The visit to the Clinton-Peabody public housing complex in St. Louis was originally designed with a straightforward objective. The neighborhood surrounding the development has a high infant mortality rate and staff members of a local nonprofit called Generate Health wanted to educate residents about safe sleep practices for babies that might save some lives.
While parents throughout history have co-slept with their babies, research has shown that the risk of sudden infant death syndrome is greater when parents and infants share a bed—often with blankets that can restrict a baby’s ability to breathe freely—and pediatricians don’t recommend it. In St. Louis, Black babies are three times more likely to die before their first birthday than white babies, and Generate Health’s initiative—called Flourish—focuses on educating parents around the city on ways to keep their babies safe in their first year of life.
So when the organization convened a meeting of Clinton-Peabody residents, staff “were talking about strategies, talking about the importance of babies sleeping by themselves and getting access to portable cribs,” recalls Lora Gulley, Generate Health’s director of community mobilization and advocacy.
Then something happened that changed the entire trajectory of the campaign. As the meeting was about to end, one of the facilitators asked, “Is there anything else we need to talk about before we close out?”
Sam Blue, then president of Clinton-Peabody’s tenants’ association, raised his hand. “There’s no safe sleep when mice are running through your units.”
Blue went on to explain that the complex had a significant mouse infestation, and parents there were afraid to let their children sleep alone because of it.
Generate Health’s leaders were shocked. “The meeting went another 30 or 45 minutes,” says Blue. “And from that meeting on, it seemed like it took on legs of its own. All the agenda was pushed aside, and [addressing the mouse infestation problem] was a priority.”
Health organizations frequently talk about the importance of “upstream factors” that can affect people’s health, and how access to things like nutritious food, reliable transportation, and safe housing can make a major difference. At times, however, there’s more talk than action.
Generate Health’s response to this new information was unusual. Rather than discounting the issue or addressing it superficially before returning to their original plan, the organization’s leaders fully took it on and went to bat for the residents. And even when initial efforts didn’t yield results, Generate Health intensified its advocacy, helping to recruit local, state, and even national stakeholders over the course of a year until the problem was resolved.
Mice Had the Run of Clinton-Peabody
At the time of the meeting, which occurred in mid-2017, the mouse issue wasn’t new to many of the roughly 1,000 tenants at the housing complex. They had been grappling with it for years. “A lot of times my children would come home and say, ‘Oh, there’s been a mouse on my bed!’ because they’d see the droppings. It became a noise issue because you’d hear them in the walls, even if you didn’t see them,” remembers Delois Blue, Sam Blue’s wife. “Mothers were concerned about their children maybe getting bitten by mice. For me, it was like, ‘Dag, where are they coming from? And why so many?’”
The residents knew the issue was systemic. Clinton-Peabody, which was built in 1942 and has 358 units spread across 31 buildings, is the oldest public housing complex in the city, and residents saw that no part of it was being maintained well. Among other things, gaping holes around pipes and other infrastructure allowed mice to enter and move between units. They lived in the radiators, the stoves, and the refrigerators. And mice weren’t the only problem. According to Generate Health staff, other individuals who visited the complex, and newspaper reports, some units also had mold, roaches, bedbugs, or foul odors emanating from inaccessible areas.
Over the years, a few residents complained to the St. Louis Housing Authority, which owns Clinton-Peabody. But the housing authority responded on a case-by-case basis, viewing the issue as the individual residents’ problem. It would send inspectors from the city’s Department of Health, who would examine specific units and often write citations to those tenants for their lack of hygiene, says Gulley—regardless, it seemed, of how clean the units actually were. Eventually, she added, residents stopped communicating with the housing authority for fear of retaliation.
When Generate Health learned about the problem, the cabinet overseeing the safe sleep program was immediately determined to tackle it. With Sam Blue as a connector and mediator, the organization’s staff held packed, emotional meetings with residents to learn more about their experiences. They reached out to Legal Services of Eastern Missouri, which has a housing law program, to better understand residents’ rights. They got in touch with leaders of the city of St. Louis’s health department, one of Generate Health’s longtime partners.
And they contacted the housing authority, whose initial response was once again to blame tenants for the problem. “Their rationale was classes [on housecleaning] and cleaning supplies” for the renters, says Gulley. “But we had residents saying, ‘My house isn’t dirty. It’s clean and it still has mice.’”
Legal Services employees pointed out to the housing authority that it could be seriously liable if something happened to one of the residents as a result of the conditions at Clinton-Peabody. “It was just disgusting there,” says Amanda Schneider, managing attorney of Legal Services’ Health Justice Initiative. “The conditions were so deplorable.” She and other lawyers from the organization began applying for emergency transfers for the most vulnerable people there, such as pregnant women and children with medical issues. Even that, however, was a monthslong process.
In late summer, the housing authority made a suggestion that changed the tenor of the debate: its leaders proposed setting six feral cats free at Clinton-Peabody to catch the mice. Residents and Generate Health staff were livid at what they called a flippant, half-baked response. And the health department was furious, eventually suing the housing authority over alleged ordinance violations.
A local Fox News reporter who anchors a series on government waste called “You Paid for It” got wind of the plan and reported it on the evening news. The subsequent public outrage seemed to have an impact on the housing authority, which finally began taking some concrete steps to address the issue. Maintenance workers and contractors plugged holes in dumpsters, cleaned out trash-filled stormwater basins, sealed exterior doors and crawl spaces, and filled holes in walls. The housing authority also hired an exterminator to aggressively trap mice and check progress weekly.
But in November 2017, the health department issued maps showing that at least 23 of the development’s 31 buildings were still mouse-infested. At the urging of Generate Health, the health department examined the housing authority’s contractual arrangements and found that Clinton-Peabody’s management company, McCormack Baron Salazar, wasn’t carrying out all of its duties. “They didn’t do things they should do, like having a schedule for emptying trash containers, and mice were having a field day,” says Gulley. “And they weren’t being held accountable.”
