Kim Gilhuly

Kim Gilhuly
Program Director
kim[at]humanimpact.org

Kim Gilhuly joined Human Impact Partners in 2007 after receiving her Master’s in Public Health from University of California, Berkeley. Her public health and policy work has included collaboration and research on Health Impact Assessments on land use projects and policy initiatives, urban food access, evaluating violence prevention projects, and pesticide monitoring in California. She has gained HIA, Evaluation, and policy expertise from working at Human Impact Partners, the Alameda County Public Health Department, California’s Department of Health and Human Services, the Bixby Center for Global Reproductive Health, and with the Women’s Policy Institute. Before obtaining her MPH, Kim worked for 17 years in non-profits doing community organizing and advocacy, program planning, and service delivery on environmental concerns, reproductive rights, nursing and medical student training, and mental health. Kim’s interest in public health focuses on the opportunity to examine institutional power, and thus health outcomes, through the direct involvement of communities.

Gratitude for Being Invited into a New Community

 

Photo from LA convening of incarcerated women and women working in public health.
Charlene Sinclair, Center for Community Change, speaking at A Women’s Gathering on Criminalization and Community Health Inequities.

In mid-September, I attended A Women’s Gathering on Criminalization and Community Health Inequities. The gathering was different in many ways, but one aspect of it really stood out: We were being invited into a community that most of us knew very little about, a community of women who had been incarcerated at some time in their lives.

As Andrea James, founder of Families for Justice as Healing and The National Council of Incarcerated and Formerly Incarcerated Women and Girls (The Council) said, “I am a former lawyer, a community activist, the wife of a man who was incarcerated, an active resident of Roxbury, MA, and a mother. I have a lot of professional and personal experience. But I didn’t become a expert until I was incarcerated.”

Only now am I beginning to understand this reality. For the past two years, I’ve been researching the health and equity impacts of the criminal justice system and working with advocates to create a new system, one that puts health and wellbeing, instead of punishment, at the forefront. Some of the people I collaborated with had been incarcerated, and I felt as if I had some understanding of how the criminal justice system destroys people and families.

But, really, it wasn’t until September 15, 2016—when 30-plus women who had been incarcerated met with about 15 women who worked in the field of public health—that I became more profoundly and intimately connected to those experiences and impacts. The women I met drove home the urgency of needing to work together to create a system of justice that values every life, treats people with dignity, demonstrates compassion, promotes a restorative and rehabilitative approach, creates space for accountability, and improves both health and safety.

And particularly for women and girls.

The reality hit me that, as women, we all have some degree of familiarity with the conditions that led to the women being incarcerated. While I had not had the experience of being incarcerated, I had experience with many of the pre-cursors—and that was a connection I had not made until hearing their stories.

Consider this: No woman is immune to the threat of community violence, oppression, being judged by her looks, being harassed on the street. And so many of us women (1 out of every 3) have been physically, psychologically, or sexually abused. And out of women who become incarcerated, that number is even higher—a recent Vera Institute report showed that 85% of women in jail have been physically or sexually abused.

What I heard from the women who shared their experiences is that these exposures (as we say in public health) —combined with acute and ongoing bias, mistrust, and maltreatment among many government agencies and institutions—led to them making choices that were ultimately criminalized. Behaviors that a more humane society would respond to with an offer of support, healing, and recovery—were instead met with surveillance, arrest, and incarceration in the United States.

But while I felt a connection to those exposures, it became deeply clear that we experienced a different, and unequal, set of outcomes based on things like racism and where you live. My childhood and home life weren’t perfect and I had some of the same teenage behaviors that I heard about in the room. But growing up white, in a suburb, middle class—these worked in my favor. People—rooted in institutions and systems—gave me leeway to make mistakes and gave me second chances. That is what privilege looks like, and that is where much of my experience diverged from the women in the room. Being confronted with that in an honest and face-to-face dialogue was so important to our ability to establish trust and try and build an authentic partnership.

Another thing happened that also stretched my understanding of what it takes to build trust with communities who have experienced significant trauma. The public health women in the room, many of whom work in government, were held responsible and asked to own the fact that we worked in and with institutions that repeatedly harmed, alienated, and failed the formerly incarcerated women throughout their lives. The level of distrust that existed in the room—understandably—was, well, rough. But my level of respect and admiration for every single woman in that room went through the roof after hearing their honesty and their doubts. I had such respect for women who are formerly incarcerated for getting themselves to that room, sharing their stories, calling out institutions for failing them, but also having hope that we can work together. And I had such respect for women in public health who listened with compassion and anger at the stories of women, who were not offended by the call to be accountable for the sins of government, and who eagerly asked “What can we do? To help repair the harm.”

