Housing Quality in Greensboro

Housing quality is an issue for Greensboro residents. Single-family homes in Greensboro are on average over 50 years old, while multi-family homes or apartments are about 35 years old. Waves of development over the years can be seen, with homes built in the 1950s or before concentrated in the city core and the most recent development (post-1988 in the outermost suburbs). Aging housing stock itself is not an issue, if kept up. However, the trend with aging rental housing is for owners not to reinvest in maintenance, but to extract whatever rents they can while depreciating the property on their taxes and then speculating on the future resale value.

In 2016, the UNCG Center for Housing and Community Studies (CHCS), an Invest Health Greensboro partner, conducted a ‘census’ of the housing stock, assessing the structural quality of housing in Greensboro. The housing census involved a parcel-by-parcel inventory and assessment of all lots and buildings in the City, assessing the conditions and status of all structures and the property itself. CHCS found that much of the housing stock in Greensboro is aging and shows signs of disrepair.

More than 78,000 properties were assessed. Over a third (35.8%) of the properties had some sort of issue with the lot – grass or weeds over a foot high and needing mowing; shrubs obscuring the building and needing trimming; trees hanging over roof; inoperable vehicles on the lawn or drive; substantial trash or debris in the yard; building materials, tires, automotive parts, or appliances, in the yard; or dangerously low-hanging power lines. While some of these code enforcement issues are simply a nuisance, unsightly properties due impact property values of adjacent property and can lead to potential health and safety issues.

CHCS also noted a significant issue in lack of repair and maintenance. For instance, 18.7% of multi-family and 31.1% of single-family homes had fair to poor roofing conditions; 9.0% of multi-family and 11.8% of single-family had no gutters; 9.0% of multi-family and 9.0% of single-family had fair to poor windows; and 3.7% of multi-family and 5.7% of single-family had fair to poor foundations.

Poor maintenance of roofing leads to moisture inside the home, mold, rot, and structural damage creating potential health and safety hazards. Missing gutters leads to water or moisture in the crawl-space or basement as well as structural decay of the foundation. Poor windows pose an energy-use problem. Poor foundations may compromise the structural integrity of the home.

Looking at major structural conditions like roof, windows, foundations as a composite statistic of these features CHCS found 13% of properties to be a standard deviation below average and 4.2% two and a half standard deviations below the mean. Applying these figures (13% and 4.2%), back to the total number of properties in our data we calculate 9,516 of properties surveyed as being below average and 3,074 of properties surveyed as ‘well below average.”

Figure 2 – Estimated Percentage Housing with Poor Roof Conditions Greensboro, NC

Figure 3 – Substandard Housing in Greensboro (UNCG CHCS Analysis)

Pediatric Asthma and Housing

Studies have shown that substandard housing is clearly related to increased likelihood of health concerns and mental health issues. Specific health hazards of substandard housing including: frequent changes of residence (community instability), mold from excessive moisture, exposure to lead, exposure to allergens that may cause or worsen asthma, rodent and insect pests, pesticide residues, and indoor air pollution. Depression and self-perception of health status are higher for those living in areas of extreme poverty.

Asthma is the leading chronic illness of childhood and an increasingly prevalent disease that disproportionately affects low-income children. According to the Centers for Disease Control and Prevention, an estimated 10.5 million (14.0%) of children in the United States have been diagnosed as having asthma. According to the CDC, asthma prevalence rates are especially high in Guilford County – 15% compared with 8% nationally. The Asthma and Allergy Foundation of America (2015) shows that Greensboro’s asthma rate is influenced by higher than average poverty and uninsured rates. The NC DHHS has noted that nearly a third of children in NC visited the ER or Urgent Care in 2015 due to asthma. According to the CDC the overall rate of discharges from the hospital for Asthma was 90.6 per 100,000 residents for Guilford County. This means that for every 100,000 people 90.6 were hospitalized for the primary diagnosis of asthma. Our own analysis of data from Cone Health shows more than 8,000 pediatric hospital visits for treatment of asthma or related respiratory illness in 2016. Patients were geographically concentrated in low-income neighborhoods with high proportions of rental units.

Asthma develops through the interaction of genetic factors with environmental exposures. Substandard housing is known to have several health-related risks that increase the probability of a child developing asthma, as well as exacerbate asthma symptoms and attacks, once the condition has developed. Exposure to indoor allergens is widely recognized as a major source of asthmatic reactions. Numerous studies have linked the prevalence of asthma attacks and other asthma symptomatology to a range of indoor allergens – dust mites, mold, rodents, pets, scents, tobacco smoke, and chemical particulate matter. Environmental conditions in homes increase the presence of these asthma triggers: plumbing or roof leaks, inadequate ventilation, faulty or inoperative exhaust systems, and unclean floors and surfaces.

