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Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
Friends, May is an especially exciting month here at Health Affairs this year as it marks the release of a new theme issue dedicated entirely to the intersection of climate change, health, and equity. There's so many interesting and important articles in this one, including a number of path breaking research articles that really do move the evidence base forward, as well as a handful of deeply insightful commentary and analyses from people doing really critical work on the front lines to protect people's health and well-being. Now there's a number of common threads that run through these articles, and one of them is the idea that often the people and the communities most deeply affected by climate change are those with the least resources and power to implement proven climate mitigation interventions and adaptations. This disconnect is the subject of our Humble podcast today. I'm here with Doctor.
Rob Lott:Cynthia Strathmann, executive director of an organization called Strategic Actions for a Just Economy, s a j e. It's a Los Angeles nonprofit organization that supports low income tenants. And she has a new article in the May issue of Health Affairs titled, quote, empowering South Los Angeles tenants to advance climate policies that protect their rights. This really is a wonderful spotlight on people and communities doing the work exactly where the rubber meets the road. There's a lot to learn from it, and I'm thrilled we can discuss it here today.
Rob Lott:Doctor. Strathmann, welcome to A Health Podyssey.
Cynthia Strathmann:Hi. Well, thanks for having me here.
Rob Lott:Well, let's dive right in. In your article, you write, quote, the concept of climate change might not be top of mind for most low income tenants, but effects such as extreme heat certainly are. Can you tell us a little more about what you see in your work with tenants in South LA? How do they experience the impact of climate change in their lives day to day?
Cynthia Strathmann:Well, I think probably the biggest impact so far has been extreme heat. And so for a lot of tenants who are living in housing that is already not great, A lot of their housing is very, very overcrowded. Los Angeles has some of the most overcrowded housing in the country, particularly in South Los Angeles. It's often very poorly maintained. They're having problems with pest infestations or mold.
Cynthia Strathmann:Windows are sometimes painted shut, they can be located in very high pollution areas. So all of these aspects of the built environment are already exacerbating the effects of extreme heat. There's very little green space, it's a very park poor area of the of the city. And also, you know, aren't a lot of places that they can go to cool down. There aren't a lot of malls, aren't a lot of movie theaters, people take transit a lot.
Cynthia Strathmann:That means they're out in the sun, in the heat, standing at bus shelters, maybe with no awning. And, you know, Los Angeles used to be a a well, it still is. It's a it's a warm climate, but you used to be able to count on it cooling down at night. And so people could use fans, open their windows. You see bars on a lot of the windows in low income areas, and it's it's it's partly so people can just leave their windows open.
Cynthia Strathmann:You open your windows in April, leave them open till October. But as it gets more humid and as the nights get warmer, people can't cool down their indoor spaces over overnight as well. So so extreme heat has been a problem, know, and people complain about it just being suffocating about not being able to get out. They have health problems that are related to heat, and then, you know, they may pass out during we had one one member who just passed out during the day in her home with her kids. She just got so overheated, and she has some other existing health conditions.
Cynthia Strathmann:So extreme heat is the biggest impact that we're seeing. You know, obviously, I think anyone who's been following the news knows that LA got hit really hard with fires last year, and so fires are another climate change effect that's going to have serious impacts on health. Even if you're not living in one of the fire zones, you know, the pollution that's coming down from a whole bunch of homes that have been incinerated was pretty severe and extensive. I'm not sure people even know exactly what the long term effects of some of these urban conflagrations are gonna be in relation to pollution.
Rob Lott:So you alluded to some of the health impacts. And do you have a sense if you were sort of to take a step back beyond any given tenant that you're working with, do you see any kind of common threads or is there evidence that you've turned to of the health impacts of climate change? How might you quantify it if someone asked you to?
Cynthia Strathmann:I haven't seen any evidence or any quantified data about the health effects, particularly in South LA, or LA County, which is mostly where we work. But I know that people have been able to quantify those health effects in other geographic areas, so I'm sure it can be done. I do know that people are saying that, experts are saying that the impacts of climate change are gonna be felt most severely in very low income communities or on communities of color, and I'm very much hoping and that's because of all of the other collateral issues that we're aware of. I'm very much hoping that we don't have to wait until we're quantifying a lot of extreme effects of extreme heat before we start to address those. I would like it to not be obvious in a gigantic and quantifiable way before we can address the issue.
Rob Lott:Sure, that seems like a reasonable aspiration and glad that you're on the front lines. They're doing some of that work to maybe get ahead of it. In world where extreme heat events are occurring more and more frequently, as you say, I'm curious what kind of mitigation and adaptations can help make one's home more livable and maybe less harmful to to one's health. What kind of work are you doing with tenants to address these concerns?
