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Research has long established important connections between housing and health, operating through at least four pathways: housing stability, housing quality and safety, neighborhood characteristics, and affordability. Recent housing research and debates have increasingly emphasized the effect of zoning and land use regulations on (primarily) the latter two pathways. This brief summarizes the role that low-density residential zoning might play in health outcomes and health equity, given the plausible effects that local land use decisions have on housing affordability, segregation, and disparities in the neighborhood environment.
Zoning In The US
A city’s zoning rules specify what can be built where, and zoning’s modern form has roots in public health justifications. The Supreme Court’s 1926 Euclid v Ambler decision cemented the state’s powers to mandate land uses for the promotion of “health, safety, morals, and the general welfare.” Many zoning codes explicitly address health concerns by separating noxious activities from residential areas, and others establish safety standards for buildings of all types. However, the focus of this brief is on low-density residential zoning ordinances—regulations that make it more difficult and costly to build multifamily housing.
In the US, as in other wealthy and Western countries, virtually all municipal space is governed by zoning codes. Where the US differs is in the large share of residential space in which only single-family homes can be built. Even in undoubtedly urban environments such as Los Angeles, California, and Seattle, Washington, only detached single-family homes are allowed on 75 and 81 percent of all residential land, respectively. Further, cities add other density limits, including minimum lot sizes and parking minimums. Although such rules are often intended to address legitimate concerns that arise from unwanted density, such as traffic and environmental harms, the effect is often to artificially raise the cost of housing for everyone by limiting housing supply, as well as to exclude people who cannot afford to buy single-family homes on large lots.
Zoning’s Effects On Segregation And Housing Affordability
That low-density zoning has an exclusionary purpose is evident from both historical inspection and contemporary analysis. Zoning restrictions proliferated in the first half of the twentieth century, when Black Americans (primarily) had both a growing desire and increasing means to move into previously White spaces and racial zoning had become unconstitutional. Cities became much more eager to adopt zoning ordinances that preserved all-White neighborhoods, first in the South but increasingly in the North as Blacks moved to northern cities during the Great Migration. The racist and classist origins of the first comprehensive zoning code in the US—created in New York City—have been well documented. A retrospective study of the early zoning code in Chicago, Illinois, shows that density was readily permitted in Black areas and not allowed in White ones.
Contemporary research validates the notion that zoning can exacerbate segregation by income and race. Although data on these regulations are not plentiful, more data of this type are being amassed now than ever before. In an early example, Rolf Pendall tested whether land use regulations caused what he termed a “chain of exclusion.” The concept is illustrated in exhibit 1. In the first link of the chain, land use controls reduce housing growth; in the second link, these controls reduce the share of an area’s multifamily housing stock, resulting in a reduction in rental units in the third link; in the fourth link, this is correlated with a reduction in affordability; and in the fifth and last link, this reduces the minority population, labeled “racial exclusion” in the exhibit. Empirical work using Pendall’s land use surveys and similar data sources finds that low-density zoning and other measures of land use stringency increase segregation by race and by income.
EXHIBIT 1 The chain of exclusion
Sources R. Pendall. Local land use regulation and the chain of exclusion. J Am Planning Assoc. 2000;66(2):125–42. Used with permission.
In some communities, segregation through the zoning code likely reflects local preferences for exclusivity and the maintenance of property values and the existing social hierarchy. However, zoning codes do not tend to change quickly and may frequently be out of date with the local population’s preferences as they evolve.
Research also confirms that low-density zoning makes housing more expensive. Although it is challenging to establish causal relationships, mounting empirical evidence supports the economic theory that lower housing supply leads to elevated prices. Much of this research has been conducted in Massachusetts and California because of data availability, but national surveys of land use regulations have helped make a broader case. Research in England has further validated these results.
Housing Affordability, Location, And Health
It is clear that low-density zoning makes housing more expensive and exacerbates segregation. These two outcomes are key to the connections between housing and health. Unsafe housing conditions, housing insecurity, and homelessness are acute circumstances that undoubtedly make health outcomes worse. Highly restrictive zoning can contribute to these acute conditions by making housing more scarce; more commonly, restrictions on housing production contribute to higher housing cost burdens and financial stress, which have been found to affect a range of health outcomes.
