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San Francisco Public Housing Redevelopment a Health Impact

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San Francisco Public Housing Redevelopment a Health Impact HOPE VI to HOPE SF San Francisco Public Housing Redevelopment A Health Impact Assessment November 2009 Suggested citation UC Berkeley Health Impact Group (UCBHIG), HOPE VI to HOPE SF, San Francisco Public Housing Redevelopment: A Health Impact Assessment, University of California, Berkeley, CA, November 2009. Authors Edmund Seto, Carol Chao, LeConté Dill, Kim Gilhuly, Caitlin Kontgis, Jerusha Breslar, Maya Negev Corresponding Author Edmund Seto [email protected] Acknowledgements We thank the participation of residents of Bernal Dwellings and North Beach Place, our advice and guidance from our partners at Mission Neighborhood Community Center and Telegraph Hill Neighborhood Center, and the facilitation of the HIA from Human Impact Partners. We are greatly appreciative of the collaboration and participation of the San Francisco Department of Health in this assessment, particularly Dr. Rajiv Bhatia, who is a Co-Principal Investigator on the grant, and his team, who have helped connect this work to that of the Department of Children, Youth and Their Families, as well as other community partners, and provide helpful input and feedback on the scope of the study and its survey instrument, review and dissemination of our findings. This work was funded in part by a grant from the US Centers for Disease Control and Prevention. Cover photo Edmund Seto i Contents Executive Summary Introduction Current Health and Neighborhood Conditions Healthy Housing and Environmental Health Displacement Social Cohesion Crime and Safety Youth Programs and Services Healthy Eating and Active Living Appendices ii Executive Summary Affordable quality housing is an important determinant of health. Homes provide shelter, safety, and a place to rest, belong, and to be with family and friends. Our lives are centered on our home and neighborhood. Poor housing is associated with poor health. Substandard and poorly maintained housing is associated with injury, poor mental health, toxic exposures, and chronic disease. It is often easy to see the tell-tale signs of poor housing, such as overcrowding, insect and rodent infestation, mold, and the presence of old peeling lead-based paint. Other aspects of unhealthy housing are not so easily seen, but are still very much felt. Fear of crime and violence in and around one’s home, stress of not being able to make housing payments, and the feeling of being socially isolated from one’s community are all unhealthy. Housing quality depends on neighborhood quality. A neighborhood can impact health through the availability of goods, services, transportation options, and opportunities for exercise and a healthy diet. Environmental hazards in the neighborhood can also What is HOPE VI? have an adverse impact on health. Housing Opportunities for People Everywhere, or The Public Housing Authority in San Francisco (SFHA) serves an HOPE VI, was a federal important role in improving health of the city’s residents by Housing and Urban providing access to affordable housing to low income families, the Development initiative introduced in 1993 aimed at elderly, and persons with disabilities. Through federal HOPE VI addressing a large funding, SFHA has redeveloped five seriously distressed housing inventory of severely sites over the past 12 years. Although HOPE VI funds have largely distressed public housing dried up, the SFHA is embarking on a new chapter of public housing units in the U.S. The program attempted to redevelopment. A new HOPE SF process aims to redevelop other fundamentally transform distressed public housing sites, increasing affordable housing and public housing by both ownership opportunities, and improve the health of existing public physically revitalizing properties and also housing residents and the neighboring communities. changing the character of low-income housing To inform the new HOPE SF redevelopment process, we have communities and services, conducted a Health Impact Assessment (HIA) of public housing through changes in housing design, management, and redevelopment in San Francisco. Our goal was to explore both the community services. The positive and negative impacts of past HOPE VI redevelopment at HOPE VI program helped two sites, Bernal Dwellings and North Beach Place, to understand fund five public housing revitalization projects in their current health needs, while at the same time identifying San Francisco. opportunities to improve health in the HOPE SF redevelopment process. ES-1 HOPE VI to HOPE SF HIA UCBHIG What is Health Impact Assessment? Our HIA analysis consisted of a review of the Health Impact Assessment (HIA) is a process literature on public housing and health, conducting used to evaluate the potential effects of a surveys and interviews with housing residents, policy or development plan on the health of a management, and key individuals in the population. The goal of a HIA is to inform redevelopment process, and mapping decision-making through the systematic consideration of health. neighborhood-level data for the two housing sites. An HIA tries to consider the best available Based on guidance from public housing residents our evidence for decision making, which may assessment considered the following topics: come from stakeholders, the scientific literature, and quantitative and qualitative analyses of primary and secondary data. • Healthy Housing and Environmental Health • Displacement The steps of an HIA include: • Screening • Public Participation and Social Cohesion • Scoping • Youth Programs and Services • Assessment • Healthy Eating and Active Living • Reporting • Crime and Safety • Monitoring & Evaluation Our findings of HOPE VI redevelopment indicate that: Healthy Housing and Environmental Health • Housing conditions improved, exposures to environmental hazards were reduced, and satisfaction with public housing improved. • Despite these improvements, there remain ongoing challenges to housing maintenance that affect health, which need to be addressed by housing management. • The state of health of current public housing residents is poor. There remain high rates of chronic diseases such as asthma, and chronic health conditions such as overweight and obesity. Stress was very high at both sites surveyed. Cardiovascular risk factors such as high blood pressure and high cholesterol were reported at North Beach Place. 1 out of 6 respondents to our survey reported combinations of 3 or more poor health conditions. Displacement • Many current residents were newly introduced after redevelopment, e.g., a majority of the residents who lived in the housing developments did not return after redevelopment. • During redevelopment, social ties were stressed because families may have been relocated throughout the Bay Area. • Many people may not have been able to return because fewer housing units were available, people had established new lives in other areas, or people did not meet re-entry criteria. ES-2 HOPE VI to HOPE SF HIA UCBHIG Social Cohesion • Both sites analyzed have many potential physical assets for social interaction, most notably the community centers, which provide a variety of programming and services that can bring residents together. • Displacement from redevelopment has negatively impacted social networks. • Redevelopment has been accompanied by an increase in diversity in public housing. Some noted that this has come at the expense of African Americans not being able to return to or get into public housing. Yet, decreasing residential and economic segregation may have health gains potentially by reducing racism, increasing residents capacity to gain resources, and decrease crime. • Resident volunteerism was reportedly very high. However, the lack of an ongoing, well- supported tenant governing body may contribute to stress and to discontent about housing management. Crime and Safety • Crime and safety were priority issues among residents. • Some considerations of safety were made in the HOPE VI redevelopment process, and generally resident survey responses suggest that crime and safety have improved. However, at Bernal there remains fear of gang-related activity on one hand and police harassment on the other. • The on-site community centers serve an important role as safe havens against crime. • At both sites, there was concern that management’s perspective on crime largely focused on eviction, which is a cause of great stress among residents. Youth Programs and Services • On-site community centers exist at both sites, and serve an important role in providing programs and services to youth, promoting social cohesion within the complex, and keeping youth out of trouble. • Programs and services are precieved to have improved with redevelopment. • At North Beach, there is a need for more services, better outreach, and better use of space. Healthy Eating and Active Living • Both sites benefited from redevelopment through the creation of dedicated space for community kitchen and food pantry, though in some cases space for physical activity is limited. • North Beach Place benefited from mixed-use redevelopment that included retail and a grocery store, however suffers from strict management rules that restrict physical activity. • Bernal Dwellings has community center that organizes healthy snacks, but the park across the street is underutilized. ES-3 HOPE VI to HOPE SF HIA UCBHIG “I get the idea of what they were trying to accomplish – mixing different incomes and family types is a good idea. But I would say don’t forget the mission of public housing. Don’t exclude low-income
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