We mostly discussed the question, “What’s next after Naloxone?” Our program intends on answering this question through best practices that include harm reduction, community partnership, and careful case management.
We want to thank Governor Cooper for his leadership in this opioid fight, Caring Services, Inc. for their decades of service to the Guilford County community, and Guilford County EMS for saving lives in Guilford County on a daily basis.
Chase Holleman – Advocate of the Year
Posted on January 12, 2018
Mr. Chase Holleman, UNCG GSTOP Rapid Response Navigator, was selected by the National Association of Social Workers North Carolina Chapter’s (NASW-NC) Legislative Committee as the 2018 Myrna Miller Wellons Advocate of the Year Award recipient.
NC Health News: Mapping Opioid Deaths in Guilford County
Posted on December 19, 2017
On December 19, 2017, Catherine Clabby wrote about the CHCS’s work tracking Guilford County opioid deaths, for North Carolina Health News:
“To improve efforts to reduce the opioid death toll in Guilford County, a UNC-G research center is collecting and mapping relevant data. There’s plenty to upload. Public safety officials there have counted 700 opioid overdoses and at least 80 overdose deaths since January of this year. Unfinished autopsy reports are expected to increase the opioid death count.
“The mapping is just one step in the development of an opioid-overdose quick-response team in Guilford involving many organizations. The General Assembly earmarked $250,000 in funding for that project earlier this year.”
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 3 – Substandard Housing in Greensboro (UNCG CHCS Analysis)
Affordable housing means little in terms of impact if the quantity available is not sufficient to meet individual, family, and community needs.
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:
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.
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.
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.
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.
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.
Guildford County COVID19 Vaccine Health Messaging
Posted on May 05, 2021
The rates of COVID morbidity and mortality are the highest among people of color. According to the Center for Disease Control and Prevention, Non-Hispanic African Americans, Hispanics, and Indigenous people are almost four times more likely to be hospitalized and nearly three times more likely to die of COVID-19 than white people. Communities of color are faced with many barriers that contribute to vaccine hesitancy. These factors include medical mistrust due to systemic racism and unethical medical treatment, misinformation about the vaccine and accessibility (i.e. lack of transportation or care giver care) and availability issues (i.e. proximity to vaccine clinics). The UNCG Department of Health Education and the UNCG Center for Housing and Community Studies in response to a request from Guilford County Department of Health and Human Services will be working to examine COVID-19 vaccination rates and causes for disparities. This assessment process may be used by Guilford County DHHS and related organizations to determine priorities, make improvements, or allocate resources for health messaging and better vaccine coverage especially in vulnerable populations and those with existing health disparities.
CHCS May Newsletter 2021
Posted on May 06, 2021
Housing Instability & Mental Health
Posted on May 10, 2021
Mental health is correlated with housing in several ways both as cause of housing precarity as well as an effect of poor housing. Studies have shown that mental illness is a predictor of living in a precarious housing situation, and one quarter of the homeless population in America suffer a mental illness. Yet also evictions, temporary housing situations, and poor housing conditions have been shown to lead to or reinforce issues with depression, anxiety, and other mental health problems. A key element to improving mental health for those in precarious housing and those experiencing homelessness is the provision of affordable, safe, stable, and permanent housing. Our panelist will discuss how mental health can affect housing stability, as well as the limitations of our social support systems for those suffering a mental illness. This month’s Housing Hangout will be facilitated by Destiny Alston, MPA Candidate at UNC Greensboro and research assistant for the CHCS Eviction Mediation Program.
Speakers:
Brooks-Ann McKinney , Head of Vulnerable Populations , Cone Health
Lindy Garnette , Associate Adjunct Professor , University of Maryland Global Campus
Nakia Brown , Case Manager , Interactive Resource Center
Valerie Jones , System of Care Coordinator , Sandhills Center
Housing & Reproductive Justice
Posted on May 10, 2021
SisterSong, a national organization and reproductive justice collective, defines reproductive justice as the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities. Housing insecurity threatens one’s ability to parent their children in a safe and healthy environment. Our panelists will describe the housing crisis within the context of reproductive justice and will offer strategies on how to mobilize local efforts to address this public health issue. This month’s Housing Hangout will be facilitated by Erica Payton Foh, PhD MPH, Assistant Professor of Public Health Education at UNC Greensboro and CHCS Research Fellow. Speakers:
Christina Yongue: Assistant Professor and the Director of Undergraduate Studies in the Department of Public Health Education at UNCG
Laura Vail: Director, Health Equity at Cone Health
Love Odetola: Doctoral Student, UNCG Department of Public Health Education
Natacha Nikokeza: UNCG Center for New North Carolinians Community Centers Senior Program Coordinator
Breanna Grant: Adolescent Parenting Program Coordinator YWCA Greensboro
Right to Counsel in Eviction Cases.
