An August 22 Health Affairs Web First traces the evolution of the health policies of the US Department of Housing and Urban Development (HUD) from the Johnson administration to the Obama administration. The article, by Raphael Bostic of the University of Southern California’s Sol Price School of Public Policy and coauthors, also looks at the opportunities and challenges involved in incorporating health considerations into housing and community development policies.

Since its establishment in the 1960s, HUD has increased its awareness of its role in health and health policy over time, with the current administration’s approach being the most full-throated embrace of the concept to date. In HUD’s early years, health initiatives targeted indoor environmental health hazards, such as prohibiting lead in paint and gasoline products in its housing. The 1990s introduced programs allowing residents of public housing in impoverished neighborhoods to move to more affluent neighborhoods; research showed that these residents may have enjoyed improved mental and physical health and well-being.

The Affordable Care Act, along with the Obama administration’s place-based initiative, has created an environment where attention to intersections of policy areas is encouraged. The secretaries of the Department of Health and Human Services and HUD have taken steps to integrate policies, and HUD Secretary Shaun Donovan has created a health council within the department, which “goes a long way toward institutionalizing the health in all policies approach at HUD.” Looking ahead, the authors call one of the biggest impediments to success the federal budgetary process itself, because congressional committees consider budgets for different agencies separately; these “predetermined silos” create “barriers to investing in programs that are likely to show results in more than one federal spending category, even though those programs are likely to save the federal government money.”