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Affordable Housing Policy: It’s Not All Gloom and Doom
It’s no secret that Arizona has an affordable housing crisis. It’s not unique to Arizona – but some of the most acute effects are being experienced here. While the crisis is still acute – at least housing and homelessness are widely recognized as being a community and public health crisis and policy makers are beginning to respond.
While the large-scale efforts to compel recalcitrant cities to humanize their overly restrictive zoning restrictions contributing to the lack of housing supply, there were some good policy movements last legislative session. Let’s start with the state legislature.
State Legislature
There were 4 modest housing reform bills that were passed last session that over time will make some difference, three of which go into effect on January 1 (one goes into effect January 1, 2026).
- HB2720: Cities with more than 75K residents will need to modify their zoning regulations to allow ‘accessory dwelling units’ aka casitas, on lots zoned for single-family use by Jan. 1, 2025.
- HB2297: Cities with 150K people will need to allow apartments on up to 10% of commercial, office or mixed-use buildings by Jan. 1, 2025. The law also includes language to speed up the zoning process. Sadly, Scottsdale set up their rules and practically won’t allow any (only 1%) – perhaps sparking a fistfight with the legislature this session.
- SB1162: Under this new law, cities will need to install zoning code changes that speed up the approval process for construction. The localities also have to publish a housing needs assessment every five years and outline the total need for added housing through population and job growth data and how much of a locality’s land is zoned for housing, starting Jan. 1, 2025.
- HB2721: Under this law that will take effect 1/1/26, cities with 75K people will need to allow for the development of duplexes, triplexes and other multi-family home options on lots zoned for single-family use.
State Agencies
There are also some things happening at the state agency level that are encouraging. For example, the Arizona Department of Housing is using the Arizona Housing Trust Fund to address housing instability and develop housing solutions across the state. Key initiatives include:
- Affordable Housing Development: Over $62 million has been allocated to create new affordable housing units, addressing the critical housing needs of low-income families and individuals
- Transitional and Permanent Housing: Investments include $9 million for transitional housing and homeless shelters, $7.5 million for permanent supportive housing, and $4.7 million for youth homeless shelter facilities
- Rental Assistance and Eviction Prevention: A significant portion of funding, $17.7 million, supports rental assistance programs and eviction prevention to stabilize families at risk of homelessness
- Support Services: Funding also supports operational services for homeless shelters, case management, utility assistance, and employment and education programs. For example, $6.3 million was given for these supportive services, enhancing long-term housing stability
AHCCCS is also stepping up to the plate by implementing a new waiver that follows a ‘Permanent Supportive Housing Model an evidence-based and cost-effective strategy for addressing & improving health outcomes for persons with a serious mental illness.
This intervention will also be key for reducing homelessness – as nearly of those experiencing homelessness in Arizona have an SMI designation, highlighting the disproportionate burden on this population.
AHCCCS is also funding a new facility on the grounds of the AZ State Hospital that will provide ‘bridge housing” for persons with behavioral health needs.
The facility will have a separate (physically attached) outpatient behavioral health service setting. When completed, it’ll have capacity for approximately 70 people (w/privacy).
Related:
AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program – AZ Public Health Association
AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program – AZ Public Health Association
Water Fluoridation is Good for Public & Oral Health
In addition to his desire to halt immunizations in the US, Robert F. Kennedy Jr. is also urging cities to stop fluoridating their public water systems.
While Kennedy wouldn’t have the authority to directly stop fluoridation if confirmed as the HHS Secretary, he could alter CDC guidance so as to discourage water fluoridation, causing many communities to reconsider this essential public health measure. This is troubling, especially since his stance is, once again, not backed by evidence.
Community Water Fluoridation Evidence Review: Mel & Enid Zuckerman College of Public Health
Fluoridating water to optimal levels is one of the greatest public health achievements of the 20th century, according to the CDC. It prevents tooth decay across all age groups and socioeconomic statuses, saving families and communities money on dental care.
Ten Great Public Health Achievements 2001–2010
About Community Water Fluoridation | Fluoridation | CDC
In Arizona, where dental care access is already uneven, fluoridated water has been a key to improving overall oral health at the community level, especially for children and low-income families, who are more likely to suffer from cavities. About 58% of the state’s population benefits from fluoridated public water.
