Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity (2023) / Chapter Skim
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6 Neighborhood and Built Environment
6 Neighborhood and Built Environment
Pages 305-354
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reservations and Native Hawaiian homelands, and federal rental assistance)
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For instance, historical housing discrimination and redlining (and, conversely, "greenlining") caused inequities that continue today, including reduced homeownership and reduced access to affordable housing for many racially and ethnically minoritized populations (see the section later in this chapter and Chapter 3 for more information on redlining)
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is responsible for identifying lead paint hazards in HUD-assisted housing but has not completed a comprehensive evaluation of the Project-Based Rental Assistance Program to distinguish properties presenting the greatest risk to children under age 6 (GAO, 2020)
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homes has been exacerbated by federal policies -- past and present -- that segregate neighborhoods, exposing specific communities to precarious health outcomes. For example, although redlining, an explicitly racist mortgage lending policy of the federal government from the 1930s to the 1960s, is now unlawful,2 its legacy of structural racism is still observable today in patterns of neighborhood disinvestment and residential segregation by race and consequent effects on other social determinants of health (SDOH)
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Displacement and Health: Housing for American Indian and Alaska Native and Native Hawaiian People Federally mandated and supported segregation and displacement have been uniquely harmful to AIAN individuals. Federal government actions encouraging settler colonialism through, in part, forcible removal of AIAN people from their traditional, ancestral lands caused intergenerational physical, spiritual, mental, emotional, economic, and environmental harms, including death and population loss (Hoss, 2019; NASEM, 2017)
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The Native American Housing Assistance and Self-Determination Act of 19964 is the main source of federal assistance for affordable, safe, accessible housing for AIAN and Native Hawaiian people. A bipartisan group of senators introduced the Native American Housing Assistance and SelfDetermination Reauthorization Act of 20215 to reauthorize the bill's programs through FY2032 (National Low Income Housing Coalition, 2021)
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. The grant provides funds that tribal governments can use to finance rental assistance for AIAN people living on tribal lands (CBPP, 2022b)
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. Federal Rental Assistance Affordability is an important component of housing.
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administers the USDA Section 521 Rural Rental Assistance program. HUD administers three major programs, including housing choice vouchers,8 public housing,9 and Section 8 project-based 8 This a federally funded program in which low-income households use tenant-based vouch ers to obtain rental housing in the private market; it is administered by state and local housing agencies (Mazzara, 2017)
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. The federal government offers other programs to build or rehabilitate rental housing with tax credits,11 grants, and reduced-interest loans, but without rental assistance, these units are often unaffordable to families with the lowest incomes (CBPP, 2022b; NASEM, 2022b; National Housing Law Project, 2021; National Low Income Housing Coalition, 2022)
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NOTE: Currently about one in four households eligible for a voucher receives any type of federal rental assistance. Latino category may contain individuals of any race who identify as Latino or Hispanic; other categories exclude individuals that identify as Latino or Hispanic.
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Safe, quality housing is necessary for maintaining an adequate standard of living, and there is a compelling link between housing and health equity. Increased federal investment in housing interventions for low income people, such as the housing voucher program, could improve housing security and health outcomes for children and adults, especially among Black, Latino/a, American Indian and Alaska Native, and Na tive Hawaiian and Pacific Islander populations, and advance racial and ethnic health equity.
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. Race and ethnicity are significantly correlated with hazardous exposure after controlling for income; research has found new facilities are often sited where racially and ethnically minoritized communities already existed (Ash and Boyce, 2018; Bullard, 1983; Liu et al., 2021; Mikati et al., 2018; Mohai and Saha, 2015)
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. This section provides additional detail and examples of how federal investment and disinvestment in infrastructure can help or harm community health and contribute to racial, ethnic, and tribal health inequities.
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Safe Drinking Water Act,16 which ensures that communities have access to potable water; (3) the Clean Water Act,17 which establishes the necessary guidelines for ensuring clean and swimmable waters; and (4)
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. The Safe Drinking Water Act regulates the public drinking water supply and authorized EPA to set national minimum standards to protect against contamination from naturally occurring and anthropogenic health risks.
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Neighborhoods with lower-income, racially and ethnically minoritized communities are less likely to have features such as well-marked crosswalks and sidewalks or other types of infrastructure that lower speeds and improve pedestrian safety (Montgomery, 2021)
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Given the range of linkages between transportation and health and the legacy of structural racism in land-use and planning decisions (e.g., devaluing the Black communities displaced by a new highway project) , transportation agencies at all levels of government can play robust roles in furthering health equity.
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. Transportation agencies at all levels of government are required by Title VI of the 1964 Civil Rights Act2 and Executive Order 128983 Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Popula tions to assess whether infrastructure projects will affect low-income and racially and ethnically minoritized communities.
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. The effects of aging or substandard infrastructure are felt by all but particularly by racially and ethnically minoritized communities.
