Home Improvement Loans and Grants

Interventions Addressing the Social Determinants of Health

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What are home improvement loans and grant interventions?

Home improvement loan and grant programs provide funding for low-income families to repair their homes, make improvements, and remove health and safety hazards.[1] These programs can be one part of a broader home or housing improvement initiative or focused on specific issues such as heating and insulation, lead, or mold.[1] The purpose of the intervention is to enable low-income homeowners to improve the safety and habitability of their homes.

These home improvement loan and grant programs can be implemented at the local, state, or federal levels.[1] Examples of states using these types of programs include Maryland and Minnesota. Maryland’s Department of Housing and Community Development administers the EmPOWER Low Income Energy Efficiency Program, which assists low-income homeowners in making household improvements that reduce energy use and may improve air quality.[2] Minnesota’s Housing Finance Agency administers a Rehabilitation Loan/Emergency and Accessibility Loan Program with the stated purpose of “assisting low-income homeowners in financing basic home improvements that directly affect the safety, habitability, energy efficiency, or accessibility of their homes.”[3] Federal programs that facilitate the provision of loans or grants to homeowners for repairs and improvements include the U.S. Department of Agriculture’s Single Family Housing Repair Loans & Grants program[4], and the U.S. Department of Housing and Urban Development’s Rehabilitation Mortgage Insurance program.[5]

A group of illustrations of lungs, a doctor with a stethoscope, a dog, a dustmite, an inhaler, a building, a breathing machine (nebulizer), a nose with mucous dripping out of one nostril, a person coughing into their hand

CDC’s EXHALE package features evidence-based strategies to improve asthma control and reduce healthcare costs, including policy information about home weatherization assistance programs.

What is the public health issue?

Many internal housing conditions, such as temperature, dampness, the presence of lead paint, and other safety hazards, can influence health.[6, 7] Lower income families are at a higher risk for living in unhealthy housing conditions.[7] The Environmental Protection Agency found that Americans spend on average 87 percent of their time indoors, almost 69 percent of which is in a residence.[8] Evidence shows that one primary health outcome associated with housing is respiratory health.[9] Cold and damp conditions within the home may lead to or worsen respiratory health issues. [6, 9] In 2004, the Institute of Medicine (IOM) found that there was sufficient evidence to link indoor exposure to mold with upper respiratory tract symptoms, coughing, and wheezing in otherwise healthy people; with asthma symptoms in people with asthma; and with hypersensitivity pneumonitis in individuals susceptible to that immune-mediated condition. The IOM also found suggestive evidence linking indoor mold exposure and respiratory illness in otherwise healthy children.[10]

What is the evidence of health impact and cost effectiveness?

Home improvements that address warmth and energy efficiency, such as weatherization to improve insulation, air quality, and dampness, have been most strongly associated with health benefits, particularly where household members suffer from existing chronic respiratory disease.[11] Multiple systematic reviews and studies examining the evidence for the impact of home improvement interventions on health found

  • Improvement in general health status [11-15]
  • Improvement in respiratory health[11, 12, 14, 15]
  • Improvement in mental health[11, 14]
  • Reduction in visits to general practitioners.[15]

A randomized control trial also found that improvements to insulation led to warmer, drier homes and were associated with reductions in self-reported wheezing and visits to a doctor, as well as reductions in school and work absenteeism among children and adults.[15] An analysis of the costs and benefits associated with that trial estimated the overall benefits from improvements to health and energy efficiency to be one and a half to two times the magnitude of the costs of installing insulation in the homes.[13, 16]

  1. Robert Wood Johnson Foundation, University of Wisconsin Population Health Institute. County health rankings & roadmaps: housing rehabilitation loan & grant programs. 2015. Available from: Housing rehabilitation loan & grant programs. Accessed 2015 Nov 30.
  2. Maryland Department of Housing and Community Development. EmPOWER Maryland Low Income Energy Efficiency Program. 2016. Available from: EmPOWER Maryland Low Income Energy Efficiency Program. Accessed 2016 Jun 14.
  3. Minnesota Housing Finance Agency. Rehabilitation Loan/Emergency and Accessibility Loan Program. 2016. Available from: Rehabilitation Loan/Emergency and Accessibility Loan Program. Accessed 2016 Jun 14.
  4. U.S. Department of Agriculture. Rural development. Single family housing repair loans & grants 2016. Available from: Single Family Housing Repair Loans & Grants. Accessed 2016 Jun 14.
  5. U.S. Department of Housing and Urban Development. 203(k) rehabilitation mortgage insurance. 2016. Available from: 203(k) Rehabilitation Mortgage Insurance. Accessed 2016 Jun 14.
  6. Gibson M, Petticrew M, Bambra C, Sowden AJ, Wright KE, Whitehead M.  Housing and health inequalities: a synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health & Place 2011; 17(1):175–84.
  7. Pollack C, Egerter S, Sadegh-Mobari T, Dekker M, Braveman P. Where we live matters for our health: the links between housing and health. In: Issue Brief 2: Housing and Health. Princeton (NJ): Robert Wood Johnson Foundation, Commission to Build a Healthier America; 2008.
  8. Klepeis NE, Nelson WC, Ott WR, et al. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants. J Expo Anal Environ Epidemiol 2001;11(3):231–52.
  9. Shaw M. Housing and public health. Annu Rev Public Health 2004;25:397–418.
  10. Institute of Medicine. Damp indoor spaces and health. Washington, DC: The National Academies Press; 2004.
  11. Thomson H, Thomas S. Developing empirically supported theories of change for housing investment and health. Soc Sci Med 2015;124:205–14.
  12. Breysse J, Jacobs DE, Weber W, et al. Health outcomes and green renovation of affordable housing. Public Health Rep 2011;126(Suppl 1):64–75.
  13. Jacobs DE, Breysse J, Dixon SL, et al. Health and housing outcomes from green renovation of low-income housing in Washington, DC. J Environ Health 2014;76(7):8–16, 60.
  14. Thomson H, Thomas S, Sellstrom E, Petticrew M. The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 2007. Am J Public Health 2009;99(S3):S681–92.
  15. Howden-Chapman P, Matheson A, Crane J, et al. Effect of insulating existing houses on health inequality: cluster randomised study in the community. BMJ 2007;334(7591):460.
  16. Chapman R, Howden-Chapman P, VIggers H, O’Dea D, Kennedy M. Retrofitting houses with insulation: a cost-benefit analysis of a randomised community trial. J Epidemiol Community Health 2009;63(4):271–7.