Without fluoridation, these Arizonans would face higher rates of oral disease, worse health outcomes, and increased dental costs.
Communities of 1,000 or more people see an average estimated return on investment of $20 for every $1 spent on water fluoridation.
The ROI for community water fluoridation increases as the community size increases, but even small communities save money for their residents and cities with fluoridated water save an average of $32 per person a year by avoiding treatment for cavities.
Kennedy’s pattern of promoting pseudoscientific claims is well-documented. From vaccines to water fluoridation, he often ignores mountains of scientific evidence to chase fringe ideas. His opposition to fluoridation, despite decades of research proving its safety, risks undermining public health progress.
CDC Scientific Statement on Community Water Fluoridation | CDC
If the CDC revised its guidance under Kennedy as HHS Secretary, some or many cities would likely stop fluoridating their water, leading to preventable cavities, poorer oral health, and higher healthcare costs, particularly in low-income communities.
Note: CDC does not mandate community water fluoridation. The U.S. Public Health Service (USPHS) recommended fluoride level is not an enforceable standard.
The U.S. Public Health Service (PHS) Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries is science-based guidance on the optimal level of fluoride in community water supplies.
The PHS panel that provided the recommendation considered all sources of fluoride intake and recommended 0.7 mg/L as the concentration that maximizes fluoride’s oral health benefits while minimizing potential harms, such as dental fluorosis.
Public Health Journalism this Week
Preventing child fatalities in Arizona – Arizona PBS
Attorney General Kris Mayes ‘outraged’ by opioid distributor payments
AZ poised to end health care coverage for millions if Trump and Republicans cut Medicaid funding
Connecting through music | Center for Health Equity Research
Pinal County workers have probable bird flu; first humans in Arizona
UnitedHealthcare covers state of Arizona employees, among others.
RSV, COVID-19 cases drastically decrease in Arizona as flu cases spike
Arizona Public Health Grant Opportunities
Compiled by the Vitalyst Health Foundation
Due November 29th: Centene Foundation (Healthcare Access, Social Services, & Education)
NEW Opens December 1st: Fighting Hunger Grants
Due December 3rd: Science for Nature and People Partnership
Due December 4th: Kroger Giving Back
Due December 4th: Ken Kendrick Grand Slam Awards
Due December 5th: Agriculture and Food Research Initiative Competitive Grants Program
Due December 9th: OneCause Software Grant
Due December 11th: City of Tempe Human Services Funding
Due December 13th: Cohort to Improve the School Food System
Due December 15th: Sundt Foundation
NEW Due December 31st: Medicaid Beneficiary Advisory Council Planning and Implementation (learning collab)
Due December 31st: The Stocker Foundation (literacy & STEAM)
Due January 6th: Annual Seeding The Future Global Food System Challenge
Due January 9th: Regional Infrastructure Accelerator Program
Due January 10th: Farm to School Implementation Grant
Due January 13th: Agriculture Conservation Experienced Services Program
Due January 13th: Building Capacity for Small Organizations To Engage in Patient-Centered Comparative Clinical Effectiveness Research
NEW Due January 15th: Journey for Good Grants (food, workforce, education, and veterans)
Due January 23rd: AmeriCorps State and National Competitive Grants
Due January 23rd: Tribal Clean Energy Planning and Development
Due January 30th: National Infrastructure Investments
Due January 31st: Bloomberg Philanthropies – Asphalt Art Initiative
Due February 28th: Rural Business Development Grant Program
NEW Due March 1st: Endowment for the Arts Grant
NEW Due March 1st: Dr Scholl Foundation
NEW Due March 21st: The Peter and Pat Hirschman University-Community Research Partnership Fund
Due March 31st: Sunset Grant
Ongoing: Arizona Housing Fund
Ongoing: Arizona Together for Impact Fund
H5N1 Influenza: Birds, Cattle, and Humans
Influenza is a sneaky virus. Perhaps the biggest wildcard with the virus is its ability to mutate. Flu viruses undergo two main kinds of change: routine antigenic drift (small, gradual tweaks) and antigenic shift (big, dramatic changes).
Big (and potentially dangerous) antigenic shifts happen mainly in birds, where different flu strains can swap genetic material, creating entirely new versions of the virus.
