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Rural Health Information Hub
Rural Health Information Hub

Housing Quality Approaches

Access to high-quality housing and affordable housing is an important social determinant of health (SDOH). In some rural communities, a lack of quality housing options creates barriers to attracting and retaining a skilled workforce or promoting the ability of older adults to age in place. Substandard housing, including inadequate plumbing, overcrowding, structural issues, and contaminants can also contribute to multiple health risks, for example, developmental and behavioral issues related to lead exposure.

The Housing Assistance Council, a nonprofit organization that invests in housing across rural America, offers a wealth of information about rural housing quality.

Strategies to Promote Housing Quality

Strategies to improve rural housing stock and promote housing quality include making repairs and renovations to existing housing and developing new high-quality housing that replaces dilapidated structures. Housing rehabilitation loan and grant programs that improve housing quality and safety can improve physical and mental health outcomes by removing health and safety hazards.

Improving housing quality often involves:

  • Improving the safety of the home, including installing carbon monoxide detectors and smoke alarms and addressing any electrical hazards, such as exposed wiring.
  • Removing contaminants such as asbestos, peeling and deteriorating lead-based paint, or lead-contaminated soil.
  • Improving the indoor air quality, such as upgrading heating appliances and installing proper ventilation. Rural communities with multi-unit housing may also consider implementing smoke-free policies.
  • Making structural improvements to keep the home warm, dry, and pest-free. Inadequate heating and cooling systems and lack of insulation can affect costs, comfort, and health. Water leaks and moisture can lead to the development of mold and mildew. Cracks and openings to the outdoors can lead to pests, including mice.

Examples of Rural Housing Quality Programs Addressing SDOH

  • The Rural Alaska Community Action Program, Inc. (RurAL CAP) addresses many housing quality and home improvement concerns that affect health and well-being. Programs include weatherization services that prepare rural homes for the winter months, improvement of indoor ventilation systems, and installation of smoke and carbon monoxide detectors. Senior Access and Home Modification programs provide home accessibility measures from wheelchair ramps to grab bars and roll-in showers, making it easier for people experiencing disabilities to enjoy a greater degree of safety and independence.
  • The North Country Rural Preservation Apartments project made renovations to 254 low- to moderate-income rental units in rural New York State. When the project was launched, homes in the region were, on average, 15 years older than the median national housing age. Rehabilitation efforts included installing new roofs, new appliances, and retrofits to accommodate people with disabilities.
  • The Owe'neh Bupingeh Rehabilitation Project restored traditional adobe homes on the Ohkay Owingeh tribal reservation. The project improved dilapidated homes, using naturally-occurring materials for functional home renovations, and preserved sacred structures in the village center.
  • NeighborWorks Umpqua's Self-Help Housing Rehabilitation Program facilitated financing and provided construction coaching to rural Oregonians seeking to repair their homes. The program helped renovate over 70 homes, addressing issues such as damage from termites, leaking roofs, and septic systems.
  • Officials in rural Curry County, Oregon, launched the Housing Stock Upgrade Initiative to understand and address the effects of substandard manufactured housing. County officials and community partners used a Health Impact Assessment (HIA) to measure the potential benefits of upgrading manufactured housing, including decreased rates of asthma exacerbations. A cross-sector coalition is implementing the recommendations of the HIA and helping community members secure loans to improve substandard housing.

Implementation Considerations

Creating stable, quality, and affordable housing for rural residents requires the involvement of many partners. Rural communities may need to involve community development agencies as well as code enforcement, permit, and planning departments to identify comprehensive strategies to address substandard housing.

Some rural communities may not have building code infrastructure or enforcement resources. Building codes are typically designed to regulate housing issues that affect safety concerns, such as structural integrity and fire hazards. In rural communities without building codes or code enforcement, program planners may need to take additional measures to assess the safety and integrity of the local housing stock.

Rural communities can investigate a range of dedicated funding to improve housing quality. The U.S. Department of Agriculture (USDA) Office of Rural Development offers many rural housing loans and grants that can help cover the costs of repairs and structural improvements, such as:

Other federal agencies, such as the U.S. Environmental Protection Agency, offer grant programs that address specific housing issues such as the Lead Renovation, Repair and Painting Program.

Rural communities may also connect to local health departments and healthcare systems to leverage housing-related funding or resources. For example, local agencies may offer programs to mitigate environmental exposures, such as asthma home visiting programs or lead abatement programs. Rural communities may also help new homebuyers prevent quality issues from worsening. The USDA offers loans for home inspections, which can allow prospective homebuyers to identify existing structural or quality issues. The homebuyer can then negotiate costs of repairs during the buying process, which can prevent the need for costly renovations in the future.

For more funding opportunities related to housing, see Funding by Topic: Housing and Homelessness.

Program Clearinghouse Example

Resources to Learn More

Improving Outcomes in Rural & Frontier Communities: Perspectives from Healthy Homes and EPH Experts
Video/Multimedia
Highlights expert perspectives on healthy homes in rural communities. Includes information on funding opportunities, guidance for building partnerships, and public health strategies to overcome housing quality challenges.
Organization(s): National Environmental Health Association
Date: 7/2024

Rural Voices
Journal/Magazine
Includes all past issues of the Housing Assistance Council's Rural Voices quarterly magazine, which describes various considerations for rural housing affordability, quality, financing, and more.
Organization(s): Housing Assistance Council