Posted on June 10, 2021
We’ll Need it After the Moratorium Runs Out.
Two Charlotte city council members the other day floated the idea of adopting a right to counsel program for tenants facing eviction. That’s a milestone, and an indicator both of how serious the eviction crisis is about to get, and of how fast the right to counsel laws are catching on.
The moratorium on evictions, which blocks landlords from evicting tenants who have fallen behind on rent because of COVID-related income losses, has been pieced together now for over a year with successive and overlapping extensions, renewals and improvements. But now, barring something unexpected, it’s finally set to expire on June 30. If and when that happens (and even if it is extended in some form), we will see a rise in evictions – possibly a massive rise. Thousands of tenants will find themselves in scary, fast-moving and barely comprehensible court proceedings. Whether they will have lawyers to help them will be an urgent question.
We’ve spent a lot of time thinking about this question of who will have lawyers to help them. In the course of our research across the state over the past year for our study of civil legal needs in North Carolina, we asked people what measures they would support to improve low-income North Carolinians’ access to justice. Right to counsel in civil matters was high on their wish list, but low on their list of probability of achievement. They may be right. The National Coalition for a Civil Right to Counsel reports “no recent civil right to counsel activity in North Carolina.” Only Alaska, Idaho and West Virginia receive an assessment as dispiriting as this in the Coalition’s state-by-state accounting. But when it comes to the right to counsel specifically in eviction cases, North Carolina has much more company: forty-eight other states recognize no right to counsel in eviction cases. But interest is building, and while the vicious cycle of housing instability and homelessness keeps spinning, help is on the way.
The “right to counsel” will be familiar to anyone with knowledge of the criminal justice system, and even to those whose knowledge is limited to what they learned watching cop shows. “If you cannot afford a lawyer, one will be appointed for you.” The Supreme Court in its unanimous decision in Gideon v. Wainwright in 1963 had set down the simple proposition – one required by common sense as well as by the constitution – that a criminal defendant cannot get a fair trial unless they have the assistance of counsel. Therefore, courts have to provide counsel to indigent defendants in felony cases (and a few years after Gideon, the right was extended to misdemeanor cases).
These breakthrough developments shifted forever the balance of power in the criminal courts. But they gave rise to two big problems. One, Gideon is an unfunded mandate. Somebody has to pay for all those public defenders, and state legislatures have been perennially unwilling. So, who’s going to pay for yet another cadre of lawyers to provide assistance on the civil side? Two, the Supreme Court has been unwilling to extend the constitutional guarantee to civil cases. Early on, they did so for juvenile delinquency; after all, as in a criminal prosecution, the defendant’s very freedom was at stake. But in the following years, the Court refused to go further. Though important interests were at stake – parental rights and even jail for civil contempt – the right to counsel, like many other rights of poor and vulnerable people, fell victim to the backlash against the progressive jurisprudence of the Warren Court era.
This means the courts won’t impose on state and local governments the obligations to provide counsel in civil cases, but legislatures can choose to do it by statute, and they have sometimes done so. North Carolina, that reluctant state, actually does have it for several categories of litigants, including both parents and children in abuse and neglect cases and termination of parental rights cases, vulnerable adults in wardship cases, a minor bypassing parental consent in abortion cases, and indigent respondents in civil commitment. But in many of the most important subject areas, such as child custody, domestic violence, public benefits, and eviction cases, where very substantial family, health, safety, and financial interests hang in the balance, you’re on your own.