Ducks, chickens, and other fowl are the mixing bowl for flu strains, creating combinations that are sometimes capable of infecting mammals. Pigs are usually the next link in the antigenic shift chain because they share respiratory receptors similar to humans.
If a bird flu virus infects a pig, it can further adapt to replicate efficiently in mammals (called ‘reassortment’). When this happens, the virus has the potential to jump to humans, raising concerns about severe illness and even pandemics.
So, where does H5N1 fit into all this? H5N1 is a type of avian flu that has been circulating among birds for decades, occasionally infecting humans. In recent years, its spread has taken a concerning turn, showing up not just in wild birds but also in poultry and, most recently, mammals—including cattle.
The Current Situation
According to the CDC and USDA, H5N1 infections in birds have increased dramatically in the last year with widespread outbreaks among wild and domestic flocks.
The virus is now present in every state including spillover to mammals like foxes, raccoons, polar bears and cattle. While cattle don’t seem to transmit the virus, infections highlight how H5N1 is adapting to new hosts – potentially leading to a reassortment event where the virus becomes easily transmissible among humans.
Surveillance and Response
To stay ahead of the virus, extensive surveillance efforts are underway. The USDA and wildlife agencies are testing birds, while state and federal animal health officials are closely watching cattle herds. CDC is coordinating with state health departments to track potential cases and support readiness for larger outbreaks.
H5 Bird Flu: Current Situation | Bird Flu | CDC
Meanwhile, public health and animal health experts are collaborating to implement interventions like culling infected bird flocks, restricting animal movements, and implementing stricter biosecurity practices on farms.
For humans, the focus right now is on educating those at risk—like poultry workers—about proper protective gear and vaccination options.
H5N1 hasn’t yet made the leap to efficient human-to-human transmission. But the situation demands vigilance because it could happen.
H5N1 is a reminder that flu viruses are dynamic and unpredictable. Continued surveillance and a coordinated response will be key to keeping this virus in check—for birds, mammals, and humans.
Preventing Child Fatalities in Arizona: The Case for Firearm Safety Reform
Back in the mid 1990’s the AZ State Legislature set up the Arizona Child Fatality Review Program to evaluate every child death and provide evidence-based policy recommendations to prevent child deaths.
Over the years many policy and operational interventions came out of these reports, from safe sleep to new seat belt laws for kids. The goal of each year’s report is to conduct a comprehensive review of all child deaths and make policy recommendations to prevent as many as possible.
The report 2 years ago found that firearm deaths increased 41% over the previous year, while child death rates were 250% higher than the national average (likely due to the lack of mitigation measures implemented by the previous administration).
View this Year’s Child Fatality Review Report
The Arizona Child Fatality Review Program’s goal is to reduce child deaths in Arizona by conducting a comprehensive review of all child deaths to figure out what steps could have been taken, if any, to prevent each child’s death.
- Among children aged 1-4 years, drowning was the leading cause of death.
- Among children aged 5-9 years and 10-14 years, motor vehicle crash was the leading cause of death.
- Among children 15-17 years, firearm injury was the leading cause of death.
Preventable Deaths
The review teams carefully look at each death to decide whether each was preventable (some deaths – like congenital anomalies may not be preventable). The leading causes of Preventable Deaths among all kids 0-17 are as follows:
- Motor Vehicle Crashes (81) 20%
- Firearm Injury (68) 16%
- Suffocation (52) 13%
- Poisoning (34) 8%
- Drowning (31) 7%
Report recommendations include:
- Safe Sleep Environments: Continue to educate parents on safe sleeping environments.
- Prevent gun deaths: “Remove firearms in households with children; and incentivize proper firearm storage of guns by making gun owners legally civilly & criminally responsible for improper firearm storage.”
- Prevent vehicle deaths: Require children younger than 13 to be in the rear seats of vehicles; Promote child safety seats; Increase awareness of the risks associated with driving under the influence; and ensure helmets are worn when needed.
- Prevent prematurity: Policies to encourage pregnant women to avoid using substances such as drugs or alcohol during pregnancy; Increasing the availability of affordable health insurance; Awareness of AHCCCS coverage up to one year postpartum; and increasing availability of home visiting programs.
