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Healthy Housing
A Handbook for Portland Property Owners

A number of local efforts have recently shined a spotlight on the relationship between the built environment and the health of low-income Portlanders. Poorly designed housing; a lack of sidewalks and safe crossings; and limited access to recreation, schools, nature, places for social interaction, vital services, preventive medical care, and healthy food all contribute to health challenges that disparately affect low-income residents and communities of color.

Policy Context

The impact of housing on health

While each of us has a personal responsibility to maintain good health, our health is largely influenced by the condition of the environment where we live, work, play and recreate. Research suggests that communities that have a variety of opportunities for families to lead healthy lives experience better health outcomes, and their residents have greater life expectancy.

The social, economic and physical determinants of health play a critical role in predicting population health outcomes. Examples of health determinants include the following:

  • Safe and affordable housing
  • Family-wage employment
  • Active transportation options including public transit and safe pedestrian and bicycle routes
  • Environmental design that integrates public safety and crime prevention features
  • Access to quality education
  • Availability of healthy foods
  • Access to high-quality, affordable health care

Housing is an important determinant of health. Many academic studies have addressed the impact that poor-quality or substandard housing has on health, particularly among low-income people and communities of color. Key housing-related health issues that have historically been of concern for public health leaders, housing providers and decision-makers include asthma and lead poisoning, physical injuries from unsafe building amenities, communicable diseases resulting from poor sanitation and pests, and overall stress resulting from these health conditions.

Recently, jurisdictions in Oregon and other cities across the country have initiated efforts to improve housing-related health conditions and to focus on additional factors impacting health, such as a lack of physical activity and poor nutrition. “Healthy Housing: A Handbook for Portland Property Owners” addresses a range of these issues — from controlling indoor moisture to increasing open space — and provides suggestions for on-site property improvements.

Project background

Starting in 2010, a “Healthy Kids, Healthy Communities” partnership, with funding from the Robert Wood Johnson Foundation, examined healthy eating and active living in affordable housing communities managed by community development corporations. Building on this work, a new consortium of partners, consisting of community-based organizations, health equity advocates and the City of Portland, turned its attention in 2012 to housing that is neither income- nor rent-restricted to explore how changes to housing design, construction and maintenance practices in open-market, non-restricted housing can improve residents’ health.

Funded through a Kaiser Permanente Community Fund Implementation Grant, the City of Portland’s Bureau of Planning and Sustainability convened a group of community advocates and nonprofit consultants, including the Community Alliance of Tenants, the Center for Intercultural Organizing, Oregon Public Health Institute and Housing Development Center. The group’s task was to investigate housing-related health challenges of low-income renters living in East Portland and to develop appropriate solutions. The purpose of this work was to explore how changes to open-market housing could improve the health of low-income residents. “Healthy Housing: A Handbook for Portland Property Owners” — a set of recommended best practices for housing owners and managers — is the product of this effort.

The Community Alliance of Tenants (CAT) and the Center for Intercultural Organizing (CIO) conducted extensive outreach and built relationships with residents of East Portland; CAT and CIO provided residents with information about their rights and responsibilities as tenants, and learned about residents’ housing-related health concerns. Oregon Public Health Institute advised the project team, providing health policy information and guidance regarding health amenities in multifamily housing. Housing Development Center worked with a team of property owners, managers and landlords to investigate solutions to the health-related challenges identified by residents; and led the writing and production of this handbook.

East Portland was chosen as a study area because it is home to many low-income residents and because it is affected by especially unhealthful environmental conditions. Poorly designed housing; lack of sidewalks and safe street crossings; and limited access to recreation, schools, nature, places for social interaction, vital services, preventive medical care and healthy food all contribute to health challenges that disparately affect low-income residents and communities of color. East Portland has a disproportionate share of multifamily housing complexes and incomplete streets, and it contains a significant number of households living in poverty.

East Portland’s structural challenges

Most of Portland’s development occurred during the streetcar era of the 1920s. While Portland proper had a tight development pattern and small city blocks, East Portland was mostly an agricultural outpost. And in contrast to the rest of Portland, East Portland was defined by big parcels of land. Around the 1950s, East Portland began evolving from a rural landscape to an automobile-oriented district.

As East Portland transitioned from an unincorporated area of Multnomah County to a part of the city in the 1980s, land owners began subdividing large parcels of property, often without connection features, such as streets and sidewalks. Only in more recent history did the City begin requiring property owners to provide street and sidewalk improvements through land divisions as part of new development.

East Portland residents have voiced concern that their community has not received its fair share of investments in infrastructure, services and amenities. Though City leaders are starting to address these inequities, East Portland residents still do not enjoy the easy access to parks, supermarkets, job centers, public transportation and pedestrian infrastructure that the rest of Portland’s residents do. Compared to the rest of the city, East Portland has...

