Maintaining safe and healthy housing
Last Revised: September 30, 2025
Strategy overview
Housing safety and quality impact wellbeing: Housing directly impacts individual health and wellbeing. This occurs through multiple pathways, including housing stability, quality and safety, affordability, and broader neighborhood conditions. This guide is focused on safety and quality, which largely attends to environmental factors in homes, such as structural deficiencies (e.g., fire hazards) and exposure to biological and chemical agents (e.g., lead). For a broader view of how housing can affect health, see the Creating affordable housing and Addressing vacant or abandoned properties strategy guides.
Levers for local government to address housing safety and quality concerns: A safe and healthy home is “dry, clean, safe, ventilated, free of pests and contaminants, well maintained, and thermally comfortable” (for more, see the National Center for Healthy Housing’s resources). Key interventions that local governments can take to improve housing conditions within their jurisdiction include: adopting evidence-based housing and building codes, a proactive code enforcement model, a cooperative compliance enforcement model, and providing financial assistance programs for housing rehabilitation.
Overall, there is strong evidence that healthy home interventions improve individual health and wellbeing. The evidence of effectiveness for comprehensive, whole-home assessments paired with interventions to remediate hazards is strong. The effectiveness of stand-alone interventions varies; however, several strategies (e.g., lead paint abatement) have proven effective as individual interventions. Finally, providing financial support for housing rehabilitation has also shown strong evidence for effectiveness.
A 2024 systematic review identified lead paint abatement programs as a scientifically-supported strategy for reducing lead exposure.
A 2022 systematic review identified housing rehabilitation loan and grant programs as a scientifically-supported strategy for improving housing conditions, health outcomes, and mental health.
A 2022 systematic review identified healthy home environmental assessments as a scientifically-supported strategy for improving health outcomes, reducing hospital utilization, and reducing exposure to allergens.
A 2009 literature review identified multiple evidence-based healthy homes interventions, including moisture intrusion elimination, smoke alarm installation, radon air mitigation, among others.
A 2017 program evaluation in New York State found that visual inspections paired with low-cost healthy home interventions were associated with a statistically significant reduction in the number of hazards in participating homes.
Before making investments in this strategy, city and county leaders should ensure it addresses local needs.
The Urban Institute has developed an indicator framework to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.
The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.
Several indicators in the Upward Mobility Framework may be improved with investments in maintaining safe and healthy housing. To measure these indicators and determine if investments in these interventions could help, examine the following:
Housing stability: Number and share of public-school children who are ever homeless during the school year. These data are collected by local public school districts.
Social capital: Number of membership associations per 10,000 people and the ratio of residents’ Facebook friends with higher socioeconomic status to their Facebook friends with lower socioeconomic status. These data are available from the Census Bureau’s County Business Patterns and Opportunity Insights’ Social Capital Atlas, respectively.
Environmental quality: Examine air quality. These data are available from the Environmental Protection Agency’s Air Quality Index.
Safety from trauma: Number of deaths due to injury per 100,000 people. These data are available from the National Center for Health Statistics’ Mortality File and the CDC’s WONDER database.
Safety from crime: Reported property crimes per 100,000 people and reported violent crimes per 100,000 people. These data are available from the Federal Bureau of Investigations’ Uniform Crime Reporting Program.
Adopt an evidence-based housing code: Housing codes generally address safety and quality standards for existing housing. A comprehensive housing code policy should attend to the full set of ways that housing can impact health, including pests, moisture control, ventilation, and chemical agents, among others. For a code to be effective, experts advise that it should provide detailed standards for these elements to effectively guide property owners and enable enforcement. The National Center for Healthy Housing’s National Healthy Housing Standard provides a model for structuring local housing codes; their Code Comparison Tool can also be used to help jurisdictions understand how their existing code compares to these best practices.
Proactively enforce the housing code: Traditionally, code enforcement has been reactive, relying on reports of violations to trigger investigations. Experts recommend that jurisdictions shift to a proactive model for code enforcement, in which all rental housing is periodically inspected. This approach encourages preventative maintenance and protects vulnerable renters, who may be less likely to submit complaints. Typically, a PRI model requires property owners to register their properties with the jurisdiction in order to receive a certificate of occupancy and rent the property. Then, each rental property is regularly inspected (often every 2-4 years); when resources are limited, jurisdictions may adopt a different inspection regimen, such as inspecting units more frequently when they have a history of code violations or randomizing inspections. For more information on PRI, see ChangeLab Solutions’ Guide to Proactive Rental Inspections and Results for America’s case study on PRI in Syracuse (NY).