Cynthia Strathmann:Well, know, the types of measures that one would advocate to have in a home to make it more livable and extreme heat would be cooling measures. And so that could be things like having shade trees outside that would help protect the home from heat or cooling systems inside fans, air conditioning. Everyone loves heat pumps because they don't create as much pollution, but are actually, you know, will cool down the space like air conditioning does. But for tenants, you really need policies in place to support that because unlike homeowners, they can't just decide to put these in. You know, landlords will put all sorts of of of barriers to to them to do that.
Cynthia Strathmann:It's very expensive. A lot of tenants don't have a lot of money, so there's that structural problem. Even if they're willing to put the the air conditioning in at their own expense, landlords will sometimes say they don't want it in there. A lot of landlords complain that they don't like the way that the window boxes look outside the apartment, which just in the face of what tenants are having to experience seems like a somewhat superficial concern. So there are going to have to be policy policy measures and policy mandates probably in place, but it's I think that that's something that can often be difficult because in US culture, I think we still tend to think of people who live in homes as being homeowners, but in a lot of places, they're tenants.
Cynthia Strathmann:And so that has to be woven into any kind of policy mechanism that's going to be used to address that. So just to give an example, the main adaptation that we're really advocating for now is a cooling mandate in rental properties so that there has to be a mechanism in place so that tenants can keep the indoor space cool. And in Los Angeles, one has been established and it would keep indoor it would mandate that indoor temperatures had to be able to be cooled to 82 degrees Fahrenheit or lower. And then there's an exception for smaller property owners that they only have to have one room available to be cooled below 82 degrees. So that's the main adaptation that we're looking at now.
Rob Lott:Well, were just sort of alluding to this kind of dynamic. In many cases, we assume people own their own homes, but there are risks associated with initiating certain interventions, especially in cases where there is this tenant landlord relationship that may be more fraught, especially when landlords are focused on maximizing revenue and cutting costs and that kind of thing. And I'm curious if you can say a little more about how you've seen that dynamic play out in your work.
Cynthia Strathmann:Well, yes. I mean, not all landlords are unscrupulous, and I want to be clear that but because we deal with tenants who are in crisis and because we're a tenant rights group, we generally have a selection process by which we tend to see only the bad landlords. So we have seen a lot of issues with landlords doing very, very unscrupulous or unpleasant things with tenants. So we've seen landlords use any kind of government mandate as an excuse to try to evict tenants because tenants do have some protections in Los Angeles. To give an example, there was a landlord in West Los Angeles, a huge apartment complex, over 500 units, who was mandated to put in sprinklers because there kept fires and somebody died.
Cynthia Strathmann:It was not an unreasonable mandate, but they then used that as an excuse to try to evict over 500 households from that building, which was obviously, you know, the mandates are being put in place to protect the tenants, but if the tenants end up getting evicted, then the protections aren't really doing them very much good. And that's particularly true in a in a situation like Los Angeles where rent burden is a huge problem, and oftentimes the only reason that tenants are stable is that they're in a rent stabilized unit. And if they get evicted from that unit, the odds of them becoming homeless are extremely high. So much much higher than they would be for like a typical tenant. So so that has been a big problem because of the of the incentive that landlords have to to evict their tenants, don't use any kind of mandate as a leverage point to try to get that tenant out.
Cynthia Strathmann:And our staff has heard when they're talking to tenant associations in other parts of the state that evictions being done to do, you know, what are called substantial remodels are one of the biggest threats that tenants are seeing right now. So those tenant those those threats are very real, and there are there are very real risks that can come when you mandate, you know, however well intentioned when you mandate improvements to buildings.
Rob Lott:Got it. So in the face of that dynamic where there are these risks and trade offs associated with many of the climate mitigation efforts, you know, particularly for low income tenants. Can you say a little more about what steps we can ask of community leaders and policymakers to address that tension, if you will? How can public officials support and bolster tenants as they navigate these trade offs?
Cynthia Strathmann:I think that's a great question and it's a key question because I certainly don't mean to imply that we shouldn't try to tackle the problem of extreme heat or the problems of climate change. It's really important that we do both of those, both to address greenhouse gas production, but then also to kind of keep people safe in the face of these effects of climate change. I think the first thing that it's really important to do is to really understand your community's housing composition, recognizing that not everybody is a homeowner. And in some places like New York, I think everybody assumes that this is true and everybody knows it, but, know, as I said before, I think there's this assumption and that people are homeowners. And so when you're building a policy for any kind of mandate, make sure you keep in mind that that is not always true.
Cynthia Strathmann:And I think that's particularly true as housing affordability becomes more of an issue. Fewer and fewer people are, you know, going to be able to step into homes at a young age, and you're going to see more and more tenancy. I think an important thing for policymakers and leaders is to really think about how they're framing the question of what to do in a home. In The United States, we hold the rights of property owners very, very dearly to us, but we also, I think, have to think about the responsibilities that a landlord has. Landlords are making money, and in some cases, a lot of money, by providing a particular kind of service or product, however you wanna frame it, and they need to abide by standards and regulations as they do that.