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. They also reduce the available land for green spaces, such as tree canopies in neighborhoods and safe and accessible parks and playgrounds that provide opportunities for physical activity and social connectedness (Arnold and Resilience Justice Project Researchers, 2021)
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found that majority Black, Hispanic, and American Indian census tracts were more vulnerable and less likely to be able to adapt and respond to wildfires than majority White tracts. Furthermore, climate change is likely to intensify challenges presented by aging infrastructure, especially among racially and ethnically minoritized communities (Arnold and Resilience Justice Project Researchers, 2021; USGCRP, 2018)
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. Although several factors, such as home value, perceptions of crime, and polluting infrastructure, can preclude access to high-quality green spaces in neighborhoods, it is crucial that cities' GI plans acknowledge causes of racial and ethnic health inequity and displacement and use inclusive processes to design and evaluate GI so that the systems do not perpetuate harms (Arnold and Resilience Justice Project Researchers, 2021; Barber et al., 2022; Grabowski et al., 2023)
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This means establishing GI standards in federally sponsored programs that also account for racial and ethnic health inequities. Conclusion 6-2: The federal infrastructure policies governed by the Department of Housing and Urban Development, the Environmental Protection Agency, the Department of Transportation, and other agen cies play critical roles to ensure health equity.
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The gender pay gap contributes to financial stability, and it is larger for AIAN, Hispanic or Latina, Black, and Native Hawaiian and Pacific Islander (NHPI) women than for White and Asian women.
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. The National Institute for Occupational Safety and Health has recognized occupational health inequities as "differences in work-related disease incidence, mental illness, or morbidity and mortality that are closely linked with social, economic, and/or environmental disadvantage such as work arrangements (e.g.
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oversees most occupational sector safety standards, but EPA exerts authority over agricultural worker safety through the federal WPS, which is largely administered by states and meant to reduce risk of pesticide poisoning and injuries among agricultural workers (EPA, 2023a)
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Inadequate workplace protections from pesticides for agricultural workers disproportionately impact Latino/a workers, their children, and surrounding communities. FOOD ACCESS AND PRODUCTION Healthy neighborhoods require access to healthy food systems.
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. The Agriculture Improvement Act (commonly referred to as the "Farm Bill")
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. Given the bill's size, scope, and impact, it could benefit from an equity audit to review its effects on racial, ethnic, and tribal health equity; the USDA Equity Commission's interim report recommends equity audits across USDA's services (USDA Equity Commission, 2023)
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. Adding provisions to the 2018 Farm Bill aimed specifically at tribal governments and communities is a positive example of incorporating community voice in federal policy making; building strong community leadership and capacity is an important way to improve public health (NASEM, 2017; NCAI, 2021)
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However, given the bill's size and scope, an audit of the equity implica tions of the bill could identify additional areas of improvement, such as areas to expand further tribal self-determination and self-governance in relevant programs and other mechanisms to advance racial and ethnic health equity. CONCLUDING OBSERVATIONS This chapter has outlined some of the key ways that the built environment functions as an SDOH and how federal policies in this area positively and negatively impact racial, ethnic, and tribal equity.
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• Highlight the co-benefits of -- or shared "wins" that could be achieved by -- considering health equity in the development of comprehensive plans (e.g., improving public transit in transit-poor areas supports physical activity, pro motes health equity, and creates more sustainable communities)
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First, expanding access to effective programs such as federal rental assistance can improve housing security and health outcomes among racially and ethnically minoritized communities. Second, federal support for infrastructure projects provides opportunities to prevent health inequities from being built into racially and ethnically minoritized communities; integrating several existing tools into infrastructure investment decisions will need to be a priority.
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https://www.bls.gov/ news.release/osh.nr0.htm (accessed March 17, 2023)
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2022c. United States Federal Rental Assistance Fact Sheet.
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2022. Presentation to the Committee on the Review of Federal Policies That Con tribute to Racial and Ethnic Health Inequities.
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2021. Does rental assistance improve mental health?
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https://www.epa.gov/newsreleases/epa-proposes-rule-protect-farmworkers-and pesticide-handlers-exposures (accessed March 15, 2023)
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https://cepr.net/the-historic-opportunities-for-racial equity-in-the-infrastructure-investment-and-jobs-act/ (accessed March 2, 2023)
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https://www.hud.gov/topics/housing_ choice_voucher_program_section_8#hcv02 (accessed March 14, 2023)
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Paper presented at Meeting 3, Part 2: Committee on the Review of Federal Policies That Contribute to Racial and Ethnic Health Inequities. Mazzara, A
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2019b. Vibrant and healthy kids: Aligning science, practice, and policy to advance health equity.
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2019. Occupational Health Equity.
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https://www.osha.gov/agricultural-operations/hazards (accessed March 3, 2023)
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https://www.ruralhealthinfo.org/funding/5593 (accessed March 2, 2023)
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https://www.cbo.gov/publica tion/52463 (accessed March 2, 2023)
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https://www.ers.usda.gov/topics/farm-economy/socially-disadvantaged beginning-limited-resource-and-female-farmers-and-ranchers/ (accessed March 2, 2023)
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2019. Green infrastructure provision for environmental justice: Application of the equity index in Guangzhou, China.
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