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Rural Health Information Hub

Housing Quality Approaches

Access to high-quality and affordable housing is a major social determinants 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. Housing is also an important asset for many rural residents, who have higher homeownership rates than their urban counterparts. Preserving housing quality allows rural homeowners to maintain the value of their homes.

Substandard housing, including inadequate plumbing, overcrowding, and structural issues, can also contribute to multiple health risks. For example, water leaks can contribute to the development of mold and other allergens that trigger respiratory issues, including asthma. In addition, exposure to lead can cause serious health issues among young children, including developmental and behavioral issues. Cases of lead poisoning can originate from lead sources in the home, including chipping and peeling of lead-based paint and lead pipes. Older homes, especially those built before 1978, are more likely to contain sources of lead.

Distribution of Substandard Housing

Rural populations face unique housing quality concerns, including a higher likelihood of using heat sources that contribute to poor indoor air quality, such as coal- and wood-burning stoves. In rural America, racial and ethnic minority groups are more likely to live in substandard housing than White residents. For instance, the rate of housing without basic plumbing on rural tribal lands is up to 10 times the average national rate. 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 can 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 have shown evidence of improving physical and mental health outcomes.

Improving housing quality could involve:

  • 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 dry and pest-free. 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 a wide range of 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, 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 and also focused on preserving sacred structures in the village center and used indigenous materials for functional home renovations.
  • 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 caused by 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 for improvements to substandard housing.

Implementation Considerations

Creating stable, quality, and affordable housing for all requires the involvement of many partners. In addition to community development agencies, rural communities may also need to involve 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 opportunities 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 agencies, such as the U.S. Environmental Protection Agency, also 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 focus on helping 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 that need to be addressed. 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 Examples

Resources to Learn More

Best Practices in Healthy Homes and Rural Rehab

Includes guidance from rural housing rehabilitation experts, such as lessons learned and suggestions for rehab strategies.
Author(s): Windham, J.
Organization(s): Housing Compliance Solutions, LLC and NeighborWorks America Rural Task Force
Date: 7/2016

The Healthy Homes Partnership: A Cooperative Extension Model
Highlights outcomes of the Healthy Homes Partnership sponsored by the USDA and the Department of Housing and Urban Development. Describes the role of Cooperative Extension Services in implementing the partnership.
Author(s): Booth, L. & Peek, G.G.
Citation: Journal of Extension, 51(1)
Date: 2/2013

Housing an Aging Rural America: Rural Seniors and Their Homes
Describes the demographics of the aging rural population. Discusses issues of housing quality that particularly affect aging rural residents, including need for renovations to accommodate physical disabilities.
Author(s): Oberdorfer, E. & Wiley, K.
Organization(s): Housing Assistance Council
Date: 10/2014

Rural Alaska Healthy Homes Checklist
Provides a checklist of environmental hazards that could be used to perform a home assessment. Includes considerations for pests, mold, and ventilation, among other environmental risks.
Organization(s): Alaska Native Tribal Health Consortium
Date: 1/2018

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