Over 19,000 children in Greensboro (29.3%) live in households below the poverty level. These families have few options in terms of affordable and healthy housing, which consigns over 6,000 children with asthma to live in places that make them sick. Current housing code enforcement data shows that 65% of open violations involve rental properties. With so many cost burdened renters, landlords do not have the cash flow to make necessary repairs, exposing low-income families to conditions which increase the incidence and morbidity of asthma. A recent study funded in part by the Kresge Foundation investigated the efficacy of interventions, ranging from education to home improvement projects, to address triggers among children who had recent hospital visits for asthma. The reported occurrence of asthma attacks among children in the study was associated with triggers such as dust and mold. Past flooding or water damage, conditions that promote mold, was reported in over 40% of homes. This project documented reduction in asthma hospitalizations after housing assessments and interventions. A second study identified unambiguous evidence of asthma clustering in low-income areas with high rates of code violations, condemned and vacant housing. Other work by members of our team show that over 36.8% of homes in low-income neighborhoods are substandard. Addressing housing affordability and rental maintenance, especially in low-income neighborhoods, will be key to overcoming the barriers to positive community health.

There is an increasing understanding that medical care alone cannot reduce asthma and other ailments, and that health and wellbeing are dependent on the conditions in which people are born, grow, live, learn, work, and play. Over the last several years, research has demonstrated that the homes we live in – specifically, the physical conditions within the home, neighborhood conditions, and housing affordability – shape our behaviors and influence our health in several important ways. Most studies that report on the home environment of children with asthma note the homes often have substandard conditions, such as plumbing or roof leaks, inadequate ventilation, faulty or inoperative exhaust systems, unclean floors and other surfaces, presence of rodents or cockroaches, or building structure issues, that promote the presence of asthma triggers. This is currently the case in Greensboro, which has a long-standing need for safe, affordable housing that has increased greatly due to current economic and demographic trends.

Figure 4 – Poor Housing Quality

Building an Asthma-Safe Greensboro

The 2015-2019 Guilford County Consolidated Plan – Planning for a Resilient Community – adopted three goals: (1) “Increase the supply of decent affordable housing; (2) Promote a suitable living environment; and (3) Expand economic opportunities.” Concentrated poverty, as well as vacant and substandard housing, has not been adequately addressed. Neighborhoods continue to deteriorate and consequential negative health outcomes are well-documented. The need to rehabilitate the housing stock is evident and in line with the Consolidated Plan. The most successful strategies will address three areas in an integrated way: (a) housing, (b) infrastructure, and (c) business interests.

Subsequently, members of our Invest Health team have been involved in the launch of the Housing Our Community Initiative (HOCI) with a vision that, “Everyone in our community lives in safe, affordable housing” and a mission to address Greensboro’s housing affordability gap through collective community action. In February 2017, at the annual Greensboro Housing Coalition Housing Summit, the president of the Community Foundation of Greater Greensboro announced plans for the Foundation to convene stakeholders and assemble the resources for the Housing Our Community Initiative and urged the Mayor and council members to also support the HOCI. The Invest Health team are key stakeholders in this initiative and have developed strategies necessary to restore deteriorating housing to asthma-safe condition, in cooperation with others in real estate, health, economic development, and human service fields. The plan is based on broad community input with the intention to build political will for policy changes and attract significant investment in making housing safe, affordable, and available.

The City of Greensboro has made clear in its master plan that investment of CDBG, HOME, HOPWA and ESG funds should be made to address the lack of affordable and safe housing our city. The Neighborhood Development Department Housing Rehabilitation Program has available funds in several housing support programs including the Citywide Rental Housing Improvement Program, a Citywide Homeowners Housing Rehabilitation Program, and the Homeowner Emergency Repair Program. These programs are designed to assist homeowners and landlords via subordinated, deferred payment loans and grants to rehabilitate eligible housing, especially those identified as threats to the health and/or safety of residents. Greensboro’s recently updated code enforcement ordinance allows for the city to make repairs and place a lien on the property if the owner does not correct violations in the specified time. Moreover, last year, the City passed a 25-million-dollar affordable housing bond to be used for rehabilitation of substandard housing and development of new homes, making potentially additional funding available to the goals of Housing Our Community Initiative. Thus, our project intends to leverage local political will, foundation support, and federal dollars, to address the issues of safe and affordable housing while partnering with developer, investors, and community members to ensure sustainable, long-term success.

Our overarching vision is to build an asthma-safe Greensboro by reinvesting in healthy housing for neighborhoods affected by pediatric asthma. An investment in housing stock quality and a reduction in pediatric asthma and healthcare utilization rates, will lead to improved school attendance, housing stability, improved work attendance, better incomes, fewer health care costs, and healthier children and families.

Our business plan describes the key systems strategies to address these issues and create an asthma-safe city through the deployment of five interrelated sub-projects:

1. Identify Health Impact Neighborhoods. Action: Creation of a community-based process to identify children with asthma living in housing with addressable environmental triggers associated with incidence or exacerbation of their asthma.
2. Health System Integration. Action: Development of an educational initiative to better inform the health care system including insurers about the role that substandard housing has on the incidence and exacerbation of asthma in children.
3. Repair and Rehabilitation Programs. Action: Development of an assessment approach to increase the focus of existing minor repair / housing rehabilitation programs so that they target substandard properties in areas of high concentration of cases of pediatric asthma.
4. Leverage Public and Private Funds. Action: Creation of an initiative to produce recommendations to public and private funders for the use of public and private redevelopment funds to rehabilitate and redevelop multifamily properties that have high concentrations of substandard housing conditions that produce known environmental triggers associated with the incidence and exacerbation of childhood asthma.
5. Information Exchange Network. Action: Establishment of an information exchange network for the purposes of providing current and critical information for the purposes of informing property code enforcement and City policies that consider community health in future development plans.