A movement to change that – the “Civil Gideon” movement – has burgeoned over the past couple of decades, with the support of commentators, advocates and staid bar associations. And in recent years, the civil Gideon spotlight has shone brightest on housing courts. New York City led the way in 2017, with its first-in-the-nation law guaranteeing counsel to low-income tenants in eviction cases. Any tenant facing eviction, with household income of not more than 200 percent of the federal poverty guideline, and regardless of neighborhood or immigration status, get full representation (and even higher-income tenants can get free legal advice though not representation).
Several cities have followed New York’s lead, with Baltimore, Cleveland, Louisville, Newark, Philadelphia, and San Francisco now requiring counsel in eviction cases. A pilot program has started in Houston, and in April, Washington became the first to mandate counsel in eviction cases statewide.
And, just as important, advocates and legislators across the country are watching New York and learning much from their experience. For one thing, it’s clear that it works. We’ve long known that low-income tenants who are represented by counsel have better outcomes in eviction proceedings than unrepresented ones. A New York study from the 1990s showed that tenants representing themselves were evicted more than four times as often as those with lawyers; and in a Boston pilot program from 2009 to 2011, one-third of unrepresented tenants remained in their homes, while two-thirds of those with lawyers did.
Early evidence from the New York program is encouraging. They don’t yet have data showing the difference in outcomes between represented and unrepresented tenants, but the court administration reports that of those tenants with lawyers, 86% remained in their homes – an astonishing number. Before the law went into effect, less than ten percent of tenants were represented in housing court, against 90 to 95% of landlords; tenants rightly saw housing court more as a debt collection agency than as a place where they might assert rights.
The Gideon court wasn’t seeking more acquittals in criminal cases; their goal was procedural, to ensure a fair trial as required by the constitution. Today, though, the right to counsel has become a tool of public policy, wielded by legislators with ambitious social and political objectives. Some have claimed for it the potential to transform poor neighborhoods in cities across the country. In the housing arena, the goal is to keep more tenants in their homes, to keep families safe, to prevent the harms of eviction both to the tenants and to the society at large. This is the goal of those forward-thinking council members in Charlotte, not only to make the process fair, “to ensure that families are being properly represented and getting the legal advice that they need,” but to promote the desired outcome of eviction cases, “to keep people in their homes.”
Been, Vicki, Deborah Rand, Nicole Summers and Jessica Yager. 2018. “Implementing New York City’s Universal Access to Counsel Program: Lessons for Other Jurisdictions.” NYU Furman Center Policy Brief. https://furmancenter.org/files/UAC_Policy_Brief_12_11-18.pdf.
Latest publication from CHCS – Testing residential tap water
Posted on June 28, 2021
Abstract
Background
In 2015 alone, community water systems serving about 21 million Americans violated the United States Environmental Protection Agency’s (US-EPA) water quality standards. While water at community treatment and distribution centers is regularly monitored and tested, little is known about pollutants in the water systems at the household level.
Aims
This pilot study assessed the feasibility of (1) testing for the presence and concentration of 14 contaminants and physicochemical parameters in household tap water in a low-income neighborhood and (2) using community engagement for recruitment and citizen science approaches to data collection.
Methods
We used a multistage approach that included geo-mapping to delineate testing sites, community engagement for recruitment and citizen science approaches to increase the response rate. We used a 14-in-one dipstick test designed to measure trace amounts of heavy metals, non-metallic elements, and physicochemical water properties in drinking water in a sample of 70 homes.
Results
In 50%, 25%, and 7% of water samples tested, the concentration of mercury, lead, and chromium, respectively, were higher than US-EPA drinking water standards. Citizen science approaches were effective for increasing response rates and low-income household participation in water quality testing.
Significance
The overlap between poverty, older homes, and high concentrations of potentially toxic metals in drinking water presents concerns for community health. Our pilot community engagement and citizen science approaches are likely scalable and would be of benefit to both the scientific community and to municipalities with constrained budgets. Future studies may examine the role of the principles of environmental justice in the distribution and prevalence of toxic elements in drinking water.
Odetola, L., Sills, S. & Morrison, S. (2021) “A pilot study on the feasibility of testing residential tap water in North Carolina: implications for environmental justice and health.” Journal of Exposure Science and Environmental Epidemiology.
Abstract