Fact Sheet: Improving Population Health Through Housing Policy: Lessons From the Public Housing Program

Introduction

Housing instability and unaffordability are contributing to adverse outcomes across a wide range of health domains. In a Milbank Quarterly Perspective from the 2026 special issue, Disease Burden, Mortality, and Life Expectancy in the United States: What Can State Policymakers Do to Meet the Challenges?, Andrew Fenelon of the University of Minnesota School of Public Health calls for an expanded public housing program that focuses on high-quality construction, integrates with social programs administered at the state-level, and serves a broader spectrum of income levels in order to address the US population health crisis.

Context

Housing is a fundamental social determinant of health that can be effectively addressed with policy intervention. Established during the New Deal, the US public housing program now provides housing to nearly 1 million low-income families. Despite decades of federal disinvestment, the public housing program is associated with improved health across the lifespan. Public housing is associated with more benefits than other rental assistance policies such as housing vouchers. For example, public housing has been found to improve child and adult mental health, reduce lead exposure, reduce food insecurity, diminish the risk of asthma-related emergency department visits, and improve diabetes outcomes. Fenelon argues that the early public housing program of the 1930s and 1940s, which served low- and middle-income families and emphasized high-quality construction and good management, offers lessons for the future of housing policy, specifically for how states might leverage housing to improve health across the life course.

Policy Solutions

Fenlon recommends that a renewed public housing program:

1. Serve a broader spectrum of income levels: Increase the economic diversity of public housing tenants and the total number of families that could be supported.
2. Enable integration across multiple levels of government: State programs could provide subsidies for construction and management for affordable housing; more effectively provide public housing in higher-opportunity neighborhoods; and integrate with other state programs like food assistance.
3. Capitalize on the social support benefits of project-based housing: Recognize the importance of residential and community stability, rather than residential mobility emphasized by housing vouchers, for health and well-being.
4. Emphasize effective program administration: Early public housing emphasized strong relationships between housing authority management and tenants. Recognize the importance of having a landlord accountable to the public that can respond to grievances.
5. Develop funding sources less susceptible to political shifts: Funding housing support with approaches used for homeownership—such as the mortgage interest deduction —would make funding less vulnerable to political pressure.