President-Elect Trump has named Ben Carson as his Department of Housing and Urban Development (HUD) secretary. With his lack of experience—or a public record—we don’t know what he will do. But as a physician who has cared for children, I hope he will recognize the critical role that safe, stable housing plays in supporting health and well-being, especially for children.  

Millions of families depend on federal programs like public housing and vouchers, but there is not enough assistance to go around and only one in four are lucky enough to get the subsidies. These housing programs are often reviled and blamed for social ills, but the evidence shows that growing up in public housing can lead to better outcomes for kids and vouchers are the most effective way to prevent homelessness.

HUD plays an important oversight and management role in maintaining the nation’s stock of public housing, ensuring that local housing agencies properly manage their properties and administer the voucher program. History tells us when HUD fails in that role, the costs can be devastating for families and communities.

In my new book, No Simple Solutions, I tell the story of the Chicago housing Authority’s (CHA) journey from the most dysfunctional public housing agency in the country to the well-managed agency it is today. By the 1980s, the CHA’s high-rise projects were emblematic of the failures of federal social welfare policy.

But it wasn’t just a Chicago story; HUD’s neglect, especially during the Reagan administration of the 1980s, contributed to the decline of public housing in Chicago and across the country.

In Chicago, lack of oversight and inadequate funds for maintenance and management left the housing agency caught in a downward spiral. Tenants with the resources to move fled, leaving behind an increasingly vulnerable resident population. Those residents endured constant violence and housing that was becoming nearly uninhabitable; too many children paid the price in trauma, injury, poor health—and even death.

But the CHA’s experiences in the 1990s demonstrated what HUD could do with enough resources and political will. In 1995, with an administration committed to improving and strengthening housing programs, HUD took control of the struggling agency, spending four years cleaning up the CHA’s books, bringing in new management, and breaking the logjam that had prevented the demolition of some of the CHA’s most notorious properties. 

HUD returned the CHA to local control in 1999, approving the city’s Plan for Transformation that would lead to all of the agency’s high-rise projects being replaced with new, mixed-income housing. HUD has remained involved, approving the agency’s plans as they’ve evolved, and providing the federal resources needed to support the transformation. As I document in my book, most of the families who lived in those terrible places now are living in decent housing in communities that are less poor, less violent, and offer a better quality of life for their children.

The CHA’s story is a story of success—but also a cautionary tale. If under a new administration, HUD loses resources and pulls back its oversight role, or if Congress slashes funding for housing programs and local housing agencies, or if tax reform undermines the funding for the new mixed-income developments that have replaced the high rises, then the gains for the CHA and other public housing agencies could easily be lost.

That would be a tragedy, undermining a precious resource—decent, safe affordable housing—and leaving another generation of children at risk for growing up with the kinds of trauma that stunted their parents’ life chances.

As my colleagues wrote a few weeks ago, America can’t be great if we abandon our commitment to fair housing. I would add that it can’t be great if we abandon our commitment to poor children.