Housing, Environment, And Living Conditions for Transformed Health (HEALTHe Birmingham)

Abstract Disparities in lung disease and other chronic conditions between poor, mostly Black residents of public housing communities and the general population are profound, leading to an extraordinary human and economic burden. Rooted in structural inequalities, these disparities are exacerbated by the conditions of daily life,

including housing and neighborhood physical (built) and social environment. Together, adverse housing and neighborhood conditions increase disease risk through multiple pathways, including behavioral and biological. Despite compelling evidence of the health effects of neighborhoods, few interventions have examined the

extent to which specific modifications of housing and neighborhood conditions improve health outcomes. The proposed study, Housing, Environment, And Living Conditions for Transformed Health (HEALTHe Birmingham), aims to fill this research gap. Taking advantage of a major investment by federal and local

government, businesses, and organizations, we will evaluate, in a natural experiment, the health effects of a comprehensive intervention that addresses multiple social determinants of health (SDoH): public housing quality and features of the neighborhood built and social environments (Aim 1). Recognizing that major

community revitalization efforts are not always possible, to generate solutions that are potentially more feasible and have wider reach, we also will conduct a prospective trial to determine whether less-expensive improvements, such as indoor air purification, can positively impact lung health in public housing sites not

undergoing housing renovation, comparing a site exposed to industrial pollution vs one less contaminated (Aim 2). To bolster the public health and policy implications of this research, we will conduct cost-effectiveness analyses from economic and societal perspectives and use implementation science to prioritize intervention

strategies, recommend scale-up efforts across communities and contexts, and inform policy on federal and local levels. We also will assess the extent to which specific components impact health equity between intervention and control communities (Aim 3). Study findings will facilitate translation of SDoH interventions

into practice, inform public policy across locations and contexts, and contribute to the evidence base of reducing health inequity through action on SDoH.