- Support healthy families: Expand of the DCS Workforce Resilience Experiences and home visiting programs; Increase awareness of Adverse Childhood Experiences and increasing awareness; and Support for the All-Babies Cry Program.
2024 Focus: Firearm Deaths
This year’s Report sheds light on a grim reality: firearm-related deaths among children have surged by 171% over the past decade.
In 2023 68 children lost their lives to firearm injuries—all preventable. Of these deaths, 44% were suicides, and 40 out of 61 homicides were firearm related.
From the Report:
“CFRP believes that the most effective way to prevent firearm-related deaths in children is to remove all firearms in households with children because the presence of firearms in a household increases the risk of suicide among adolescents.”
“Parents of all adolescents should remove all guns from their homes, especially if there is a history of mental health issues or substance use issues.”
“In addition, CFRP recommends that all gun owners should practice safe storage of their firearms by keeping guns unloaded and locked in a safe separate from the ammunition.”
The report highlights the pressing need for policies to protect children from firearm-related harm.
Added recommendations include:
- Mandating mental health screening and gun safety training before firearm purchases.
- Enacting Child Access Prevention laws to ensure safe firearm storage.
- Licensing and tracking firearm ownership.
- Promoting public awareness of the importance of reporting stolen firearms and implementing penalties for non-compliance.
The recommendations in this year’s report can be implemented in various ways. Some, like passing Child Firearm Access Prevention laws require legislative action, while others can be implemented by AHCCCS, ADHS, ADES and DCS without added statutory authority.
For more insights, view the full 2024 report here.
Firearm Violence in Arizona: Data to Support Prevention Policies
Public Health Journalism this Week
Gun-related deaths soar among Arizona youth, but fewer are dying from fentanyl
Does your throat hurt when you swallow? It could be the flu
Arizona saw 853 children die in 2023. Nearly half were preventable
Maricopa County backyard flock tests positive for bird flu
How Trump’s Picks for HHS Could Impact Arizonans: Sunday Squareoff
More Arizona kindergartners are getting vaccine exemptions – Axios Phoenix
Arizona’s SMI System: Performance Improvement & Accountability Start with Measurement
In public health and health care, tracking and measuring performance isn’t just about generating numbers—it’s about accountability. For state agencies, transparency in reporting is the foundation for finding gaps, distributing resources effectively, and improving outcomes for vulnerable populations.
AHCCCS’ recent report under state law shows the power of measurement in holding agencies accountable.
The report provides some demographic, housing, and incarceration data on Arizona’s population of persons with a Serious Mental Illness (SMI), shedding light on the significant challenges they face.
For example, the report reveals that 12% of Arizona’s SMI population (7,812 individuals) experienced homelessness last year, compared to just 0.2% of the general population.
Half of those experiencing homelessness in Arizona have an SMI designation, highlighting the disproportionate burden on this population.
Housing instability isn’t the only issue. Nearly half of SMI members on the housing waitlist remained there for more than 6 months and 6.4% of the SMI population was incarcerated in the past year—a rate more than 10 times higher than that of the general public.
Reports like these force state agencies to confront hard truths and give advocates and policymakers the tools they need to spark interventions.
Without data transparency, systemic challenges can remain hidden, and meaningful improvements may never materialize.
The Transformative Potential of SB1311
Senator Miranda’s SB1311, passed in the 2024 legislative session, is a big step toward improving transparency in the metrics and outcomes for persons in Arizona with a serious mental illness.
The new law builds on the previously existing reporting requirements by mandating enhanced data collection and analysis and tying funding to specific performance benchmarks.
The First Year of reporting under SB1311 is due by December 31, 2025. Some of the outcomes required by the bill include:
- Hospitalizations and rehospitalizations;
- Screening and evaluation facility use and discharge data;
- Tracking when folks are released without treatment;
- Treatment adherence & program dropout data;
- Incarceration events;
- Rehospitalizations;
- Crisis interactions;
- Substance use;
- Employment;
- Mortality data;
- In-depth housing data including homelessness; and
- Behavioral health residential facility uses and discharge data.
SB1311: Mental Health; Oversight; Documentation
The data AHCCCS will publish next year will provide for more accountability in Arizona’s public mental health care system like minimum performance standards for housing programs serving individuals with SMI. This is critical, given the stark reality that so many SMI members spend months or years waiting for housing.
AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program
The bill also emphasizes collaboration across systems. For example, it directs AHCCCS to work with the Arizona Department of Corrections to reduce incarceration rates among the SMI population.
By addressing the root causes of criminal justice involvement— like untreated mental health conditions and housing instability—SB1311 aims to provide the data needed to inform interventions that break the cycle of incarceration that disproportionately affects those with SMI.
Another benefit of the new law is its focus on equity and access, requiring agencies (AHCCCS’ Managed Care Contractors) to disaggregate data by demographic factors such as race, ethnicity, and geographic location, ensuring that disparities are found and addressed.
SB1311 also includes mandates for stakeholder engagement, requiring AHCCCS to ask for input from individuals with SMI, their families, and advocacy organizations. This ensures that reforms are informed by the voices of those most affected by the system’s shortcomings.
A Path Forward
By providing and monitoring performance we’ll be in a better position to identify gaps in the system and make necessary and targeted and systemic improvements.
These new data will also be key to informing performance metrics to hold AHCCCS, their contractors and the state legislature accountable for the performance of (and funding for) Arizona’s public behavioral health system.
What Gets Measured Gets Done: Tackling Housing & Incarceration Challenges for Persons with Serious Mental Illness
The old adage from the U.S. Management Association is right: What gets measured gets done.
AHCCCS’ latest report highlights some of the basic information about outcomes and social determinants for folks Serious Mental Illness (SMI) designation. The findings paint a challenging picture about homelessness, housing waitlists, and incarceration rates among the 63,000 folks living with a serious mental illness in Arizona.
AHCCCS 2024 Serious Mental Illness Report
Housing & Homelessness
Let’s start with homelessness. The report reveals that 7,812 SMI members experienced homelessness in the last year – 12% of the SMI population. To put that in perspective, Arizona’s general population has a homelessness rate of just 0.2% (14,200 out of 7.5 million according to the latest ‘Point in Time’ Survey).
About half of all individuals experiencing homelessness in Arizona have a SMI designation (7,812/14,200). That means SMI members are overrepresented in Arizona’s homeless population by a factor of 60.
AHCCCS data also found that half of the SMI population on the housing waitlist had been waiting for stable housing for more than 6 months. That’s a long time for people who need housing stability to manage their health and daily lives.
Justice System
Another statistic from the report: 6.4% of SMI members were incarcerated in the past year. That’s over 10x the incarceration rate for Arizona’s general population of 0.6%. For those with a serious mental illness incarceration often results from untreated symptoms, a lack of housing, and insufficient community support.
Interventions Under Way
So, where do we go from here? Fortunately, AHCCCS is stepping up.
Their new H2O (Housing to Outcomes) initiative aims to tackle housing instability head-on by integrating housing solutions with health care services.
As described in our recent blog post below, H2O is designed to address the root causes of housing insecurity, expand access to stable housing, and improve health outcomes for Arizona’s most vulnerable residents. It’s a promising step in the right direction, and AHCCCS deserves credit for recognizing the urgency of the situation and acting.
AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program
AHCCCS and ADOA are also partnering to build a new facility on the grounds of the AZ State Hospital to provide ‘bridge housing” for persons with a serious mental illness. I’ve been keeping tabs on the construction each time I go down Van Buren – and the facility appears to be coming along quickly.
The facility will have a separate (physically attached) outpatient behavioral health service setting. Residents will not have to be in treatment to access housing services.
According to a PowerPoint from AHCCCS, it’ll have 24/7 shelter staff for supervision & security. Housing & services will be available by referral only (no walk-up services).
New Facility on AZ State Hospital Grounds to Provide Bridge Housing for Persons Experiencing Homelessness with Mental Health Needs
The overall challenges with the lack of housing, the wait for stable housing, homelessness and incarceration continue to be huge problems and far more needs to be done.
But… measuring challenges like homelessness, long housing waitlists, and incarceration among the SMI population brings the scope of the problem into focus.
With initiatives like H2O, there’s hope that future reports will show meaningful progress. After all, what gets measured truly can get done. In my next post I’ll highlight the added measures that will become available next year at this time as a result of the successful passage of SB 1311 last year.