It was a full day. It was a day like no other I have ever had in my 20+ years of public health work. The Women’s Gathering on Criminalization and Community Health Inequities was a beginning and we are now figuring out what we can do together. Lots of ideas emerged: new research and advocacy campaigns, new collaborations and capacity-building efforts, invitations into our institutions to humanize each other. It is on all of us now to continue to build this fledgling trust.

To be explicit about my gratitude: thank you to all the women who attended from The Council, women who are formerly incarcerated but may not be part of The Council, and all the women from the public health institutions. Your open hearts and minds is what made the day such a meaningful experience.

And a special thanks to our Women’s Advisory Team who helped plan the gathering: Jeanne Ayers (Minnesota Department of Health), Solange Gould (California Department of Public Health), Donna Hylton (The Council), Paula Tran Inzeo (University of Wisconsin Extension and THRIVE Wisconsin), Andrea James (Families for Justice as Healing & The Council), Marilyn and Pamela Winn (Women on the Rise & Georgia Racial Justice Action Center)—and especially to Charlene Sinclair, Caitlin Dunklee, and Cindy Eigler from the Center for Community Change for organizing the gathering and including HIP as co-conveners. Thank you all!

 

Group photo
Group photo at A Women’s Gathering on Criminalization and Community Health Inequities

Family Caregiving—A Public Health Crisis

Caregiver in scrabble text.
Photo credit: Flickr, Michael Havens.

This last year was the hardest one of my life. And I’m writing a blog about it because my personal experience is a public health issue.

In the midst of taking vacation time off to help my 80-year old mom move into a retirement community, the St. Louis Dispatch released an article about the health impacts of caregiving for elderly parents. The article notes that adult children who are caring for elderly parents have a myriad of poor health outcomes themselves—stress, higher rates of chronic disease, social isolation, and economic harm.

I relate. My mom’s move came about 6 months after my father died after a lightning-quick struggle with stage 4 lung cancer. During the last year, I have experienced everything covered in the National Academies of Sciences, Engineering, and Medicine (NAS) report, Families Caring for an Aging America: lack of exercise, poor eating habits, lack of sleep, incredible stress, extreme difficulty navigating our insane medical care system, and lack of support in how to set up my mom’s new life. Tearfulness, depression. My brother, in commenting on the difficulty of the last year, said, “I see now why it is very common that people die within one year after their spouse dies.”

The NAS publication cautions that our society is dependent on family caregivers. Nearly 14% of the US adult population has been a caregiver for an aging adult in the last year, and that is a role that typically lasts 5 years or more.

So. My personal experience raises two public health issues. The first—as noted—how we need to get on it to deal with the dearth in support for family caregivers, or train and pay (and pay very well!) an army of caring people to help our aging population. Policies like the Domestic Workers Bill of Rights in New York and 5 other states newly support domestic workers’ rights to minimum wage, overtime pay, and other worker protections. The organizing efforts of the National Domestic Workers Alliance brought together family caregivers alongside the people they care for—people with disabilities, families with young children, and elderly people like my mom. Both domestic workers and the people who pay them understand that better working conditions will help ensure that our families are well cared for.

In addition to paid caregivers, sometimes we need to take time off to provide care directly. Only four states—California, Rhode Island, Washington, and New Jersey—and the District of Columbia have Paid Family Leave policies to help people take extended time off to care for their families. My own state of Massachusetts tried to pass a Paid Family Leave law earlier this year, which would have required employers to offer up to 16 weeks of leave for family care, with a portion of salary paid out of a state fund. Unfortunately it got blocked in the State House, so like the majority of the US, I still do not have access to these benefits.

So instead I took vacation time to take care of my mother. I can tell you, my time off was no vacation.

Public Health Advocates – Stop Waiting for Evidence about Gun Control!

In public health, especially government-run public health departments, we often debate whether there is “enough” evidence, or whether the evidence is “robust” enough, to justify speaking out and becoming an advocate on a particular issue. A bill in the California legislature right now would fund a Gun Violence Research Center at University of California at Davis if passed – a welcome addition. However, pioneering researchers have already provided scientific evidence that indicate there is no reason for public health practitioners to tiptoe around this issue.

