Ben Carson’s nomination as secretary of the Department of Housing and Urban Development raised some eyebrows, and not just because Carson had recently said he wasn’t interested in running a federal agency.
The responsibilities of the job — running a federal agency whose budget in 2016 neared $50 billion and which is responsible for helping local housing authorities manage over a million households — struck some as an odd fit for his training as a neurosurgeon.
“At first, one is struck by the oddity of this appointment of someone who’s had no history with public housing to the extent that we know of,” said John Spengler, a professor of environmental health at the Harvard T.H. Chan School of Public Health, who has done research on health in public housing.
But public health professionals are hoping that he’ll bring his medical lens to the job — pushing for quality housing for low-income people and improving people’s health conditions within public housing.
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“Not having access to safe, affordable housing is one of the least healthy situations you can find yourself in,” said Mariana Arcaya, an assistant professor of urban planning and public health at MIT.
Research has shown that lacking stable housing is related to a variety of health outcomes, such as higher levels of depression and anxiety, more illicit drug use, and greater use of emergency departments at hospitals.
“For people who move from place to place, it’s very difficult to have a regular source of healthcare,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “We know that a regular source of healthcare is very important to having good health.”
And being sick makes it difficult to find better housing, Benjamin said. Bad health and bad housing go hand in hand — and there are some things that the federal agency can do to help.
HUD funds housing developments and neighborhood projects across the country. It gives money to state and local organizations that build and subsidize housing, and makes policies for public housing that impact the health of residents and communities, such as setting the acceptable levels of lead in the blood of children living in federally-subsidized homes, and a ban on public smoking in such homes announced at the end of November.
Where money is invested in housing, and what kind of housing is built, both have large health impacts, scholars say.
“The location of housing itself is the determinant of all the neighborhood factors you’re exposed to, and those have implications for health,” Arcaya said. For instance, where you live determines where you go to school, where you buy your food, where you can exercise in public parks, and whether or not you’re close to a doctor’s office.
The quality of your home can also have a direct impact on your health. Dr. Megan Sandel, a pediatrician at Boston Medical Center, recalled an 8-year-old girl she saw in the intensive care unit 20 years ago. The child had terrible asthma, and Sandel couldn’t figure out why — until the family told her that they recently got a cat. The child was allergic to cats, but the family bought one anyway to get rid of a mouse in the child’s bed.
“The prescription I wanted to write was for a healthy home,” Sandel said. The bad house, she said, was “was ultimately the underlying illness. Asthma was the symptom of the disease.”
Arcaya said that she hopes a physician in the secretary’s seat would take medical-related housing concerns more seriously. But that she’s concerned about Carson’s critiques of some HUD programs, including his characterization of certain agency programs as “social engineering.”
“These government-engineered attempts to legislate racial equality create consequences that often make matters worse,” he wrote in the July 2015 op-ed.
Such views are at odds with what might be best for health, said Justin Steil, an assistant professor in MIT’s urban studies and planning department.
“Residential segregation by race and by income are characteristics that have been repeatedly associated with negative health outcomes, yet Ben Carson has voiced opposition to existing fair housing policies that seek to prevent discrimination in housing,” Steil said.
Still, Carson’s high profile could benefit the agency. Sandel said that HUD is often a “forgotten department” that doesn’t get enough attention, and that Carson’s nomination opens up “a critical window of opportunity to potentially have the ear of the President.”
And while a neurosurgeon’s knowledge may be little help running the federal agency, scholars say some attributes that make Carson a good doctor may benefit him in his position.
Benjamin said that while he has “no idea” how Carson’s medical training will influence how he does the job, neurosurgeons are good at working on a team and at making detailed plans, both of which could benefit Carson in the position. Spengler said that Carson could bring a doctor’s sense of compassion to the agency.
But Benjamin offered Carson a suggestion — he would like to see HUD release an annual report about the health of people living in public housing. This would allow the agency to gauge its success in part by how the health of public housing residents changes year to year.