Title : Building healthier cities: How zoning, affordable housing, and environmental quality shape population health
Abstract:
Objective: Population health outcomes are fundamentally shaped by the urban environments in which people live and work. This research examines the critical intersection of land-use policy, zoning regulations, affordable housing availability, and environmental quality as upstream social determinants of health. The study investigates how exclusionary zoning practices perpetuate health inequities while inclusionary zoning policies, coupled with environmental quality improvements, can promote equitable health outcomes across diverse populations. By synthesizing legal and spatial epidemiological analyses, this study demonstrates that built environment interventions targeting affordable housing and environmental inequities are essential mechanisms for reducing persistent health disparities in rapidly urbanizing regions.
Methods: This mixed-methods research integrates a comprehensive policy scan utilizing LawAtlas datasets across seven comparable jurisdictions, qualitative semi-structured interviews with 20 local government officials, planners, and stakeholders engaged in housing and community development, and spatial epidemiological analysis examining correlations between demographic characteristics, housing affordability, environmental exposures, and health outcomes. Census tract-level data were analyzed to assess relationships between racial and ethnic composition, housing cost burden, proximity to environmental hazards, and prevalence of chronic diseases including diabetes, hypertension, coronary heart disease, and stroke. We conducted statistical analyses to test whether the relationships among variables reflected theoretical predictions linking housing policy environments to health outcomes, controlling for socioeconomic mediators including income, education, and employment. We extracted data from Centers for Disease Control and Prevention PLACES, U.S. Census Bureau, The Eviction Lab, and interviews.
Results: Our results indicate that restrictive zoning practices, limited affordable housing options, and adverse neighborhood environmental conditions, such as unsafe streets, lack of access to
pedestrian sidewalk, bike lane, green spaces and transit routes, and proximity to environmental hazards, are significant predictors of poor health outcomes. Census tracts with higher proportions of Black and Hispanic residents exhibited substantially elevated rates of cardiometabolic diseases and related risk factors. These disparities were partially mediated by lower levels of educational attainment and household income among heads of households, while environmental risks further compounded inequities in these communities. Collectively, the results illustrate how institutional barriers rooted in land-use policy, educational opportunity, and neighborhood conditions drive racial health disparities. Interviews highlighted the need for more localized and nuanced measures of housing affordability, as well as expanded density and mixed-use development.
Conclusion: Land-use and zoning policies function as powerful yet often underleveraged tools for advancing public health. Our findings highlight the importance of moving beyond siloed planning approaches toward integrated frameworks that link housing policy, education, employment opportunities, environmental quality, transportation, and health systems. Such coordination is particularly critical as communities confront widening socioeconomic and racial inequities. Strengthening access to quality education and economic opportunities, ensuring fair and inclusive land-use practices, expanding mixed-income and mixed-use housing opportunities, and addressing environmental hazards are essential strategies for improving population health. Together, these efforts can help reduce entrenched health inequities, especially in rapidly growing mid-sized urban areas where development pressures and affordability challenges are most acute.
