Mapping the Gap: Retrofitting for Health Equity for D.C. Families

Housing and health are inseparable. For families living in older multi-family buildings, substandard conditions, including poor ventilation, mold, and pest infestations, can exacerbate chronic illnesses like asthma and bronchitis. In Washington, D.C., where an estimated 16,000 children suffer from asthma, these challenges intersect with affordability pressures and energy costs, creating systemic barriers to well-being. The burden is not evenly distributed: asthma rates are significantly higher among D.C.’s communities of color and working class households, amplifying health disparities and underscoring the need for targeted interventions.

Recognizing the inextricable link between housing and health outcomes, NHT launched the D.C. Healthy, Green and Affordable Housing (D.C. HGA Housing) Program. D.C. HGA Housing’s mission is to increase climate resilience, improve health outcomes, and preserve affordability for residents in six multi-family properties in the District. Housing more than 800 families, including 178 children with asthma, these properties are benefiting from technical and funding assistance for energy retrofits designed to reduce energy burdens and costs, improve indoor air quality, and enhance long-term health outcomes for residents. 

D.C. HGA Housing is a coalition of partners led by the National Housing Trust (NHT), including Children's National Hospital’s IMPACT DC Asthma Clinic, Children’s Law Center (CLC), VEIC, and Latino Economic Development Center (LEDC). These partners have combined expertise to address the epidemic of childhood asthma in D.C.  By fostering cross-sector partnerships and leveraging pediatric asthma data with energy data, the program demonstrates how data-driven strategies can improve health outcomes, advance energy efficiency, and inform policy solutions.

Why Health Data Matters

The D.C. HGA Housing Program layered health and energy performance data to catalyze action. IMPACT DC, CLC, and local partners developed an asthma registry and an interactive map identifying multifamily properties in D.C. where children with asthma live. The Healthy Housing Map is a geospatial tool that combines anonymized patient data, such as emergency department visits, with publicly available housing condition complaints to pinpoint properties with the highest health risks (see Figure 1).  The result is a clear picture of which buildings pose the greatest health risks and need remediation. The map identifies 200 multi-family properties of concern. 

In addition to health indicators, the program integrated energy performance data to aid property selection. Using Open Data D.C.’s Building Energy Performance dataset, NHT reviewed each property’s ENERGY STAR Score or Energy Use Intensity, enabling them to identify multi-family properties that not only house high concentrations of children with asthma but also suffer from poor energy performance. 

The program’s data-driven approach reframed conversations with property owners and policymakers. Nobody wants to think their housing is making children sick. When presented with clear evidence linking certain buildings to pediatric asthma patterns and poor energy performance, owners who were previously hesitant to invest in improvements became engaged. For government decision makers, the integrated dataset underscored the urgency of aligning housing programs with public health and climate goals, reinforcing the need for coordinated decision-making across sectors.

Building Cross-Sector Partnerships

The D.C. HGA Housing Program’s success hinges on an innovative partnership among a diverse group of organizations—each contributing expertise to resolve challenges that no single entity can handle alone.

NHT provides deep experience in green, affordable housing development, policy, and financing; CNH’s IMPACT DC and the Children’s Law Center contribute clinical and legal insights into child health and housing remediation and have helped build relationships with local government; LEDC brings strength in resident engagement and community organizing; VEIC and its D.C. Sustainable Energy Utility (DC SEU) subsidiary offer technical energy efficiency expertise and implementation capacity; and D.C.’s Department of Energy & Environment leverages its public-sector leadership and funding mechanisms to scale impact. Together with committed property owners, these partners combine complementary strengths to tackle barriers and advance healthier, more climate-resilient homes for families.

A key part of this work is centering resident voices throughout the process, ensuring those most impacted shape decisions about their homes. To build trust and ensure meaningful resident participation, NHT partnered with LEDC, a trusted tenant‑organizing CBO in the District. Together we work with resident leaders, property management, and Resident Service Coordinators to conduct outreach, host kickoff events, and hold small group listening sessions to incorporate residents’ priorities and concerns into project development.

The program’s multi-disciplinary approach has enabled creative solutions, such as integrating healthy housing assessments with energy audits, providing property owners with a comprehensive retrofit package that addresses both energy and indoor air quality. NHT and VEIC prepared property incentive analyses that aligned available public funding incentives with specific measures recommended in the audits. DC SEU, as D.C.’s energy-efficiency program implementer, has begun awarding incentive funds, issuing scopes of work for bid, and overseeing contractor work. 

To date, the program has helped five of its six participating properties qualify for up to $16.8 million in energy-efficiency incentives through D.C.’s Affordable Housing Retrofit Accelerator and Income Qualified Efficiency Fund. Retrofits are underway at two properties, including the installation of heat pumps, smart thermostats, and lighting and air-sealing upgrades. The team continues to work with property owners to develop healthy housing scopes and secure funding.

Lessons Learned

The D.C. HGA Housing Program offers insights into what works when addressing the intersection of housing and health. Hospital usage data on asthma not only identified properties in need but also served as a powerful motivator, helping property owners and policymakers understand the urgency of specific problems and commit to retrofit projects. 

The data also shifted conversations with property owners from basic code compliance goals, such as removing mold but not necessarily the sources of moisture. Now, we’re moving toward whole-building strategies, like commissioning a property moisture assessment study to identify water intrusion issues at their source. Meanwhile, by embedding resident experiences alongside health and energy data and housing conditions, the project team developed retrofit scopes that reflect resident priorities and strengthen trust. 

Policy and Practice Recommendations

To replicate and scale this model, several elements are essential. 

• Promote cross‑sector partnerships. Collaboration across public health, housing, energy, legal aid, and community‑based organizations expands capacity and aligns disparate priorities toward shared outcomes.
• Use cross‑sector data to target interventions. Integrating clinical health, housing conditions, and energy performance data—such as asthma prevalence, emergency department utilization, and ENERGY STAR scores—motivates decision makers and ensures that retrofits address the most pressing needs.
• Align decarbonization investments with health outcomes. Structuring retrofit priorities around both energy savings and resident health outcomes builds broader support and maximizes long‑term impact.
• Center resident engagement as a core practice. A structured, community‑driven engagement model—using resident leaders, trusted CBO partners, listening sessions, and continuous feedback—helps ensure retrofit scopes do not create unintended harms.
• Aggregate projects to achieve scale. Bundling multiple properties into a single initiative makes projects more attractive to government agencies, technical partners, philanthropy, and lenders, enabling greater efficiency, stronger funding competitiveness, and streamlined implementation.

Broadening Impact

The D.C. HGA Housing Program is more than a local success story—it’s a blueprint for other cities grappling with overlapping housing and health challenges. The program demonstrates that cross-sector partnerships, supported by robust data and aligned incentives, can deliver measurable benefits for families and communities. Families deserve homes that support their well-being, and communities deserve strategies that address root causes—not just symptoms. Hospitals, housing advocates, and policymakers nationwide can replicate this approach to create healthier, more equitable housing systems.