Guns lead to death and injury. You don’t need a study to know this. There is a mantra that the National Rifle Association perpetuates, that even Michelle Obama has echoed, that there are instances in which it is justified for someone to own a gun to make the gun owner safer.

Well, owning a gun is dangerous and does not make you safer. It actually increases the chance that the gun owner or a family member will die or be injured (see links to that evidence below), and the number of guns per capita in a country is a predictor for the number of firearm-related deaths. And despite a ban that muzzled the Centers for Disease Control and Prevention (CDC) from doing research on guns (which was lifted in 2013 but not funded), academics have been doing the very difficult work of studying the impact of owning guns and policies and practices that limit or ease gun ownership.

The increase in risk of gun owners being injured or killed – compared to people who do not own guns – has been proven in several epidemiological studies that control for factors that might make gun owners at higher risk, such as area levels of violence, unemployment, urbanization and other factors. Some studies looked at keeping guns in the home, and found the same results: a higher risk of being harmed by guns among those who own guns. Yet the NRA’s claim is that any law to make restrict gun access will hamper the ability of law-abiding citizens from owning a gun. And Americans, despite the evidence, believe it.

I’m just going to say it again, though: By owning a gun, you are 4.5 more likely to be shot by a gun. And every single case-control study conducted has found that gun ownership is a strong risk factor for suicide. In fact, more than 60% of the firearm-related deaths are suicides.

A recent HIP study considered the health impacts of police purchasing “smart guns”, which only operate when activated by a biomarker (such as a fingerprint) of the owner. The study showed that between one-third to over one-half of the deaths by firearm could be prevented – this is homicides and suicides, and includes deaths from guns shot by children, by those who steal legally purchased guns, and guns taken from police. Based on 2013 deaths by firearm, this means between 9,400 to 17,200 deaths could be averted.

The data and evidence are out there. Webster, Vernick and Wintemute have studied the impact of policies to keep firearms away from high-risk individuals; Wintemute has shown that it is possible to take guns away from those who have been arrested and convicted of domestic violence or have a restraining order; Anestis and Anestis have found that laws that limit access to guns decrease suicide deaths. Irvin, et al studied the impact of regulating firearm dealers, finding that states requiring licensing and inspection have lower homicide rates. These brave researchers have bucked significant pressure to look away from these life and death questions.

In some cases the data can be flawed. For example the Department of Justice’s reporting of civilians killed by law enforcement was viewed as so unreliable that news source’s such as the Guardian and The Washington Post started collecting and analyzing their own data on police killings.

If public health practitioners consider themselves advocates for health – and consider themselves opposed to death and injury – there is truly plenty of excellent evidence that makes it imperative for us to stand up, call ourselves advocates for reducing gun ownership, and speak out.

A Tale of Two Policies

Last week in Massachusetts saw the release of recommendations from Gov. Charlie Baker’s task force on the epidemics of addiction to and death from opium-derived narcotics prescription drugs. The Massachusetts plan includes welcome public health solutions: 100 new beds for people addicted; increased use of naloxone, a drug that counters the effects of opioids, to help people who have overdosed; longer operating hours for a statewide hotline; public education to reduce the stigma that prevents many from seeking help – 65 recommendations in all. States across the nation are responding in kind, with a similar response from leadership at the federal level. This is great news for people who need rehabilitation and support for their addictions.

But what occurred to me was the response to the mostly white prescription drug addicts who are now using heroin, compared to the government’s response to people who use other drugs – harsh laws that target people of color and criminalize their addictions. Opioids? Let’s help them! Other drugs? Lock ‘em up!

My head-scratching began at the National Health Impact Assessment Meeting, held in Washington in June, in a session examining how well HIAs incorporate equity as well as physical health and well-being. David Liners of WISDOM in Wisconsin, with whom HIP worked on an HIA on Treatment Instead of Prison, talked about how the subsequent dramatic increase in treatment alternative programs, from seven in 2011 to 34 today, has improved prospects for those who go to prison – but because of the opioid epidemic, many of those slots have gone to white addicts. HIP and WISDOM had hoped this solution would help decrease the disparities of over-incarceration of African-Americans in Wisconsin – and it has, but why do these common-sense alternatives to prison continue to benefit whites more?

