Further Inspection: Leveraging Housing Inspectors and City Data to Improve Public Health in Chelsea, MA

Abstract

Substandard housing represents an important and growing public health problem. It is associated with higher rates of mental illness, chronic and infectious disease, and other negative outcomes. Housing inspectors, by nature of their work inside homes and close contact with residents, are some of the only public officials to witness these risks. Early intervention can reduce public health risks and reduce costs to governments and society. However, current housing inspection focuses on technical enforcement of housing codes rather than broader socioeconomic or health impacts that the codes were originally designed to address. Further, the potential for early intervention is limited because 1) cities are not aware of problems soon enough, as inspection is often reactive or relies on tacit knowledge, and 2) housing inspectors lack systems to respond to the range of public health risks they encounter. In response to these problems, the objective of my DrPH dissertation was to: 1) Develop and implement a social-service referral innovation within a city’s inspectional services department that leverages the unique role of housing inspectors to link at-risk residents with social services, and 2) Develop an approach to using city data to identify and prioritize the response to prevalent housing-related health threats. I carried out this work in Chelsea, Massachusetts, in collaboration with Chelsea City Hall and other City agencies. The goal is that the complex public health risks related to substandard housing are reduced because the City is aware of problems sooner and housing inspectors respond with both enforcement and service provision interventions. I drew from action research methods, a process of systematic inquiry that is collaborative, reflective, and participatory. The result was a sub-contract between City Hall and a local social-service agency to respond to referrals from housing inspectors and intervene early on problems that cannot be resolved through code enforcement alone. Further, through aggregating and analyzing City data, I identified housing-related public health problems and ways to improve efficiency, effectiveness, and equity of code enforcement. In this dissertation, I capture the lessons learned, describe the impact achieved, and lay a conceptual foundation for future inquiry and public health change.