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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Housing Instability: Pregnancy.

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Strategy. Housing Reparations (Pregnancy)

Approach. Enact housing reparations to reduce racial disparities in housing stability

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Overview. Housing reparations programs can come in multiple forms. They can be financial awards to be used at the discretion of eligible recipients, or they can be multicomponent interventions that support homeownership for eligible recipients through housing specific means such as down payment grants, housing revitalization grants, or access to government subsidized mortgages with very low interest rates and low or no down payment.[1, 3] Housing reparations programs often increase regulation to de-commodify the housing market, reform tax policies to discourage predatory housing speculation, restructure housing finance systems, and expand the social housing sector by increasing the share of housing resources owned by public, not-for-profit, or community organizations.[1] These programs include initiatives to invest in communities that historically experienced systemic disinvestment,[4] especially to improve housing and infrastructure resources, build community wealth, and increase home equity values.[1] Housing reparations include formal apologies and public acknowledgment of historical injustice and its current manifestations. Housing reparations programs can also develop political power, invest resources to enforce fair lending laws, and work to prevent and prosecute ongoing discrimination in the housing market.[1, 5, 6, 7] Government agencies can change mortgage insurance and finance regulations, tax benefits for homeowners, and industry norms to improve consumer protection, transparency, and public access to information to benefit homeowners in neighborhoods previously excluded from these opportunities.[1] Housing reparations programs are one component of a broader reparations and racial equity agenda.[1] Some experts reserve the term reparations for comprehensive federal programs to atone for slavery and close the racial wealth gap,[6] while others suggest additional reparations programs are needed to redress discriminatory policies limiting housing, education, business, and other wealth-building opportunities for both descendants of people enslaved in the U.S. and people of color more broadly.[1, 2, 5]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of housing reparations programs or initiatives established to address racial disparities in housing stability. (Shows the scale and scope of the approach)
  • Number of eligible individuals or families from historically marginalized racial groups who apply for and receive housing reparations. (Indicates the reach and uptake of the approach among the intended beneficiaries)

OUTCOME MEASURES:

  • Number of individuals or families from historically underserved racial groups who achieve stable, affordable, and quality housing as a result of housing reparations. (Shows the approach's impact on its primary goal of promoting housing stability)
  • Number of individuals or families from historically underserved racial groups who experience increased wealth and economic security through homeownership or other housing-related assets acquired through reparations. (Indicates the approach's effect on building intergenerational wealth and reducing the racial wealth gap)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of housing reparations funds allocated to community-led initiatives and organizations with deep roots and trust in the impacted neighborhoods. (Shows the level of community ownership and support in the implementation of the approach)
  • Percent of housing reparations programs that incorporate ongoing monitoring, evaluation, and accountability measures to ensure equitable distribution and impact. (Indicates the commitment to transparency, learning, and continuous improvement in the approach)

OUTCOME MEASURES:

  • Percent reduction in the homeownership gap between historically marginalized racial groups and the general population in communities served by housing reparations. (Shows the approach's impact on reducing racial disparities in access to homeownership opportunities)
  • Percent of individuals or families who receive housing reparations and report improved physical and mental health outcomes, educational attainment, and overall quality of life. (Indicates the approach's effect on addressing the social determinants of health and well-being)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships and collaborations formed between government agencies, community organizations, and private sector entities to design and implement comprehensive housing reparations programs. (Shows the level of multi-sector alignment and coordination to support the approach)
  • Number of policy and system changes supported and implemented to address structural barriers to housing equity and create an enabling environment for reparations (e.g., fair housing laws, tenant protections, equitable zoning). (Indicates the broader institutional and regulatory reforms needed to sustain the impact of the approach)

OUTCOME MEASURES:

  • Number of jobs created and businesses supported in historically disinvested neighborhoods through housing reparations investments in construction, property management, and related industries. (Shows the approach's economic multiplier effect and contribution to community development)
  • Number of cities, states, or federal agencies that adopt and scale housing reparations as a mainstream strategy for advancing racial equity and addressing the legacy of housing discrimination. (Indicates the approach's potential for catalyzing broader systems change and replication)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of housing reparations program design and decision-making process that are led by and center the voices and priorities of historically marginalized racial groups. (Shows the degree of self-determination and representation in the approach)
  • Percent of public and private sector institutions that commit to ongoing funding, resource allocation, and policy changes to sustain housing reparations beyond initial pilots or short-term initiatives. (Indicates the long-term political and financial will to support the approach)

OUTCOME MEASURES:

  • Percent increase in the overall housing stability, economic well-being, and quality of life indices for historically marginalized racial groups in communities served by housing reparations, relative to baseline. (Shows the approach's population-level impact on reducing racial disparities and advancing equity)
  • Percent of public narratives, media coverage, and community conversations that frame housing reparations as a necessary and effective strategy for achieving racial equity and inclusive prosperity. (Indicates the approach's influence on shifting dominant narratives and building broad-based support for transformative change)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 PRRAC-Haberle 202[1] - Haberle M, House S, eds. Racial justice in housing finance: A series on new directions. Washington, DC: Poverty & Race Research Action Council (PRRAC); 2021.

2 NAARC-Reparations eligibility 2022 - National African-American Reparations Commission (NAARC). Who should receive reparations and in what forms? March 25, 2022.

3 CA-AB 312[1] - State of California, Department of Justice, Office of the Attorney General. Assembly Bill (AB) 3121: Task force to study and develop reparation proposals for African Americans.

4 Williams 2004a - Williams DR, Collins C. Reparations: A viable strategy to address the enigma of African American health. American Behavioral Scientist. 2004;47(7):977-1000.

5 Brookings-Ray 2020 - Ray R, Perry A. Why we need reparations for Black Americans. Washington, DC: Brookings Institute; 2020.

6 Darity 2008 - Darity WA Jr. Forty acres and a mule in the 21st century. Social Science Quarterly. 2008;89(3):656-664.

7 Kaplan 2007 - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.