The War on Drugs that began in the mid-80s is largely to blame for the astronomical increase in imprisonment of people for addiction and other drug-related behaviors. One of the most egregious examples of discriminatory criminalization of addiction is the federal Anti-Drug Abuse Act of 1986, which created a 100-to 1-sentencing disparity for possession or trafficking of crack, largely used by African-Americans, vs. powder cocaine, largely used by whites. Laws that criminalize drug use instead of policies and programs offering support and rehabilitation have been responsible for a dramatic rise in incarceration and in the ranks of people with a criminal record. In the 1980s the number of arrests for drug offenses rose by 126%, compared to a rise of 28% in arrests for all crime. By 2008, The Washington Post reported that 1.5 million Americans are arrested each year for drug offenses, and one in five black men spend time behind bars due to drug laws.

But these laws have not decreased drug use. Drug addiction rates have remained relatively stable despite the incredible amount of money spent criminalizing people with drug problems.

What if we fought the prescription drug epidemic with the same fervor with which the War on Drugs was waged? First we’d lock up the addicts. Then we could go after the pharmaceutical companies that make the drugs that get people addicted, and send them to prison. Then we’d target the distributors – the drugstores. A ridiculous idea, but that was the thinking behind the War on Drugs.

Just compare the public-health term being used for this crisis – “the opioid epidemic” – to the military lingo of “the War on Drugs.” An epidemic is something we are all susceptible to and that we look to our governments to help solve. But battling a war fosters an us-against-them attitude: Drug addicts are not like us. They are morally wrong and they must be suppressed, punished, and eliminated.

That way of thinking must stop. As Massachusetts Attorney General Maura Healey said, “We’re not going to arrest or incarcerate our way out of this. Addiction must be treated like any other chronic illness.” Amen.

Treatment, Not Prison: Reforming Sentences for Low-Level Crimes Will Boost Health and Safety for All Californians

[Originally posted at The Pump Handle]

Reforming California’s sentences for low-level crimes would alleviate prison and jail overcrowding, make communities safer, strengthen families, and shift resources from imprisoning people to treating them for the addictions and mental health problems at the root of many crimes, according to a study by Human Impact Partners.

Rehabilitating Corrections in California, a Health Impact Assessment of reforms proposed by a state ballot initiative, predicts the changes would reduce crime, recidivism, and racial inequities in sentencing, while saving the state and its counties $600 million to $900 million a year – but only if treatment and rehabilitation programs are fully funded and implemented properly.

Read the full article at The Pump Handle.

Public Housing, Public Health and the Public Interest

This blog post was originally published at The Pump Handle on February 18, 2014.

The quality of public housing is a key determinant of health among low-income populations. Substandard housing – where mold, pest infestations, fire hazards, or other health risks are present – is associated with a wide range of health problems, including respiratory infections, asthma, lead poisoning and mental health issues. Nor is illness the only concern: Each year millions of Americans are injured, and tens of thousands killed, by accidents in and around their homes that may be linked to housing conditions. Access to safe and affordable housing is not just an economic issue, but a major public health issue.

However, much of the public housing in the United States is in disrepair – unhealthy, unsafe, even uninhabitable. The federal Department of Housing and Urban Development (HUD) has been working for many years to fix the problem, but with the cost of bringing public housing up to standard estimated at more than $20 billion nationwide, it’s a daunting task. (It doesn’t help that HUD’s budget, especially the portion for maintenance and renovation, which was inadequate in the first place, has been repeatedly slashed for the last 30 years.)

In 2011, Congress passed the Rental Assistance Demonstration Project (RAD), a pilot program providing for the purchase and renovation of some 60,000 units of public housing by nonprofit organizations or private entities. A linchpin of the program is the requirement that for 15 to 20 years the new owners must continue to make the housing available to the same populations that currently live there.

Public housing has received increasing attention from the field of Health Impact Assessment, which evaluates multiple health impacts of proposed policies and projects. HIAs have been conducted on housing inspections in Ohio and in Marin County, Calif., and on the HOPE VI program in San Francisco. Currently the Health Impact Project is in the midst of an HIA done in collaboration with HUD about changing the rules for elderly and disabled public housing.  In 2011, Human Impact Partners released an HIA of the RAD proposal.

Recently San Francisco, where soaring rents are forcing increasing numbers of low- and medium-income renters out of the city, was awarded a grant from HUD to rehabilitate its public housing stock – enough to renovate three-fourths of all units. In order to qualify for renovation, the units must be sold to private or nonprofit owners who get tax credits. The units then become Section 8 voucher properties (where low-income tenants pay 30 percent of their rent and vouchers make up the difference to the landlord), and the owners sign a contract to keep them as such for 20 years.