There is also a robust connection between housing location and health. Low-density zoning in particular prohibits multifamily housing and prevents the households who seek it from moving into single-family zoned areas. These are often the safest and healthiest neighborhoods in urban areas and also feature the highest-performing schools, most plentiful jobs, most accessible park space, best proximity to medical services, and least proximity to environmental hazards. The connection between neighborhoods and health has often been studied, and strong effects are often found. In the most widely cited experiment on neighborhood effects—the Moving to Opportunity demonstration—some of the most robust effects of leaving higher-poverty neighborhoods were on physical and mental health.
Health And The Built Environment
Urban planning researchers have focused extensively on how the built environment influences travel behavior. In the US, this behavior is dominated by auto travel. Accordingly, scholars study how to make walking and bicycling more viable alternatives, which should positively affect overall health as a result of increased physical activity. Ann Forsyth and Kevin Krizek summarize the evidence on promoting bicycling and walking and conclude that the US built environment is ill-equipped to support healthy travel behavior (that is, without automobiles) in several ways, including the low residential density of most urban spaces.
There is also an extensive literature on “food deserts” that contends that racially segregated neighborhoods suffer from both a scarcity of healthy food options and an overabundance of unhealthy services such as liquor stores and fast food. Scholars are not unanimous, however, that healthy food options are consistently less available in lower-income or racially segregated areas, nor is it clear whether spatial access to food options significantly affects food intake.
Each of these physical features of the built environment—transportation and urban form and retail food and service location—connects to zoning and land use. Zoning interacts with commercial retail demand to either constrain or expand the consumption options within a close radius of high- and low-income residential areas. Zoning has even been used to restrict new fast food establishments in low-income, racially segregated areas. But low-density residential zoning further affects both the viability of alternatives to the automobile and the likelihood that low-income people will live in areas with unhealthy food options. The latter follows from low-income households being excluded from higher-income areas, leaving them stuck in food deserts. For the former, low-density zoning limits feasible ridership for transit, making it cost-inefficient to build such transit. When zoning restricts density and density restricts alternatives to the automobile, physical activity and health likely suffer.
Further, alternatives to driving are clearly necessary to avoid the worst climate change projections, and the health effects of a warming planet are potentially dire. In California, density restrictions along the temperate coast are maligned for having a more immediate health effect: pushing housing development into desert communities where summer temperatures frequently reach unhealthy levels or where wildfire risk may be dangerously high. In other areas of the country, density restrictions in urban areas may push development into floodplains that are increasingly at risk for extreme weather events.
Zoning And Health Equity
There is little research on the direct connections between zoning and health equity, although at least two articles tackle these connections head on. Lauren Rossen and Keshia Pollack summarize research on the effects of zoning, segregation, and the built environment on myriad chronic health conditions and disparities. They emphasize how outdated zoning policies have failed to adapt to growing threats to public health, such as physical inactivity and obesity, and highlight the role of zoning in perpetuating segregation by income and race. They also discuss zoning’s role in the inequitable spatial distribution of both undesirable and desired land uses. Although they advocate for land use that chips away at segregation and redistributes resources and opportunities so that people of color and low-income households can have access to them, they do not discuss the ways that restrictions on density exclude these populations from those very resources.
Juliana Maantay focuses on noxious land uses, but her analysis of rezoning industrial uses in New York City has implications for upzoning—increasing allowable density and permitting more multifamily housing to be built. Maantay finds that neighborhoods with a higher share of minorities, lower incomes, and lower homeownership rates are more likely to be reclassified to allow for industrial activity. This affirms research in the housing and planning literatures that finds that upzoning tends to occur less frequently in neighborhoods with higher homeownership rates and higher shares of White residents, whereas downzoning (reductions in the allowed residential density) is more likely to occur in these higher-resourced neighborhoods. This has important implications for health equity, given concerns that increased density through upzoning may not be universally beneficial in low-income neighborhoods and communities of color.
