Executive Summary

The State of Healthy Housing presents the only comprehensive analysis of U.S. healthy housing conditions. The study shows that despite early success toward improving housing conditions, the Roosevelt-era goal of ensuring that every family has access to safe and decent housing remains elusive.

The study reveals that 45 million – 45% – of metropolitan homes in the U.S. have one or more health and safety hazards.

Based on recently revised criteria, the 2018 State of Healthy Housing determines that the metropolitan areas of Seattle, Washington; Jacksonville, Florida; and San Jose, California, top the list for having the healthiest housing. At the bottom of the list, having the least healthy houses, are the metropolitan areas of New York, New York; Tucson, Arizona; Oklahoma City, Oklahoma; and San Antonio, Texas.

Across metropolitan areas, rental properties tend to have more problems than owner-occupied dwellings, and central city housing tends to have more problems than housing outside the central city. Other community characteristics that influence the healthfulness of a jurisdiction’s housing include housing age and poverty levels.

The National Center for Healthy Housing (NCHH) created the State of Healthy Housing by selecting 20 key housing factors from the American Housing Survey (AHS) that are related to health. The housing characteristics that make up the study rankings are based on expert judgment of housing conditions likely to lead to health problems that are included in the American Housing Survey, largely on the federal “housing quality standards,” which represent a single uniform standard for addressing the health and safety of residential dwellings. There is ample evidence that deficiencies in any one of these areas can and does lead to health deficits and safety issues. The study found that the most common housing problems identified include signs of cockroaches, signs of rodents, water leaks, and damaged interior walls.*

This State of the Healthy Housing report presents data from 53 metropolitan areas surveyed between 2011 and 2015. The NCHH study uses survey data from the AHS, which is collected by the U.S. Census Bureau for the U.S. Department of Housing and Urban Development. In 2011, AHS reported national results and results for selected metropolitan areas based on a pooled sample. The survey reached 190,000 housing units, including about 70,000 nationally and 120,000 supplemental housing units, from 29 metropolitan area surveys. In 2013 and 2015, the survey collected a supplemental sample of housing units in selected metro areas (five metropolitan areas in 2013 and 15 areas in 2015), which was combined with the existing national sample in these areas to produce metropolitan level estimates. In 2013 and 2015, the AHS supplemental sample also included other metro areas (20 metropolitan areas in 2013 and 10 areas in 2015), bringing the total number sampled to 25 metropolitan areas in each year. Looking forward, HUD plans to survey the largest 15 metropolitan areas every two years, along with another 20 large metropolitan areas on a rotating basis (10 every two years).

The American Housing Survey data do not directly measure certain healthy housing conditions, such as lead, allergens, radon, mold, and other long-term health issues. If you have questions about the State of Healthy Housing, contact Jonathan Wilson (jwilson@nchh.org).

*For example, the Institutes of Medicine (2000) concluded that there is sufficient evidence of a causal relationship between cockroach allergen exposure and exacerbation of asthma. A study by Phipatanakul et al. (2000) concluded that mouse allergen may be an important indoor allergen in inner-city children with asthma. Another study (Matsui et al. 2006) found that for mouse-sensitized inner-city children, exposure to mouse allergen may be an important cause of asthma morbidity. The World Health Organization Guidelines for Indoor Air Quality (2009) found sufficient evidence of an association between damp and moldy housing conditions and asthma development and exacerbation.


Date of summary: November 13, 2020.

Latest page update: May 4, 2022.