Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
SB 827 (proposed by State Senator Scott Weiner, SF) is an effort to combat low-density zoning (LDZ) in California. The history and inherent inequality of low density zoning is visible in San Francisco today. The redlining map created by the Home Owners Loan Corporation in the 1930s codified racial segregation in the city by preventing black families from obtaining home loans for properties in white neighborhoods. The current zoning map, while not explicitly operating on race, has used low density zoning (LDZ) to protect neighborhoods with higher SES from new construction. If one looks at the racial makeup of the city as well as the zoning patterns, you will see that majority White and Asian neighborhoods, are typically zoned for single family units, not apartments and condos (think Pacific Heights vs. the Mission). The result of this disparate zoning practice is that new housing in SF more often disrupts communities of color. These restrictions also raise the cost of housing because large swaths of the city are zoned for low density, and the supply of housing (and new housing) is limited. The bill being proposed by State Senator Weiner would work to equalize the burden for new construction between wealthier, whiter (low density) neighborhoods and neighborhoods of color by making multi-unit construction in low density neighborhoods more cost-effective and attractive for developers.
So how does this housing policy have important health implications?
The short answer is: in a variety of ways. Reducing the amount of low-density zoning that exists in the city means fighting against housing segregation, displacement, and income inequality in the city. It means creating more housing units throughout the city, increasing affordability, and moving towards a more integrated city. As we’ve discussed in class, one factor that contributes to health disparities is neighborhood SES and segregation. By creating more housing opportunities and more affordable housing opportunities, we could see more diverse communities, racially and socioeconomically. This change could help reduce the number of ‘food deserts’ and low resource areas that exist in SF and the poor health outcomes that are associated with those areas (obesity, diabetes, high blood pressure, etc.)
Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
Assuming this policy were implemented, it would be informative to study it in order to understand the benefits of housing density in an urban area. If we find that one of the benefits of housing density is lower rates of obesity, or diabetes, or high blood pressure in previously vulnerable populations (i.e. communities of color), we will unlock another pressure point that we can use in the fight against these illnesses. It is important that we develop both proximate (individual-based interventions) and distal levers that we can pull to affect changes in health, so studying a policy like SB 827 would be a great opportunity to understand the ‘trickle-down’ effects of housing policy. Furthermore, if there are health benefits in optimizing for ‘dense’ cities (think Paris vs. SF), it is important to understand and use that when arguing against NIMBY-ism (Not In My Backyard).
Specify the outcomes and populations you think most affected or least affected by the policy.
Some of the outcomes that I think would be most affected by this policy would be rates of obesity, diabetes, and high blood pressure in people and communities of color.
Propose a study design to evaluate the policy.
If I were going to study this policy I would want to do as study where I looked at the racial and ethnic makeup of different neighborhoods in San Francisco, and the rates of obesity, diabetes, and hypertension in African-Americans, Latinxs, and Asian’s in the city before and after the policy was implemented. Because this is a rather high-level intervention and it would be necessary to wait for the length of time it takes housing to be built, it would be necessary to look at this from a longitudinal perspective – so perhaps the fifteen years before the policy was passed compared to the fifteen years after the policy was implemented.
Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
The biggest challenge to implementing and drawing inferences about the impact of the policy on health is that the length of time required to study the policy effectively means that there could be significant societal shifts that also play a role in any changes that are seen. For example, future changes to the health care law, and minimum wage could impact the outcomes that I have chosen to look at. It would be important to consider this while designing the study and collecting data.