This story is part of a series of interviews with Safer + Simpler Missouri coalition partners.
“The building code may be invisible to the person living in a house, but its consequences aren’t,” says Jasmine N. Hall Ratliff, Executive Director of Build Missouri Health. The nonprofit organization makes the case that where and how we live shapes nearly every aspect of our well-being, and that healthy and affordable housing is essential to a healthier Missouri.
“Building codes are intended to prevent a building from falling down and to meet minimum safety requirements – but that’s not all they should do,” Ratliff says. “There’s an assumption that [since] building codes keep buildings structurally sound, they are therefore safe for inhabitants. Safe is not the same as healthy, however. Health is multifaceted, encompassing our physical, mental, and financial well-being.”
That’s why Ratliff wants to expand the definition of “safe” in building code. While preventing injuries is essential, we should also be asking whether people are truly healthy in their homes, workplaces, and schools.
It’s a question well worth asking. Build Missouri Health associates poor housing quality in Missouri with increased risks of asthma, lead exposure, injuries, and chronic stress — while mold, pests, and inadequate ventilation can exacerbate respiratory problems.
St. Louis, for example, has long had higher rates of asthma than the national average, with strong racial disparities. According to the updated 2026 Environmental Racism in St. Louis report from the Interdisciplinary Environmental Clinic at Washington University School of Law, from 2010 to 2015, Black St. Louis residents made 8.5 times as many asthma-related ER visits (per 1,000 residents) as white residents. Black children had more than 42 asthma ER visits per 1,000 children versus less than 4 for white children — more than 10 times as many.
The same report shows that in 2023, the median majority-Black St. Louis ZIP code had a childhood lead-poisoning rate of 13%, eight percentage points higher than the median majority-white ZIP code.
Ratliff is quick to point out that there are multiple contributors to those statistics, including disparities in access to preventive healthcare, poor-quality housing, mold, and air pollution. To examine the effects of air pollution on specific neighborhoods, Build Missouri Health refers to the AirWatchSTL program, “a community-based monitoring network designed to fill gaps in regional air-quality data and advance environmental justice and health equity,” according to their website. Community air monitors in St. Louis feed a map showing local air-quality conditions. Ratliff suggests the data could potentially help to illuminate connections between environmental conditions and health outcomes.
But it’s also clear that the quality of the built environment has real health consequences, and those consequences are not distributed equally.
In part, that is because Missouri lacks a statewide building code standard, leaving it up to individual municipalities to establish, enforce, and update codes. Safer + Simpler Missouri’s research shows a significant number of jurisdictions follow code books that are a decade or more out of date.
In conversations with other professionals about building codes and housing, Ratliff often finds herself the “lone health person in the room,” she says. But she is not deterred.
“The way we build, maintain, and regulate homes and buildings directly affects the physical, mental, and financial health of the people inside them,” she says. For example:
- Indoor air quality. Windows, ventilation, insulation, mold, and building systems affect what people breathe every day.
- The more energy efficient the home, the lower the utility bills. Better-performing homes can mean lower household costs. According to the National Low Income Housing Coalition, our state currently has a shortage of more than 128,000 affordable rental units. For every 100 extremely low-income households in Missouri, only 31 affordable rental homes are available. Nearly 30% of Missouri households are housing-cost burdened, meaning more than one-third of their income goes toward housing.
- Mental health. Financial stresses (due to high energy bills, for example) and concerns about unhealthy surroundings create a chronic mental-health burden for residents – a dimension of building policy that is rarely discussed.
- Modern construction techniques can make homes more energy efficient and structurally resilient, which matters even more when communities are recovering from tornadoes, floods, and other disasters. (Build Missouri Health has been directly involved in relief efforts following the May 16, 2025, tornado that ravaged miles of homes and buildings in St. Louis.)
“Housing policy is health policy,” Ratliff explains. She describes her philosophy as “health in all policies,” and notes that people working in codes, plumbing and other fields may not realize they are also affecting community health.
“Modern codes establish the baseline,” Ratliff says. “Better design can go beyond that baseline. But communities first need a modern, understandable foundation from which to build.”
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