Human Impact Partners’ HIA of the RAD project predicted that the program would lead to improved housing quality, decreased stress among residents and decreased crime around renovated housing. But the devil is in the details. We also predicted that RAD, if not done well, could lead to poor health due to potential evictions, displacement, lack of authentic resident inclusion in decision-making, and stress from not knowing whether one’s housing is secure over the long term.

Here’s what we believe San Francisco must do to avoid those potential negative impacts:

  • Ensure that clear standards are set for protecting residents from evictions, displacement and changes in affordability.
  • Require new management to have a long-term plan to preserve the housing stock.
  • Create funding for services, support and protections for those typically hard to house, such as the elderly, large families, people with disabilities, those who have been arrested or incarcerated, and those with poor credit histories.
  • Create an oversight committee of leaders of resident organizations in the housing sites, housing advocates and elected officials.
  • Develop metrics that truly measure determinants of health to understand how RAD affects health over time.

Affordable housing is not only vital for low-income populations, but to the community at large. We’ve seen what happened when the mental health system that helped those who could not live without support was dismantled. Homelessness and incarceration shot through the roof. We don’t want that to happen if public housing goes away. The bottom line: We just aren’t sure that the RAD program offers enough protection to ensure that private interests wouldn’t eventually win out over the public good.

Think about it: You’re a developer who can afford to buy hundreds of units of public housing, get tax breaks from the government for improving them.  All you have to do is agree that for 15 to 20 years you will keep them available for low-income populations.  After that, you must consider keeping them available, but you’re free to sell them at market rates. In markets such as San Francisco, where even modest units have no shortage of takers eager to rent or buy at prices unthinkable until recently, would you think about public health, or your own opportunity to profit?

Policymakers must consider ways to require or incentivize the continued availability of affordable units. Policymakers who want to consider health and quality of life for their most vulnerable residents must assure that safe, well-maintained housing continues to be available for low-income residents.

How a Public Health Department Can Advance Health Equity Through Policy Change

Written by *Alex Desautels, Kim Gilhuly, and *Tammy Lee

*Guest authors from the Alameda County Public Health Department in Oakland, CA

In Oakland, Calif., an African-American child in the low-income flatlands will on average die 15 years earlier than a white child who lives in the affluent hills. This chilling statistic shows the importance of Place Matters, a pioneering initiative by the Alameda County Public Health Department to advance health equity by focusing on local policy.

Alex Desautels, the Health Department’s local policy manager, and Tammy Lee, a community epidemiologist, said Place Matters focuses on five issues: land use and transportation, criminal justice, economics, education and housing. This agenda was developed with community input, and work is carried out through partnerships with community groups and other stakeholders. For example:

  • The Health Department’s Asthma Start program works with Oakland families to eliminate asthma triggers in homes, but some, like mold, are impossible to remove without help from landlords. Place Matters has partnered with the City of Oakland to research new models of code enforcement to prevent unhealthy housing conditions.  City Council has recently approved their recommendations for a new pilot model.
  • Oakland grassroots organization Causa Justa::Just Cause asked the Health Department to testify about health impacts of water shutoffs in tenant-occupied foreclosed housing. The organization decided to work with the department to conduct further research on health impacts of foreclosure in hard-hit communities.  This research helped support passage of a local ordinance requiring banks to register vacant foreclosed properties and pay fines for ill-maintained conditions.
  • The city of San Leandro was considering approving a transit-oriented development plan that, after significant community input, included affordable housing. But some residents and business owners became vocally opposed. Community groups asked the Health Department to testify to the City Council about health benefits of affordable housing.  At the hearing, a councilmember remarked that the council must take the health recommendation into consideration. Later, a planner stated that the health perspective gave council members an objective rationale for supporting affordable housing.

Often, the community brings emerging issues to the forefront, by approaching the Health Department about an issue, such as blight from foreclosures or diesel exhaust from trucks at the Port of Oakland.  To determine if it’s appropriate to comment, the department looks for pathways from the underlying policy issue at hand to health, health equity impacts and community engagement in the issue. This responsiveness to emerging issues builds trust with the community and strengthens relationships with community partners for deeper collaboration.

The Health Department also conducts Health Impact Assessments of issues tied to the local policy agenda.  Last year, the department conducted an HIA on public school budgeting in Oakland. They are currently doing a Regional Transportation Funding and Bus Access HIA, which looks at funding for AC Transit as determined in the Regional Transportation Plan and investigates health impacts of reduced bus access.

