How the twin crises of climate change and poor public housing are harming people’s health

Climate change is an existential problem for human health. As climate change intensifies, the frequency and severity of extreme weather events such as heatwaves, cold fronts, and floods will increase. Undoubtedly, this will result in devastating effects for human health and wellbeing, contributing to increased susceptibility to infectious diseases, an already growing mental health crisis, and, most directly, heat-related mortality.

At the same time, millions of families in the United States already suffer poor health caused or exacerbated by substandard or deteriorating low-income public housing. Adverse outcomes range from household trigger-associated chronic illnesses to obesity to accidents resulting from a lack of safely built housing. Public housing is populated by the elderly, the poor, and the sick — the populations most marginalized and most at-risk for poor health outcomes due to climate change.

Further, public housing is often located in climate-vulnerable areas, which are especially susceptible to extreme weather events. Therefore, although climate change and the affordable housing crisis are often thought of and addressed as separate issues, they are intimately intertwined: increasing extreme weather events compound the poor quality and availability of public housing, placing those facing housing insecurity in the center of two major public health crises.

The city of Miami is one of the most prominent examples of this dual crisis. Sea levels in the coastal city are expected to rise by up to 6 feet by 2100, placing previously desirable seaside real estate at risk and causing an inward migration to neighborhoods previously dominated by public housing projects. Now, high rent prices are driving long-time residents to new buildings, and the cycle continues — the coastline shrinks, and public housing is replaced in favor of cheap, convenient, and climate-insecure new buildings.

The current proposed solutions to the public housing crisis are primarily financial, revolving around increasing the supply of affordable housing through government subsidies and private sector investment. While these efforts have yielded some positive results, the housing crisis persists due to a lack of a unified approach and insufficient funding, among other factors.

As the housing crisis continues, so do the adverse health outcomes that come with it. Overcrowding (leading to increased transmission of infections), poor indoor air quality, lack of access to green spaces (decreasing physical activity), and exposure to pollutants such as lead in soil and paint are just a few examples of how poor housing drives poor health. The growing effects of climate change only exacerbate these issues; solutions, therefore, need to take climate change into account.

Many public housing developments lack key infrastructure to protect residents from the changing and warming climate. For example, low-income individuals and those residing in public housing are less likely to have access to central air conditioning (or any type of AC) due to cost or lack of availability, increasing their risk of heat-related death. Today, about 65,000 people in the U.S. are hospitalized annually for heat-related complications, and there were 658 heat-related deaths per year in the U.S. between 1999-2009. Given that increasing global temperatures in coming years are likely to exacerbate heat-related morbidity and mortality, the lack of access to central AC in much of public housing further increases risk of heat-related mortality among low income and vulnerable populations.

Currently, climate change solutions and public housing solutions are addressed separately. But incorporating sustainable design principles and energy-efficient technology in the construction and renovation of housing units can address both problems at once. ​​The durability of public housing systems is closely linked to their ability to withstand the impacts of climate change, making it increasingly important to prioritize public housing solutions that are both sustainable and climate-proof.

One such solution is green roofing, which not only improves air quality (to the direct benefit of those with respiratory illnesses, for example), but also improves roof durability and helps moderate extreme heat, providing increased water resistance and protecting those most vulnerable from heat extremes.

The Biden administration has reprioritized efforts to combat climate change through a series of consumer rebates and tax credits to promote clean energy in the Build Back Better Act, which Congress passed in 2021. The act also set aside over $170 billion toward affordable housing efforts. Encouragingly, the Inflation Reduction Act, which passed in 2022, granted $1 billion for improving energy and water efficiency in HUD-funded housing.

However, the differential in dollars allocated to affordable housing in general and those toward climate-safe housing highlights the need to reevaluate how we think about public housing. Instead of a rare special program to build affordable, eco-friendly, and lasting public housing, clean and durable construction should be a requisite for federal funding. This shift would make enduring change in America’s public housing structure rather than further supporting a broken system which permits the continued construction of housing that neither protects at-risk individuals from climate disaster nor protects the environment from human destruction.

Crucially, building safe, sustainable, climate-proof housing will help to prevent the housing insecure from becoming homeless. Millions of people are being displaced by climate disasters each year; the World Bank predicts that by 2050, 200 million more will lose their homes because of climate change. The United States’ homelessness epidemic poses problems for public health at large and for the individual health of homeless individuals. Properly addressing the dual crises of climate change and poor public housing will help to ensure that an already dire situation does not get worse.

Arya Rao and Shira Hornstein are second-year students in the Harvard Medical School/Massachusetts Institute of Technology M.D.-Ph.D. Program. Both contributed equally to this article and are co-first authors.