Reference no: EM133633867

Homework: V-Population Health

Case Study: Increased Carbon Monoxide Levels in a Public Housing Community

Situation

McDougald Terrance is one of 14 public housing properties owned and maintained by the Durham Housing Authority (DHA) in Durham, North Carolina. Built in 1954, McDougald Terrace was heralded as the city's first "Black project." In 2019, McDougald Terrace had 360 units occupied primarily by African American, female-headed families (DHA, 2021).

In 2018 and 2019, McDougald Terrace did not pass U.S. Department of Housing and Urban Development (HUD) health and safety inspections due to numerous noted deficiencies (Bridges, 2020). In late December 2019, Emergency Management Services (EMS) discovered an unusual cluster of carbon monoxide (CO) calls and developed a task force (Bridges, 2020). DHA launched an immediate response in an effort to protect their residents and ordered a full inspection of the property. Over 3 days, 296 apartments were inspected, and occupants' CO levels were assessed (Bridges, 2020). Several adults and children had elevated CO levels, and some apartments had stoves and water heaters emitting higher-than-expected CO levels. After the inspections were completed, another call for unusual levels of CO prompted a voluntary evacuation of the property. Within the ensuing weeks, 270 families relocated to local hotels to allow property repairs (Bridges, 2020). Ultimately, an inspection of 346 units revealed 211 stoves, 38 furnaces, and 35 hot water heaters emitting high CO levels (Bridges, 2020). Appliances emitting high CO levels were repaired or replaced, and the original ventilation system was replaced to properly vent the gas appliances.

Background

The U.S. Housing Act of 1937 established government-funded permanent public housing under the U.S. Department of Housing and Urban Development (HUD, n.d.). The intent was to provide affordable and safe rental housing to eligible low-income families, older adults, and persons with disabilities. African Americans make up less than 15% of the population of the United States (U.S. Census Bureau, 2019) but account for 44% of people living in public housing (HUD, n.d.) in the United States. Public housing residents pay income-based rent, which is generally 30% of all adults' combined earnings or $25 to $50 per month for households where no adults earn wages (HUD, n.d.).

Over the years, a manifestation of structural racism and disinvestment in public housing has resulted in a $26 billion backlog of deferred maintenance to housing units across the nation (HUD, n.d.). The rental assistance demonstration (RAD) program is a policy solution that allows for private investment in public housing. RAD is being implemented in cities across the United States. Through RAD, private monies will help to offset critical public housing capital needs, which are estimated at over $70 billion nationwide (Schwartz & McClure, 2021).

Findings

The CO emergent situation at the McDougald Terrace apartments and the displacement of families into hotels, in some cases for up to 4 months, caused significant life disruptions. Regular routes for transportation and communication changed abruptly. A special bus route was established to provide transportation to school but resulted in children being ostracized and bullied. Many hotels had no cooking facilities, and families had to eat take-out, prepared, and processed foods for all meals. Residents feared for their families' health and safety and the security of their personal belongings, which remained in their apartments during renovation. The situation created an increased distrust of DHA and local government among some public housing residents. The McDougald Terrace property renovations, hotel room rentals, and necessities for the 270 displaced families cost millions. These monies were from the DHA budget intended to provide maintenance and upkeep to all their public and affordable housing properties.

Conclusions

Structural racism has resulted in disinvestment in public housing nationwide, jeopardizing the health and well-being of low-income families, older adults, and disabled persons. In Durham, substandard public housing caused the displacement of 270 families and more than 1,000 individuals and resulted in major life disruptions and stress. Public housing properties across the United States are undergoing RAD conversion and are receiving renovations, resulting in improved health outcomes.

Task

Question I. What implications for practice, research, and advocacy work stand out in this case study? Consider the following:

A. Zoning laws governing housing,
B. Green spaces and recreational sites,
C. Neighborhood placement and affordability,
D. Transportation,
E. Access to nutritious food, and
F. Access to healthcare.

Question II. In what ways does this case study illustrate inequity? Discuss the following:

A. Systemic racism/redlining, and
B. Social determinants/drivers of health.

Question III. Discuss the components of environmental risk assessments that you would focus on when assessing individuals living in public housing.

Question IV. How does housing insecurity affect the health and well-being of individuals, families, and communities?

Question V. Discuss the psychosocial consequences of environmental hazards, including:

A. structural violence,
B. toxic stress, and
C. social isolation.