Lee and Desautels outlined the conditions that foster the success of Place Matters.

Leadership and institutional support. There must be leadership and champions to move this work forward.  County Supervisor Keith Carson helped launch Place Matters and has remained a key partner. Tony Iton, the former director of the Health Department, made local policy work a priority.  Another prior director, Arnold Perkins, insisted on partnering with and serving the community. Finally, the department has a strategic plan that prioritizes local policy work to advance health equity.

Community partnerships and involvement. Work should support base-building and building grassroots power.  Systems need pressure to change and that pressure can only come from strong community voices.  The Health Department provides data and analyses that support changes its partners are seeking so together they can build healthier communities where all prosper.

Connection to programs and services. Engaging staff from across the Health Department ensures that policy work contributes to strengthening of public health programs.  Continually engaging staff through regular workgroups assists in institutionalizing the work, rather than creating an isolated body of work.

Innovative analysis and equity-centered tools. The Health Department’s power to move policy change forward is rooted in its ability to make a strong case using public health data. Bridging health and social determinant analyses, using analytical tools like GIS mapping, and conducting community-led research are key to telling the story and creating urgency.

Dedicated staff resources. While many staff must be involved, it’s essential to have at least one person fully dedicated to policy work.  This enables staff to build partnerships, collaborate to advance policy efforts , build support, and respond to emerging issues.

To learn more about the Alameda County Public Health Department’s work, visit:

http://www.acphd.org/social-and-health-equity.aspx

 

Measure What Matters

It’s an image made famous in the cult film Koyaanisqatsi: the 1972 demolition by implosion of the Pruitt-Igoe housing project in St. Louis – a moment some critics say marks the death of the public housing movement. But a new documentary, The Pruitt-Igoe Myth, shows how the project’s social and, ultimately, physical collapse stemmed from a flawed strategy of building public housing without planning or funding for adequate upkeep and repair – a mistake that led to thousands of dilapidated, dangerous units that today sit empty and unusable.

I was thinking about this while reding a recent study in the prestigious journal Science, in which researchers took another look at the data from a landmark experiment by the Department of Housing and Urban Development. HUD’s ‘Moving to Opportunity’ initiative of the 1990s was one of the largest randomized controlled experiments ever done in public housing. The researchers concluded that moving people out of public housing, using vouchers like Section 8, into neighborhoods with less poverty, improved the health of residents.

While these findings are laudable, let’s not jump to the conclusion that tenant relocation programs are the best way to improve health of public housing residents. Instead, let’s ask: How much healthier would the residents have been if significant improvements in the housing stock were made while they were living there? Why not see what the health outcomes would be if people could stay in their homes in public housing with fully funded maintenance, operations, and programming from HUD and local public housing authorities? For added rigor, do a study that compares better maintenance to moving out, and for good measure, compare both of those to business-as-usual. As always, what you measure matters as much as the results of the measurement.

HUD knows that housing is intimately connected to health.  They know that people who live in public housing are at higher risk for poor health due to a variety of factors.  They want to implement programs that will be good for residents’ health. But it’s not clear to me that they are measuring the right things when they are making policy and program decisions. HUD has consistently failed to provide adequate funding for maintenance and operations of public housing units, so it’s not surprising that residents’ quality of life improved when they relocated.

Human Impact Partners has conducted two HIAs on public housing, and we’ve seen that the benefits of housing experiments are not crystal clear.  Early on, Moving to Opportunity produced good health outcomes for kids with asthma and people with depression, anxiety, for general physical health, obesity and diabetes. But some of these effects, such as obesity reductions, were temporary, and others were not statistically significant. One large study showed that overall, after five years there were no significant differences in general health, asthma, physical limitations, hypertension, test scores for kids, school dropout rates, and school engagement.

What none of these studies talked about were the things we heard in our research: how residents experienced the effects of displacement, of breaking up their social networks, and of the stress of not knowing what their housing situation would be in the long-term. We feel strongly that these are important health issues that should be considered in making decisions about the future of public housing. By including a wide range of resident voices in planning these programs, HUD could gain greater understanding of the types of health benefits and burdens that could accumulate among public housing residents.

We applaud HUD’s concerns for how different public housing strategies can impact health, and for trying to think creatively about how to solve them. The Sustainable Communities program is a step in the right direction. But tenant relocation persists as an idea for solving the public housing crisis – and until we better understand what we are and are not measuring, let’s remain skeptical that relocation means better public health.