Cynthia Strathmann:And for some reason in rental housing, maybe it's just the term landlord, you know, it's so futile. And I think that not futile, futile, that people that don't really think that landlords should just have to attend to their renter's satisfaction with that product as much, I think, as they should. And if you can't provide the service, then you can't really be in the industry. I think it's it's not the case that you should just be able to maintain yourself in the industry providing a substandard service and not being held to account. I think one thing that's so that's one area, is really thinking about the composition, really thinking about how you're framing the problem.
Cynthia Strathmann:I need think we also really need to think about effective implementation and enforcement. And I mentioned before that there's a cooling mandate in the county to keep rooms at a certain temperature, and that's great. I think it's a good first start, but it is very difficult to enforce that. It's hard to know what temperature everyone's living room is at any given moment of the day, whereas it would be much easier to enforce an equipment mandate. So in the same way that you have to have a mechanism to heat a unit, which is required in many places, would have to have a mechanism to cool that unit.
Cynthia Strathmann:But that, you know, of course, that's expensive and it comes into, you know, it sort of runs into that, but I'm a landlord, I get to do whatever I want with my property, sort of cultural or psychological barrier that I was mentioning before. But I think it is really important to think about what is going to be easy to implement. And then I think, you you asked about how can we protect tenants? I think one thing that is really important to always remember is that tenants need basic protections so that they can, you know, stay in their homes and have a little bit of economic and social security. And so that means things like controls on costs, rent control or rent stabilization, so that rents can't go skyrocketing at a moment's notice.
Cynthia Strathmann:Those kinds of controls ensure that a landlord can't pass through all of the costs of a mandate. You know, say I I say you have to have fans in every room. The landlord can't then say, okay. I'm gonna just charge the tenant for all of that. And that's an important policy consideration because often, even if there's rent controls or rent stabilization, landlords will be allowed to charge tenants a bit more if they do what's called a capital improvement.
Cynthia Strathmann:And we've seen landlords just pass off the weirdest smallest changes as a capital improvement that really should not be considered a capital improvement. So you have to have some kind of standard in place around that. And I think another thing it's important to remember is when landlords have to do some kind of work in a building, that work often increases the value of the unit. And so asking the tenant to simultaneously pay for the capital improvement while they're also paying rent on the building that has the capital improvement is, you know, could be considered a type of double dipping on the part of the landlord because they're already realizing the value in the property itself. And I think another type of renter protection that's really important are eviction protections, and many municipalities have these, but not all do.
Cynthia Strathmann:Think a lot of people assume that you can't just be evicted for any reason, but you actually can be unless there are just cause eviction protections in place. Somebody can just walk in and be like, I don't like, you know, I don't like your beard, you know, you're out of here. And so having some kind of set of just cause provisions is very important. Also making sure that there are protections for tenants in the face of substantial remodels. As I said, you know, capital improvements can be used as a way to get around eviction protections.
Cynthia Strathmann:Having a policy that's comprehensive enough that you're contemplating things like what people could do with a substantial remodel provision is really important. And then, you know, the last sort of specific I'll mention is making sure that there's tenant habitability programmes in place. If you do have to ask somebody to leave so that you can do a major, major renovation, which, and I think we can all imagine scenarios in which that's true, there should be a mandated plan to make sure that we know what happens to that tenant. Does that tenant get to come back? Are they housed elsewhere?
Cynthia Strathmann:You know, is there support for them while they're being housed elsewhere? You know, is the landlord obligated to make sure they have a comparable place to live while they're, you know, taking rent for the place that they are live that they aren't able to live in at the moment? So those those types of protections, I think, are all really, really important in in in maintaining tenancy in the face of of of some of these climate mitigation measures. I guess the final point I would make is that that it is very important to not allow climate change effects to push tenants out of their housing, that tenants are an important part of a community's fabric. They are often considered somehow lesser community members, I think, than homeowners, but tenancy is going to, I believe, become more common for longer periods of time for people as housing becomes more expensive.
Cynthia Strathmann:And in any case, I think tenants never should have been considered as sort of lesser citizens when we're thinking about the comfort of the built environment or in how to maintain a community because tenants really are a part of any community protection and their well-being and the ability of them to, you know, enjoy their homes and be safe in them is really important.
Rob Lott:Great. Well, I think that's a great spot for us to wrap up. A good sort of agenda for us to look forward to potential policy interventions and certainly subjects for research going forward. Doctor. Strathmann, thanks so much for taking the time to chat with us today and thank you for your work on this really important article.
Cynthia Strathmann:Well, you so much for having me and for lifting up this issue.
Rob Lott:Absolutely. And to our listeners, check out the entire May issue at healthaffairs.org. Lots of really important and interesting research and commentary. If you enjoyed this episode of A Health Podyssey, leave a review, recommend it to a friend, and of course, tune in next week. Thanks, everyone.
Rob Lott:Thanks for listening. If you enjoyed today's episode, I hope you'll tell a friend about a health policy.