  • A deficiency of neighborhood parks. Though the City of Portland has increased its parks and recreation investment through the E205 Initiative, East Portland remains an underserved area.
  • Poor neighborhood pedestrian connectivity. Walking and biking in East Portland is more challenging than in some other parts of the city. Without adequate sidewalks, crosswalks and other pedestrian safety measures, it’s difficult for residents to be active neighborhood walkers.
  • Few supermarkets, farmers’ markets and culturally specific food centers. Huge swaths of Portland are considered food deserts by the U.S. Department of Agriculture.
  • A lack of cultural and social amenities, like libraries, community centers and performance venues. There is only one community center in all of East Portland, and there is poor recreation facility distribution.
  • A development pattern that prioritizes vehicles. East Portland is characterized by wide streets and a large, irregular lot pattern. This has led to “flag lot” housing developments that provide plenty of parking but lack pedestrian connection and are difficult to keep safe and secure.

These unhealthful environmental conditions affect a population already burdened by severe economic challenges. The average East Portlander earns 40% less than those living in other Portland districts. A large portion of East Portland families living in poverty are headed by single parents. Incomes are stagnant, and home values are lower than in the rest of the city. East Portland’s health-infrastructure deficiencies make these residents’ daily struggles that much worse.

Resident challenges and concerns

Many residents who participated in this project are refugees who arrived to the United States in the past five years through the federal refugee resettlement program. The majority are Burmese, Karen, Zomi and Bhutanese, many of whom have arrived within the last year. The process of resettlement and acculturation undertaken by these families is extremely challenging. For the first eight months after their arrival in the U.S., resettlement agencies provide families with a small amount of money, ESL classes and orientation. After eight months’ time, refugee families are left alone to provide for themselves with little or no assistance.

Unlike more established immigrant and refugee groups, these newer residents come with virtually no established resources in their native languages and very few community members who have been here long enough to serve as guides and leaders. Therefore, they lack the established social-support network that some other immigrant and refugee groups — like Latinos, Russians and Somalis — have built over time. This further exacerbates all of the usual challenges that come with moving to a new country, and it has dramatic impacts on health. The lack of support adds to the difficulty of navigating the social systems necessary for good education, mental and physical well-being, and economic independence.

Oftentimes immigrant and refugee households are large and intergenerational. Eight or more people may share a two-bedroom apartment. Furthermore, most of the residents have come to the United States from refugee camps, and many have never lived in a western environment or used modern appliances such as stoves, refrigerators and thermostats. This makes it more challenging to keep homes healthy and free of mold and other infestations. The harsh transition, lack of space and social isolation affects family dynamics and mental health.

The challenges faced by these newcomers are not unique to immigrants and refugees, nor are they unique to residents of East Portland. Though the scope and severity of their needs require a special set of solutions, their experiences illuminate housing- and health-related concerns for the rest of Portland’s low-income renters.


Residents of East Portland identified six housing-related health challenges. Please read the chapters to learn more about their benefits and solutions.

Related issues and additional concerns

Project partners identified several related issues outside the scope of “healthy housing”. They are important to understand, as they complicate the housing-related health challenges identified by residents.

Immigrants and Refugees Need Support to Realize Their Potential

  • Language and cultural barriers make it very difficult for refugee and immigrant communities to integrate into larger society. Residents expressed feeling tremendous pressure and a sense of isolation and hopelessness because of inadequate interpretation and translation services, and limited access to English classes. Without proper support, these communities are unable to navigate existing social and economic systems. They have significant difficulty reporting problems with their housing and communicating with their landlords. In order for these residents to realize their full potential in society, language resources must be improved.
  • Refugees are often offered unacceptable or inappropriate housing placements. Some residents have been placed in neighborhoods far from their ethnic enclave and support systems, creating a sense of isolation. Furthermore, some have been placed in housing that is substandard, unhealthy and far too small. Lastly, refugee families need more education and ongoing assistance in how to use appliances and systems in their apartments, and how to exercise their rights and responsibilities as tenants.

Existing Housing Stock Is Inadequate

  • The shortage of affordable housing is an overarching concern. Portland’s limited affordable housing supply is insufficient to meet swelling demand.
  • There is a mismatch in East Portland’s built environment between family sizes and apartment sizes. East Portland was developed largely during a time when small households and young families lived in apartments before purchasing homes. With an increasingly out-of-reach homeownership market, more families are staying in apartments instead of purchasing homes as their families grow. Additionally, there is a dearth of large dwelling units in Portland because it’s cheaper to build smaller units; larger units don’t command high enough rent to justify their upfront costs.
  • The City’s rental housing inspections program is effective but inadequately funded. Many of the apartment complexes surveyed as part of this project had multiple building code violations. This finding underscores the importance of using the Bureau of Development Services’ housing inspections program to address basic health and safety concerns in apartment complexes. Despite the need, there is a lack of inspectors and funding for the program. The inspection program, particularly the enhanced inspection model, must be supported to ensure healthy living standards for all households.

Next steps

In response to the challenge of integrating health-related amenities in multifamily rental housing, the City of Portland is exploring a more holistic approach to site design standards. This will require a thoughtful balance between competing demands for site area — maximum lot coverage, stormwater management facilities, recreation and garden space, and parking, in addition to other elements like setback and circulation requirements.

As part of the City of Portland’s 20-year update of its zoning code, which guides development of residential property, the City will more fully investigate how the different elements of site design can be more holistically integrated.

As the City sets policy direction, it will be important to create healthier housing opportunities without displacing current residents and pricing vulnerable people out. The unique challenges of East Portland call for a neighborhood-based approach that works with the existing strengths of the community to create sustained benefits for residents.