Disclosures: The authors report no relevant financial disclosures.
September 19, 2021
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Adoption of inclusionary zoning policies may improve CV outcomes in low-income households

Disclosures: The authors report no relevant financial disclosures.
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Cities that adopt inclusionary zoning policies benefiting low-income households may improve the municipal-level CV health of their residents, according to research published in Circulation: Cardiovascular Quality and Outcomes.

Researchers reported that individuals living in cities with inclusionary zoning policies had lower BP, lower cholesterol and less prevalent use of BP-lowering medications compared with cities without such policies.

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“Inclusionary zoning programs are designed to combat income and wealth inequality that exists across all U.S. municipalities,” Antwan Jones, PhD, associate professor of sociology, with courtesy appointments in Africana studies and epidemiology, at The George Washington University, and colleagues wrote. “Income inequality has been shown to directly predict poor health at the individual, metropolitan and country levels. Inclusionary zoning policies, which try to overcome this socioeconomic disadvantage in housing, may partially mediate the causal pathway between inequality and health. That is, the growing income inequality in the United States and the proliferation of concentrated poverty in cities has influenced the creation of these affordable housing policies and programs (such as inclusionary zoning policies) across the country.

“In this observational study, we found that these policies, and characteristics associated with those policies, are key factors related to cardiovascular outcomes among the U.S. population,” the researchers wrote.

According to the study, inclusionary zoning policies shift the responsibility of developing affordable housing from the local government to the private sector by mandating or providing benefits to developers such as subsidies in the form of density bonuses, expedited permitting or compensation for the construction of such zones. However, developer benefits are not consistent for all inclusionary zoning policies and may have social and health ramifications, but there is a paucity of research in this area.

CV benefits of inclusionary zoning

Utilizing data from the 500 Cities Project in 2017, the Lincoln Institute for Land Policy survey in 2016 and 2017 and the American Community Survey from 2011 to 2015, researchers evaluated whether the presence of affordable housing benefited residents’ CV health.

Five hundred cities were included in the analysis, of which 70 adopted inclusionary zoning policies.

Researchers observed that CV outcomes and socioeconomic characteristics were uniformly better in cities with inclusionary zoning policies, with lower prevalence of high BP, high cholesterol, BP-lowering medication use, CHD, current smokers, obesity, uninsured residents and poverty (P for all < .001).

Beneficial characteristics of inclusionary zoning policies

The following inclusionary zoning characteristics were associated with better CV outcomes:

  • more money within housing trust funds or produced from inclusionary zoning policies;
  • mandatory inclusionary zoning programs;
  • inclusionary zoning policies focused on the development of rental properties;
  • the option to preserve or rehab housing; and
  • inclusionary zoning policies with greater minimum requirement for the proportion of units allocated for affordable housing.

“Inclusionary zoning policies are poised to address complex health challenges among economically vulnerable populations, particularly if those policies are designed to create equitable, mixed-income communities in metropolitan areas plagued by rising housing costs,” the researchers wrote. “However, the placement of affordable housing units is dependent on state and local regulations, and some states have preempted local governments from enacting inclusionary zoning policies, making this tool unavailable to all local governments. Local governments and health policymakers should consider the findings of this work and create public-private partnerships in an equitable manner across various neighborhoods within their locales so that these socioeconomic and health benefits may be realized.”