Develop a cooperative but strong enforcement strategy: Traditional code enforcement is adversarial – when an inspector finds a violation, they issue the property owner a citation, requiring them to remedy the violation or face a penalty. Experts advise that jurisdictions shift to a cooperative compliance model, which pairs punitive enforcement mechanisms with information, education, and financial resources. Under this approach, housing inspectors aim to collaborate with landlords to bring properties into compliance. If this approach does not resolve the violation, jurisdictions retain punitive enforcement mechanisms. Within the bounds of state law, jurisdictions can generally enforce property code violations through administrative, civil, and criminal procedures (for more, see ChangeLab Solutions’ Up to Code guide). Creating procedures to place a lien on a property can be a particularly effective enforcement mechanism, especially for speculator-owned properties, as it prevents the transfer of the property until the violation is resolved.
Provide financial assistance for health and safety improvements: Jurisdictions can offer financial assistance to support safety modifications and housing rehabilitation and repair. Financial assistance for home safety modifications that prevent injuries (e.g., grab bars) may be structured as grants, low- or no-interest loans, or provided through in-kind labor. These programs are typically available to both renters and homeowners who are low-income and whose households include older adults or individuals with disabilities (for more on this approach, see Local Housing Solutions’ guide). Financial assistance for broader rehabilitation and repair of properties is generally restricted to low-income owner-occupied housing. When resources allow, however, financial assistance can be effective in helping property owners – and small landlords, in particular – in quickly making repairs through a cooperative compliance code enforcement process.
Reduce the likelihood and impact of displacement for renters: Severe health and safety violations can put tenants at risk of displacement if the issues are not remedied quickly. That said, displacement itself is harmful and disproportionately affects vulnerable populations. Providing financial assistance for repair and rehabilitation work can expedite necessary health and safety improvements, particularly for smaller landlords who may have fewer liquid assets. When feasible under state law, local jurisdictions may also make repairs themselves and place a lien on a property for the associated costs. Ultimately, in cases where displacement is necessary due to the danger the property poses to tenants, local governments can also take steps to mitigate the impact, such as by providing relocation assistance. For an example of relocation assistance, see the Los Angeles Housing Department’s resources.
Providing “offramps” as part of the code enforcement process: When code enforcement is conducted without the proper guardrails, it can cause the displacement of low-income households who are unable to maintain their property. To reduce this risk, experts advise that jurisdictions shift to a cooperative compliance model for code enforcement, which pairs punitive enforcement mechanisms with information, education, and financial resources. This approach aims to support willing property owners in addressing code violations before applying punitive measures that may precipitate displacement. Strategies that can help low-income, owner-occupied households address violations include waiving fines and fees associated with violations (see Results for America’s fines and fees reform resource), providing loans and grants for home repairs, investing in “aging in place” programming, among others.
Code enforcement staff: Code enforcement is typically handled by a municipal housing or buildings department. These staff may lead the development – and ultimately the implementation – of housing inspection and code enforcement policies.
Community development staff: In many jurisdictions, community development staff administer grant and/or loan programs for home repair and rehabilitation. The Community Development Block Grant Program, which is often managed by municipal community development staff, is a common funding source for these programs.
Permitting staff: Permitting staff, commonly within a municipal housing or buildings department, issue permits for housing renovations. Coordination between permitting and code enforcement staff can advance healthy housing goals (e.g., ensuring proper cleaning for lead contamination after renovation work).
Municipal or county public health staff: Public health staff may advise on “hotspots” for unsafe housing conditions (e.g., via providing data on blood lead testing) and work to assist vulnerable households. In some cases, safe and healthy housing programming may also be eligible for public health funding streams.
Public Housing Authority: Local PHAs may collaborate with municipal housing inspection staff to limit duplicate inspections for units occupied by Housing Choice Voucher holders. Depending on their condition, PHA housing units may be priority for repair and rehabilitation funding.
Rental property owners: Landlords can provide important feedback on new housing code and inspection policies. Experts generally advise that good working relationships between municipal housing staff and landlords result in greater progress toward safe and healthy housing outcomes.
Residents and tenants: Tenants and homeowners experience housing conditions directly and are an important audience for feedback on new housing code and inspection policies. Strong relationships between tenants and municipal government can also increase the likelihood that tenants will report unsafe housing conditions.
Health practitioners: Pediatricians screen for lead exposure and treat conditions among children and work with local health departments. Community health centers work in underserved areas to address health needs.
