Shows a map with multiple areas of eastern and northern Greensboro colored in red. One area, right near the center of town, is circled in yellow.
The circle marks one spot where incidence of substandard housing and the highest levels of hospitalizations for asthma treatment overlap. Map courtesy of UNC-Greensboro Center for Housing & Community Studies

By Catherine Clabby

When Google photographed tens of thousands of Greensboro properties to post pictures with its digital maps, it unintentionally helped a local campaign to reduce asthma attacks among kids.

A research center at the University of North Carolina-Greensboro last summer repurposed Google “street view” photos to survey the exteriors of 78,000 city buildings, one property at a time. The results allowed the center to map clusters of city housing in serious disrepair.

Because mold and cockroach infestations produce allergens that can trigger asthma attacks, student surveyors took pains to note cracks in foundations and gaps in flashing near chimneys and rooflines. Both increase the chance that water and insects will invade a home.

The effort took months. But once finished, UNCG sociologist Stephen Sills could merge maps showing clusters of poor-quality housing with Cone Health System data locating the neighborhoods housing city children who most frequently visit a hospital due to asthma attacks. The hot spots overlapped, suggesting a strong correlation.

Shows two middle-aged white men sitting in front of computers and maps.
Brett Byerly, executive director of the of the Greensboro Housing Coalition and sociologist Stephen Sills, director of the UNC-Greensboro Center for Housing and Community Studies. Photo credit: Catherine Clabby

“We’re not producing knowledge for knowledge’s sake. We’re producing knowledge to address real tangible problems,” is how Sills described the Center for Housing and Community Studies research.

Recognizing the UNCG effort and related work by many community partners, the national BUILD Health Challenge last week gave the local housing/health coalition $250,000 to expand its efforts. The money will allow the coalition to focus on ties between housing quality and health, particularly in one lower-income neighborhood in east Greensboro called Cottage Grove.

The award is part of the national nonprofit group’s mission to expand data-driven projects that seek to improve community health in neighborhoods rather than confining such efforts to hospital emergency rooms or health clinics.

That approach is a long overdue shift in thinking about how to prevent illness, said Brett Byerly, executive director of the Greensboro Housing Coalition, one of the leaders in the local effort.

“My predecessor used to say: ‘If you can fix housing, you can reduce medical costs,’” Byerly said. “No one would talk to us about that. Now it’s happening.”

Asthma and more

Asthma, a chronic disorder of airway inflammation, is the most common chronic illness among children in the United States. Many exposures can trigger attacks, including allergens produced by mold and cockroaches inside a home.

African-American kids have four times the rates of emergency department visits for asthma care than white kids do, three times the hospitalization rate and more than seven times the death rate.

Low-income kids are at higher risk as well.

Shows a sofa, chairs piled on the curb in front of some low-rise housing.
Furniture was piled on a curb this week outside residential units at the Avalon Trace complex in Greensboro’s Cottage Grove neighborhood. Photo credit: Catherine Clabby

Research has shown that plumbing or roof leaks, poor ventilation and exhaust systems, dirt on floors and other surfaces, the presence of rodents or cockroaches, or structural damage increase the presence of asthma triggers in a home. And evidence is growing that cleaning and repairs can reduce triggers.

In Greensboro, advocates have some evidence that such interventions can help locally. Results from a proof-of-concept study published in the medical journal Annals of Allergy, Asthma & Immunology last year showed that tutoring families within the city about risks from allergen triggers in homes; providing cleaning kits with gentle cleaners such as vinegar and Murphy’s Oil Soap; assisting with pest control; and mediating with landlords to obtain needed repairs can reduce some asthma-care medical costs.

Along with the hotspot maps the UNCG center produced, that cost-drop outcome has helped convince Cone Health and other medical providers to focus more on family residences and neighborhoods to try to improve health, said Kathy Colville, director of Cone Health’s Healthy Communities program.

Cone has committed $125,000 and a lot of in-kind services to the newly funded Cottage Grove project. In addition to educating families about asthma trigger risks in their homes, Cone clinicians will be referring them to non-medical organizations that can help them improve those environments, Colville said.

“There is a power to having those quantified maps in front of you. Any nurse or doctor could tell you about the association between poor housing and health. But it requires a higher level of evidence to ask people to think how they might use limited resources for health care differently,” Colville said.

The Collaborative Cottage Grove project, as it is now called, has big ambitions. Working with increasingly organized residents in the targeted neighborhood, participants in the project hope to use the BUILD Health Challenge money to not only reduce rates of asthma hospital visits but also to make dents in neighborhood diabetes rates, increase the availability of healthy foods, and expand locations for outdoor exercise, including sidewalks and parks.

Three African American women standing outside, one talks the other two look at her. They're all dressed in winter clothing.
Josie Alston Williams, a Greensboro Housing Coalition project coordinator, talks with women in fall 2016 on the grounds of the Avalon Trace complex within the Cottage Grove neighborhood. Photo by Mike Dickens; UNC-Greensboro.

Organizations involved in the project comprise a long list of nonprofit groups, government agencies, health providers, local researchers and others. They plan to collect and share data to allow Sills to assess any impacts, including changes in rates of asthma hospitalizations, diabetes and hypertension.

Tough pockets

People closely involved with Collaborative Cottage Grove make clear that they see both great promise and some immense challenges in their midst.

One significant trouble spot is a sizable apartment complex called Avalon Trace, which includes some condemned units, said Byerly, the housing coalition director.

Residents of the complex have complained to city officials recently about serious structural deficiencies there, including badly leaking roofs, bug-infested walls and sizable sewage backups from toilets.

Both the city’s code enforcement office and its minimum housing standards commission are pushing for improvements, Byerly said. In the past two months, for instance, the commission has upheld five city repair orders at Avalon Trace, which is for sale. If the property managers don’t make the fixes, the city will ensure they are done and then put a lien on the property to cover its costs.

Once upon a time, those efforts would have been viewed in the context of maintaining minimum housing standards in the neighborhood. But these days, the relevance to health of occupants is obvious too.

“More and more organizations recognize that there is a direct relationship between housing and health,” said Josie Alston Williams, who is a very active housing coalition project director in Cottage Grove. “That is good.”

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Catherine Clabby (senior environmental reporter) is a writer and editor. A former senior editor at American Scientist magazine, Clabby won multiple awards reporting on science, medicine and higher education...