Mapping the Housing-Health Connection

It’s no secret that the basic elements that shape a neighborhood—the housing stock, building codes, location of transit lines and industry—can impact the health of its residents. But a few years ago, an unusual coalition in Cleveland set out to get beyond that broad point and into the gritty, data-driven specifics.

The Cleveland Healthy Home Data Collaborative (CHHDC) built a unified data system that links housing conditions directly to health outcomes—address by address, block by block. It’s an effort to make the home-and-health connection truly legible to the people who need it most, from residents to policymakers. The tangible results have included an accessible app intended to help renters make individual health-related housing decisions and beefed-up city standards (and enforcement) related to lead paint.

The roots of the coalition trace back to the mid-2010s, when it launched with initial funding from The BUILD Health Challenge, a national program that supports community-driven partnerships to reduce health disparities. The lead partner in the effort was Environmental Health Watch (EHW), Cleveland’s oldest environmental justice organization, which was required by the program to bring on a hospital partner, as well as the city’s health department. “That was already a new way of doing business, by having a nonprofit lead the work,” says Kimberly Foreman, chief executive officer of EHW, who describes the organization as the backbone of the project.

Other coalition members included MetroHealth and University Hospitals and the Cleveland Department of Public Health. But having a community-based organization in the lead role (with funding from BUILD flowing through EHW) meant that the communities potentially most affected by unhealthy housing could give input about what data to collect, how to present it, and who would have access to it.

Coalition members agreed about the overarching problems. Lead poisoning in Cleveland is nearly four times the national average. Childhood asthma rates in low-income neighborhoods are among the highest in the country. The causes include old housing stock, deferred maintenance, absent landlords, and inadequate code enforcement. EHW has been working on healthy homes since the 1980s, Foreman says, trying to draw attention to “comprehensive assessment, addressing asthma triggers, addressing lead hazards.” But for decades the city lacked the tools to connect the dots between a peeling wall in a rental unit and a child showing up in the emergency room months later.

The newly formed data collaborative pulled together geocoded housing data (inspection records, code violations, lead certification status, rental registry data) and linked it to health information from hospital systems and public health departments. Integrating that data to enhance communication among institutions was the first step. (Even now, Foreman says, she meets people at conferences who marvel: “Oh, you actually work with your hospital system?”)

But the resulting public-facing portal “was not user-friendly.” A second BUILD grant followed, and EHW expanded the coalition to include Case Western Reserve University’s Center on Poverty and Community Development and its metrics. “The Poverty Center helped us decipher the data and figure out, working with renters, how to prioritize the information that they needed or wanted to see,” Foreman says. The result was a platform that could benefit renters and policymakers alike. Type any residential address into Cleveland.housing.health and you get a clear property overview: when the structure was built and who owns it, lead risk and structure risk ratings, and any code violations, among other data points.

The broad membership of the coalition has helped give it institutional staying power: When hospitals and public health departments share ownership of a system, it tends to outlast the grant cycle that created it. And in fact, the group’s work eventually helped drive one of the city’s most significant housing policy changes. In 2019, after a wave of press scrutiny and years of community pressure coordinated in part through EHW’s advocacy, Cleveland City Council passed an ordinance requiring rental properties to be certified lead safe. The data system the coalition built was both an argument for that policy and a tool for implementing it.

Cleveland is, in some ways, an extreme case of a challenging health-and-housing connection. But the underlying issues are widespread. And as the CHHDC has attracted national attention, the BUILD Health Challenge and others have sparked similar versions of the cross-sector, data-driven housing-health model for cities from Philadelphia to Oakland. The National League of Cities now runs a Healthy Housing Innovation Cohort specifically to help municipalities build data infrastructure like that which Cleveland spent years constructing from scratch.

Meanwhile, in Cleveland, researchers at Cleveland Clinic and MetroHealth are now building digital twin neighborhoods—sophisticated computational models of entire communities, derived from the electronic health records of more than 250,000 patients, that can simulate what happens to health when a neighborhood’s housing stock undergoes changes, or when a clinic is added or a bus line rerouted. Funded by a $3.14 million National Institutes of Health grant, it’s a descendant of the CHHDC’s foundational insight: Place is a clinical variable, and improving health at scale requires understanding—and intervening in—the environments people actually inhabit.

Closing the health-disparity gap will of course require not just data but resources: a funded Lead Safe Home Fund, sustained code enforcement, landlord accountability, and the political will to treat housing quality as a public health emergency rather than as a private-market outcome.

But the Cleveland coalition proved that technical barriers can be solved. Often the data exists—in hospitals, in city agencies, in health departments—but it lives in silos. The solution is organizational as much as technological: building the trust and the governance structures needed to allow those institutions to share what they know. This can make the seemingly murky challenges undeniably clear and even put a number on what neglect costs, in childhood lead levels, in asthma hospitalizations, in years of life lost before age 70. Such data-rich clarity helps meet a diffuse crisis with a set of specific responses.

That said, Foreman emphasizes that data, and even legislation, are just starting points for action. “We run incentives programs for landlords” to comply with regulations and mitigate lead issues, she points out. “We run a relocation program to help get people temporary space while their home is getting worked on. We run a hotline, we run outreach, we run education.

“Data matters,” Foreman continues, “but then what do you do with it?” Answering that question means thinking about who is collecting which data, how it’s being translated, and who can use it. “People are not units and widgets,” she concludes. “They’re people.”

Rob Walker is a journalist covering design, technology, and other subjects. He is the author of The Art of Noticing and City Tech: 20 Apps, Ideas, and Innovators Changing the Urban Landscape. His newsletter is at robwalker.substack.com.

Lead image: In Cleveland, Ohio, a data collaborative illuminates the connections between housing conditions and health outcomes. Credit: DJ Johnson via Unsplash.