How Cities Can Address Overlapping Housing, Affordability, and Health Challenges

Across the country, aging affordable housing presents challenges for residents and housing providers alike. Not only are older buildings expensive to maintain, but deferred maintenance also drives up utility costs, leads to health and safety issues, and erodes affordability.

Recognizing this overlap of health and cost burdens, a coalition of partners led by the National Housing Trust (NHT), including Children’s National Hospital’s IMPACT DC Asthma Clinic, Children’s Law Center, and the Latino Economic Development Center (LEDC)—came together to address housing quality, health, and climate into a single intervention. The DC Healthy, Green, and Affordable Housing (DC HGA Housing) program helps affordable housing providers prioritize high needs properties to retrofit. These green retrofits preserve affordability, improve health outcomes, and lower emissions and energy costs (PDF).

By combining data to inform new retrofit strategies with community insights, the DC HGA Housing program provides a cross-sector model that cities nationwide can use to address housing challenges.

Visualizing the overlapping health and cost burdens

In Washington, DC, these challenges overlap substantially:

• Roughly 36 percent of the city’s housing units were built before 1940, compared with just 13 percent nationally.
• Households with low incomes face combined energy and water costs that eat up as much as 11.2 percent of their income (PDF)—nearly five times the burden for households with higher incomes.
• More than half of Black renters and nearly half of Hispanic renters in DC are rent burdened, compared with about one-third of white renters.
• DC adults have higher asthma rates than the national average, and pediatric asthma is disproportionately concentrated among children in the poorest neighborhoods of DC, especially in Southeast, where emergency department visits related to asthma are notably higher.

The DC HGA Housing program used data from the Healthy Housing Map, a tool that combines pediatric health data with housing code violations, to identify and target properties for retrofits. Barriers to accessing administrative data from housing providers and health care systems can make it difficult to see intersecting challenges, so the map provides a unique lens to understand DC’s housing, health, and climate conditions. It came out of over a decade of work by IMPACT DC and Children’s Law Center to address childhood asthma in DC through clinical care, family education, and legal advocacy.

To visualize the intersection between housing characteristics and health outcomes, we excerpted a key part of the Healthy Housing Map’s underlying data (visits to emergency departments by children living in properties with asthma triggers) and mapped it against three characteristics of the housing stock (housing quality, affordability, and energy cost burden).

The number of kids with asthma living at properties with respiratory triggers such as pests, mold, and HVAC hazards is highly correlated with more-affordable, lower-quality housing stock and higher energy burden. It underscores the urgent need for cross-sector solutions like the DC HGA Housing model.

Turning data into action through energy retrofits

Retrofits hold promise to address these overlapping challenges. Research shows energy retrofits in multifamily buildings can cut tenant utility bills by an average of 22 percent (PDF). Property-wide retrofits can also alleviate issues like mold, pests, and poor ventilation, while upgrading energy systems (PDF).

Equipped with years of experience working with DC tenants and data showing the intersections of asthma and housing problems, NHT and its partners are retrofitting six multifamily properties in DC to improve health outcomes and energy efficiency in more than 700 affordable homes. Though renters and low-income multifamily residents have some of the highest rates of utility burden (PDF), multifamily rental properties have been historically underserved by energy efficiency programs (PDF). But unlike many efficiency programs that focus narrowly on cost savings, the DC HGA Housing initiative integrates health, affordability, and energy efficiency into retrofit design.

To ensure DC HGA targets households with the most need, NHT partnered with VEIC, which implements energy audits and technical assistance. Concerned with affordability, health, and energy efficiency, NHT and VEIC developed audit protocols to assess both healthy housing conditions and energy systems at every property. “We separated out resident and owner [energy] cost impacts, which isn’t standard in multifamily audits,” explained VEIC’s program lead, Becky Schaaf. “We also included participation agreements that residents would not face extra costs. That ensures upgrades save energy and improve health without putting families at risk of displacement.”

Together, these safeguards show how retrofits and similar interventions can translate into real benefits for families: lower bills, healthier air, and greater housing stability. But achieving those benefits requires resident buy-in.

Building trust with owners and residents

A large-scale retrofit program can be most effective when both owners and residents (PDF) are on board. After identifying properties where retrofits were likely to have the greatest cobenefits, NHT and VEIC worked together to find property owners willing to partner to resolve their buildings’ energy and indoor air quality issues.

For tenants who have historically faced unresponsive or harmful property managers, skepticism can run deep. To minimize overpromising or false expectations, NHT partners with LEDC to secure buy-in from building owners before initiating outreach and engagement with the residents, to understand their priorities and concerns regarding these kinds of upgrades.

With decades of experience in the community, LEDC provides translation services, hosts tenant meetings, and trains resident leaders as paid community liaisons. As LEDC’s Sofia Darsin explained: “We’ve been in the community for nearly 35 years, and people know we’ll show up. Live demos, bilingual staff, and resident leaders make a huge difference—it’s not something imposed on residents; it’s something they help shape.”

Legal partners are important in strengthening protections for families. “Legal advocacy brings a different kind of power to the table,” said Kathy Zeisel of Children’s Law Center. For families and residents whose health suffers because of poor housing conditions, legal support for code enforcement can be essential—and it can also be a key factor in bringing a landlord to the table. As Zeisel explained, “By combining health, housing, and legal expertise, we can make sure retrofits improve stability.”

Engaging landlords and residents early helps minimize the program’s disruption to residents’ lives and maximize cobenefits by building knowledge and excitement around the new upgrades through resident engagement. A significant benefit, Zeisel says, is “that everybody—the owners, the tenants, everybody—is moving in the same direction together collaboratively.” Tenants are empowered to shape the process and property owners see upgrades as investments in building longevity.

Addressing overlapping problems with cross-sector solutions

This cross-sector approach—using data to target interventions, centering residents, and engaging property owners—positions the DC HGA Housing program as a national model.

NHT and its partners are showing how creative coalitions can keep progress moving. Darsin reflected, “[Cross-sector collaboration] ensures that the community and the clients get the best of what each organization provides. And DC has so many different nonprofits and providers that if we work together, and we all do what we’re best at, we can have way more impact than working separately.”

By combining federal funds, local government support, and philanthropic investment, the program reduces reliance on any single source, improves population health, and ensures not just long-term affordability for residents but also cost savings for property owners and cities.

As NHT’s Leslie Zarker reflected: “What makes this work is that we’re not treating health, housing, and climate as separate problems. We’re solving them together, with residents leading the way. That’s the only way this becomes sustainable and scalable.”

The Healthy Housing Map and the DC HGA Housing program show how aligning housing, health, and climate goals can:

• target limited resources to properties whose residents are most vulnerable to converging harms,
• engage residents and owners at the outset as true partners, not afterthoughts,
• build practitioners’ advocacy power across sectors, and
• deliver lasting cobenefits: healthier homes, lower utility costs, and energy efficiency.

At a time when families face rising rents, worsening energy burdens, and persistent health inequities, the DC HGA Housing program offers a blueprint. By showing, not just telling, how burdens overlap, the Healthy Housing Map points the way toward interventions that multiply benefits for residents and communities.