At the end of a summer punctuated by media coverage of the deaths of African-American men and women at the hands of law enforcement, I passed a sign on the highway that struck me as ironic. The sign simply read: Laws Strictly Enforced. The sign was presumably intended to warn drivers that, should they speed, law enforcement would be there to enforce the speed limit and give them a ticket.

The sign struck me as interesting for two reasons. First, it made me recall that many of the offenses that were the trigger for law enforcement action in the cases of Michael Brown, Eric Garner, Walter Scott, and Sandra Bland involved “strict” enforcement of laws that are rarely enforced in other communities — jaywalking, selling loose cigarettes, having a broken tail light, and failing to signal a turn, respectively. Second, I pondered the words “laws strictly enforced” in the context of public health and safety laws, especially housing codes, and the reality that these laws frequently go unenforced in low-income communities, the very same communities where police appear to strictly enforce arguably much less important laws.

There is a great deal of discretion in our legal system with regard to which laws are “strictly enforced” and those that are not. Selective enforcement practices in low-income, predominantly African-American communities, have given rise to a long overdue discussion about law enforcement interaction with people in low-income neighborhoods. Many now question the unintended consequences of the “broken window theory,” which has long been cited as justification for this type of policing. That theory posits that having police target smaller, less serious crimes in a particular neighborhood will deter the escalation of more serious crime which can lead to greater social disorder in the neighborhood.

Moving Toward Primary Prevention

What if the premise of the broken window theory of law enforcement was applied further upstream to proactively target the unsafe housing conditions that lead to or exacerbate disease and injury and perpetuate inequality? In the context of housing safety, enforcement of the law is directly tied to the prevention of disease, particularly for children; proactive enforcement of the housing code can significantly reduce the incidence of lead poisoning, asthma, and injury.

Substandard housing affects millions of low-income families in the U.S. The 2009 American Housing Survey found that 23 million housing units had one or more lead-based paint hazards, 17 million had a high exposure burden to indoor allergens, and 6 million had moderate to severe infrastructure problems.

These housing hazards have a significant impact on population health and often serve as major drivers of health care utilization while increasing costs in other sectors, such as education and the criminal justice system.

The Short And Long-Term Costs Of Substandard Housing

Recent research points to the larger societal costs of not enforcing minimum housing codes and lead safety laws. Brown University economist Anna Aizer and colleagues studied the lead levels of African-American children in Rhode Island in relationship to the black-white educational test score gap. They found that reductions in lead poisoning among African-American children attributable to the state’s efforts to address lead hazards in homes “translated into reductions in the black-white test score gap in RI witnessed during this period.” They also suggest that, because of the importance of education for long-term economic security, reducing exposure to lead may reduce racial disparities in economic outcomes as well.

Similarly, there is new attention to the role that housing-related triggers play in asthma exacerbation among low-income children, leading to increased emergency room usage, hospitalization, and school absenteeism. It is well-documented that African-Americans have a higher prevalence of asthma than do whites, and African-American children are three times more likely to be admitted to the hospital for asthma than white children. Studies of the role of psychological stress in exacerbation of asthma are also interesting in light of the increased potential for stressful encounters with police, given “proactive policing” policies directed at their neighborhoods.

Proactive Enforcement: Prioritizing Health And Safety

Proactive and targeted enforcement of well-constructed housing safety laws can prevent disease and associated costs. Researchers examining lead poisoning in seven cities found that 50 percent of the children with elevated lead levels lived in a small number of zip codes, mostly impoverished neighborhoods.

They concluded that: “We know where these children live and we know what to do. It is four times more likely to have another lead poisoned child in a house that has had a lead poisoned child in the past if there is not strict enforcement capacity.” Strict enforcement of housing laws has been shown to reduce lead poisoning as well as related societal costs.

To facilitate effective enforcement, the law must be supported by adequate, well-coordinated government agency resources, and appropriate supports for property owners. But most cities rely on selective enforcement in which they respond to housing code violations only when tenants complain. Low-income tenants, who often have poor bargaining power, must balance their right to safe housing with the threat of eviction or retaliation by the landlord.

Proactive enforcement requires partnerships among city housing code and public health officials, health care providers, schools, and tenants. Integration of health and housing data can help direct enforcement resources. Researchers at Cincinnati Children’s Hospital Medical Center (see Exhibit 1) found that an increase in density in housing code violations explained 22 percent of the variation in rates of asthma-related emergency room visits and hospitalizations. Of the cohort of children studied, African-American children were significantly more likely to revisit the emergency department or be re-hospitalized than white children.

Examples of proactive enforcement are out there. Cities such as Los Angeles, St. Louis, and Rochester (NY) have enacted proactive enforcement policies that do not rely on tenants to seek out help.

Exhibit 1

Elizabeth_Tobin_Tyler-Beck-Exhibit_1

As with any policy change, there is the potential for unintended consequences from strict enforcement of housing safety laws. As we have seen, proactive policing can lead to overzealous enforcement and racial profiling. The argument against strict enforcement of housing safety laws is that it will result in the reduction of available affordable housing in low-income communities because property owners will pass on costs by raising rents or refusing to rent to poor tenants.

But low-income tenants should not have to choose between suffering preventable disease and injury and having a roof over their heads. A study in Rochester, NY found that proactive enforcement of a new lead law did not, in fact, lead to a reduction in affordable housing. Indeed, there are policy tools that can provide incentives for property owners to do the right thing, such as tax credits, low-interest loans, and subsidies for repairs when property owners are income eligible.

The equitable enforcement of the law signals society’s values. Proactive enforcement of housing safety laws signals to low-income residents that law enforcement is not just about punishment and crime prevention; it also about protecting and promoting their health and safety and equalizing the playing field for future opportunity.