Policy Interventions
With growing populations, environmental concerns over urban sprawl, and the health and health equity impacts resulting from segregation and expensive housing, it is clear that more cities need to allow more housing in more places. The most direct way to reduce segregation and make higher-resourced areas more accessible to lower-income households would be to upzone those areas and provide more generous housing subsidies to people with low incomes. But there is still much that we do not know. Specifically, it is unclear how precisely to upzone to spur new construction swiftly, how accessible new multifamily housing would be to lower-income households, and how to make these changes in a political system favoring the interests of those who stand athwart development. Unfortunately, it is difficult to study the effects of upzoning when it does not often happen, and difficult to make it happen when we do not have many opportunities to study it.
Changes are happening that should facilitate more research on these questions. In 2019 Minneapolis eliminated single-family zoning. Early analysis suggests that this has not been enough to promote rapid housing production, and we do not yet know whether such housing production will have broad benefits to those living in segregated neighborhoods. Oregon; Sacramento, California; and Berkeley, California, have all recently scrubbed single-family zones from their land use maps. In California, Senate Bill 9 was just signed by the governor, expediting the splitting of lots and single-family homes into duplexes. Scholars interested in health equity should find ways to study the potential health effects resulting from these changes.
These recent changes suggest that the policy pendulum is shifting in some places, but communities of color remain concerned that upzoning is more likely to push them out of their neighborhoods than benefit them through housing abundance in higher-
resourced areas (to which only some wish to move). This is particularly relevant, given that many of the political pathways to upzoning involve state preemption of more restrictive local land use policy, such as in Oregon and as proposed in California. These upzonings either effectively eliminate single-family zoning altogether, regardless of neighborhood income or racial characteristics (Oregon and California), or propose to upzone near transit and jobs (California). Such changes are derided as “blanket upzonings” that may cover relatively disadvantaged communities as well as more affluent ones—leading, detractors argue, to rapid investment and displacement. Research is limited on where development is likely to be targeted when entire metropolitan areas are upzoned, although again, these upzonings offer promising avenues for learning more. Recent studies of the effects of housing production on rents do offer promise that such upzonings would reduce, not increase, existing rents. It is not the case, however, that one can apply this small body of research to every neighborhood considering an upzoning. The equitable solution for health and other outcomes is to upzone higher-resourced neighborhoods. However, as noted in the prior section, these neighborhoods tend to be the most tenacious and successful in resisting upzoning and housing density. Research should also focus on ways to overcome these power imbalances through participatory planning and other community-
based strategies.
Although zoning is the focus of this brief, zoning reform alone cannot fix disparities in housing or health. The US combines exclusionary, low-density zoning tendencies with housing subsidy programs that do not cover nearly all of the nation’s poor and under which the subsidies provided are often too small to allow recipients to afford housing in a diversity of places. Extensive research has shown the potential for housing subsidy policy to provide opportunities for low-income, typically non-White families to move to lower-poverty neighborhoods and improve their mental and physical health. More widely available subsidies such as housing vouchers are complementary to zoning reform, given that they are easier to use when housing is more plentiful and affordable housing production is cheaper when zoning is more permissible. Inclusionary zoning, where new housing developments are required to set aside a portion of units for households below specified income thresholds, is another way to provide access to higher-
income neighborhoods. But these units can only be plentiful when the regulatory environment allows a lot of new housing.
Zoning reform is also unlikely to immediately address health conditions on a broad scale. Even if zoning reform can help facilitate access to healthier, higher-opportunity neighborhoods for lower-income families, there are several steps embedded in that process that take time. Planning is an intentionally slow and deliberative process, and any resulting housing production takes years—and in slower-growing metropolitan areas, these changes can take decades. The timeline is similarly slow to produce changes to the built environment that allow for active transportation, fewer cars, and cleaner air.
The connections between housing and health are well established. Precarious and unsafe housing conditions are toxic to health, but broader affordability problems are accelerating in US cities and likely also affect health. These problems interact with disparities in neighborhood health and segregation. Housing scholars have known for a long time that land use regulations make housing more expensive and contribute to segregation. The downstream effects of exclusionary land use regulations on health should make scholars and policy makers pay more attention to reforming zoning and expanding housing subsidy programs to make housing more plentiful and affordable.
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Low-Density Zoning, Health, And Health Equity - Health Affairs
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