Simultaneously, Generate Health’s leaders began bringing other players into the discussion, including three managed care companies that covered a majority of Clinton-Peabody’s residents. “They shared some of their data,” says Gulley. “It looked like [residents had] an uptick in respiratory ER visits and other doctor visits; there were chronic issues.” Those results, while disturbing, weren’t surprising: there is a well-established link between the presence of mice and pediatric asthma and other respiratory issues. The health care companies also mobilized their government relations staff to assist with advocacy efforts.
Generate Health also reached out to local politicians. One state legislator, Sen. Jamilah Nasheed, had grown up in the complex; she was joined by another, Rep. Bruce Franks, and they publicly appealed to the housing authority on behalf of residents. Together with U.S. Sen. Claire McCaskill, they also contacted Secretary Ben Carson at the U.S. Department of Housing and Urban Development, which funds housing authorities across the nation, to complain about the conditions.
The mouse problem at the decaying complex was slowly being addressed. According to a March 2018 news article in the St. Louis Post-Dispatch, the Housing Authority reported having spent $250,000 there on corrective actions, and a February inspection revealed that the number of infested units had been cut by half since December. But many homes still had a significant problem. Just as important, other issues remained, like backed-up sewage and a malfunctioning heating system, that could only be solved with major renovations.
Later in March 2018, the state lawmakers led a protest at the housing authority’s Board of Commissioners meeting, demanding more sweeping improvements. That event bore fruit. Within a few weeks, McCormack Baron Salazar declared that it had replaced its staff overseeing Clinton-Peabody and was committed to better engagement with residents. And Missouri Attorney General Josh Hawley announced that his office had launched an investigation against the housing authority, and later sued the agency. (The office dropped the lawsuit in 2019, after the housing authority and management company spent a year cleaning up the property.)
Gradually, other significant changes occurred. The housing authority established an online portal where residents could enter and track maintenance requests, adding a crucial layer of accountability. Members of the agency’s board of commissioners with seeming conflicts of interest were replaced. And the agency’s longtime executive director retired and the position was filled in November 2018 by the current leader, Alana Green. “The new individual was welcoming and engaging,” says Gulley. She seemed far more open to hearing from tenants, and continues to focus on improving conditions at Clinton-Peabody.
Many residents, however, still felt unsafe in their homes. Driven, perhaps, by the public outcry and realization that these conditions were unacceptable, many had begun leaving the development. Sam and Delois Blue moved their family out in late 2018; even with the improvements, their teenage children found the conditions at the complex unbearable. Losing Blue, its closest contact among the tenants, made Generate Health’s work more difficult. But the organization’s leaders built new bonds among existing tenants and have continued working at Clinton-Peabody, even after the mouse issue was slowly resolved.
Moving Toward Greater Community Engagement
In 2022, Generate Health earned the inaugural Health Justice Award from the Root Cause Coalition, a national group of health-related organizations, for its work focusing on the nexus of health and housing at the St. Louis housing development.
But while it was doing that work in 2017 and 2018, Generate Health was shifting its approach. Seeking ways to better address systemic racism, the organization’s leaders realized they needed to do more than simply include residents in a cohort of experts. Community members needed to actually drive the initiatives that concerned them. “So we shifted to a fully community-led cabinet,” says Rose Anderson-Rice, Generate Health’s deputy director.
Today, the people making decisions about the organization’s strategies and interventions are the same ones who are most impacted by the issue, whatever it may be. “And the community members don’t rubber-stamp anything,” says Anderson-Rice. “They’ll tell you, ‘Nope. Absolutely not.’ Or they’ll say, ‘Yeah, you got it.’”
Generate Health’s overall style of community-based engagement isn’t new in the field of public health, but it’s been growing in popularity over the past few years. “We are seeing more trends toward centering communities in this field,” says Melissa Monbouquette, executive director of the BUILD Health Challenge, a national initiative that works with community-centered partnerships to improve equitable health outcomes. Among recent applications from organizations aiming to be part of the BUILD cohort, she says, “we saw real progress in groups planning to share power with those most impacted by the upstream issues.”
The housing field hasn’t traditionally prioritized residents’ voices, but that too seems to be changing, if more slowly than in public health. In St. Louis, all the turmoil over the mouse infestation probably contributed to the housing authority’s eventual decision to look into redeveloping the complex. In 2022, it convened a diverse group of stakeholders, including one person who lived there, to review proposals for modernizing Clinton-Peabody.
That group ultimately chose the nonprofit Preservation of Affordable Housing (POAH), a Massachusetts-based national housing organization with a branch in Chicago, to serve as the project’s developer. “One key factor for selection was the developer’s demonstrated commitment to community engagement throughout the redevelopment process,” wrote Val Joyner, director of communications at the St. Louis Housing Authority, in an email.
POAH just began a monthslong community-based planning process at Clinton-Peabody. Residents will be involved in all aspects of the redevelopment process, from deciding whether to renovate or to completely redevelop the property, to determining the future complex’s housing options, physical features, and social and economic services offered.
That kind of participation and engagement by the people who will be the end users simply makes sense. “It just illustrates how ‘Nothing about me without me’ is true,” says Anderson-Rice, talking about participatory practices more broadly. Designers and strategists can be wonderful, she concedes. “But if you don’t talk to and listen to community, it’s for naught.”
Editor’s Note: Co-sleeping with babies is a controversial topic. While the American Academy of Pediatrics does not recommend that babies sleep in the same bed with parents, there are many arguments in favor of co-sleeping, as long as it is done safely.