Community based organizations: Local government staff may partner with community development, faith-based, tenant advocacy, and other community-based groups to conduct deeper public engagement and better understand community priorities. These groups can also provide external accountability for progress toward housing goals.
Police and fire departments: Housing department staff may build relationships with emergency services personnel to identify structures that may violate housing and building codes.
Elected leaders: Elected officials play a key role in setting healthy housing policies and allocating funding for related programs. Educating these leaders on healthy housing issues can help them better support these efforts.
Communicate with landlords early and often: When a jurisdiction adjusts its housing code or code enforcement practices, experts recommend that local officials proactively communicate to landlords what will be expected of them going forward and what training or other resources may be available to help them meet those expectations. Field research supports this recommendation, finding that earlier and proactive communication to landlords may significantly increase housing code compliance.
Support cross-department and cross-agency collaboration: In most jurisdictions, the responsibility for promoting safe and healthy housing is spread across multiple departments or even across multiple governments. While a municipal building or housing department may oversee inspections, staff from a range of functional areas touch on this work – from permitting to public health to fire. Experts advise that regular coordination meetings between mid- to senior-level staff from relevant departments and agencies can make healthy housing efforts more efficient and effective. For an example of this approach, see ChangeLab Solutions’ case study of Newark’s (NJ) Life Improvement Task Force.
Housing conditions: Data on housing conditions (e.g., via visual inspections) can help jurisdictions identify where housing code violations may be most likely. The Hopkins Housing and Health Collaborative’s Housing Quality Metric provides census tract level data on housing quality.
Public health data: Data on public health outcomes can also help jurisdictions identify where housing conditions may be resulting in negative health outcomes. In communities with older housing stock, blood lead level can be an important metric for tracking change in lead exposure over time. General health outcomes data at the census tract level are available from the CDC’s PLACES platform.
Process measures: Process measures can help local leaders understand how healthy housing programs are functioning and identify ways to improve them. Common metrics to track include: number of inspections, broken down by whether they were initiated from a complaint or through a proactive rental inspection process; number of housing code violations, broken down by severity and by owner/property; and the average time between the issuance of violations and their resolution.
Outcome measures: Outcome measures can help jurisdictions begin to demonstrate the impact of their healthy housing efforts. In addition to public health and housing conditions data, programmatic outcomes data – like the proportion of cases in which a code violation was issued and then brought into compliance within a set timeframe – can help local leaders measure progress.
Resources
Evidence-based examples
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Outcome Area |
This ranking reflects how these approaches are scored in one of the major government- or philanthropy-led clearinghouse resources. For more: https://catalog.results4americ... |
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Professional home inspections evaluating environmental health risks
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Stable and healthy families Supportive neighborhoods Kindergarten readiness |
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Funding in the form of loans and/or grants to income-eligible owner-occupants to assist with repair, rehabilitation, and/or reconstruction of homes
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Stable and healthy families Supportive neighborhoods |
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Programs focused on removing lead-based and contaminated surfaces from homes and other buildings
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Stable and healthy families Supportive neighborhoods Kindergarten readiness |
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Contributors

Albert Algarin
Albert Algarin is the Lead Paint Program Coordinator for the City of Rochester (NY). He is a seasoned public servant, community advocate, and regional leader born and raised in Rochester. Since joining the City in 2003, Albert has built a distinguished career focused on housing safety, public health, and civic engagement.
Albert has served as both a Code Enforcement Officer and Senior Code Enforcement Officer. In the latter role, he surprised inspectors in Rochester's Northeast quadrant. In 2022, he was appointed Program Coordinator of the City’s Lead Paint Program, where he now oversees a team of more than 30 inspectors conducting over 14,000 annual lead inspections.

Larry Brooks
Larry is recognized as a national expert on health and housing, with a strong expertise in code enforcement. Among other leadership roles, Larry is a member of the National Center for Healthy Housing Policy Steering Committee and the California Healthy Housing Coalition Steering Committee.
Larry previously worked in local government for over 30 years in various capacities, including in the Alameda County Healthy Homes Department, Sacramento County Environmental Management Department (Housing Code Enforcement), Sacramento County Community Development Department (Code Enforcement), Yolo County (Code Enforcement), and the Sacramento County Executive’s Office (Budget Analyst).

Henry Fitts
Henry Fitts serves as the Grant Management and Research Coordinator in the City of Rochester’s Department of Neighborhood and Business Development. In this role, he is responsible for the Department’s grant writing, implementation management, and reporting functions.
Previously, Henry held roles in the City of Rochester’s Office of Innovation, first as a Project Manager and then as a Director.