018. Accessed August 20, 2018.

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