Monday, December 12, 2011

Funders and Policymakers Increasingly Support Innovative Models to Address Housing and Health

Where we live, work, learn and play has a significant effect on our health and well-being. Recently, in a commentary from Spotlight on Poverty and Opportunity, Department of Housing and Urban Development Secretary Shaun Donovan and Department of Health and Human Services Secretary Kathleen Sebelius discussed how the Obama Administration is working to address these interconnected needs.

As more funding and policy opportunities are developed to address the relationship between housing access and health outcomes, communities can use the growing wealth of research and best practices to both take full advantage of, and influence, these opportunities. Here are some of the ways that housing and health are connected:

1. Where you live affects your ability to access health-promoting resources, such as nutritious food, medical care, a safe environment and public transit.

“An apple a day may help keep the doctor away but that assumes you can find an apple in your neighborhood.” --Dr. James Marks in a 2009 Huffington Post article

Neighborhoods of concentrated poverty can fuel and exacerbate poor health and restrict the opportunities and mobility of residents. According to Spotlight on Poverty and Opportunity’s Helping the Doubly Disadvantaged: The Role of Neighborhoods in Health, concentrated poverty and obesity/ diabetes rates have increased over the same time period, suggesting a correlation between deeply impoverished neighborhoods and poor health. Research on the U.S. Department of Housing and Urban Development’s Moving to Opportunity program, which relocated poor families from high-poverty to lower-poverty neighborhoods, found that rates of extreme obesity and diabetes among female participants declined as they moved into more resource-rich communities.

According to a report released by the Joint Center for Political and Economic Studies, Segregated Spaces, Risky Places: The Effects of Racial Segregation on Health Inequalities, “segregation continues to be a predictor of significant health disparities.” For example, Chicago’s Hyde Park neighborhood, where less than 20 percent of residents live in poverty and nearly 70 percent are white, is directly across the street from Washington Park, where 52 percent of residents are poor and approximately 98 percent are African American. Washington Park’s mortality rate is roughly 1.5 times that of Hyde Park.

In the same Huffington Post article quoted above, Dr. Marks writes, “as it relates to health, our zip code may be more important than our genetic code.” The Boston Public Health Commission has appropriately launched the "What's your health code?" campaign. Investments in neighborhood infrastructure, amenities and safety can improve the health of families.

2. Housing instability (often due to the lack of affordable housing) can cause extreme stress, harm child development and result in poor health outcomes for all family members.

Families who spend more than 30 percent of their income on housing often cannot afford other basic necessities, such as healthy and adequate food, safe and developmentally appropriate childcare and healthcare.In Affordable Housing as a Platform for Improving Family Well-Being: Federal Funding and Policy Opportunities, a report by CSSP, we discuss how affordable housing access and well-being outcomes are connected. For cities with high rates of homelessness, this is particularly problematic. According to a new report released by DC Alliance of Youth Advocates, youth homelessness is on the rise in the District of Columbia. Research has shown that homeless children are more likely to develop mental and emotional health issues and developmental delays than children with a stable home. Homeless individuals of all ages access hospital emergency departments more frequently and stay in hospitals longer than housed individuals in similar health.

3. Housing can serve as a platform for cross-sector, place-based services

Linear models of service provision may require a homeless person to combat addiction, secure employment, or otherwise demonstrate “housing readiness” before they are placed in a stable home. In contrast, permanent supportive housing provides individualized and flexible workforce training, job search assistance, medical care, substance abuse treatment and mental health services, while ensuring housing stability. The latter model operates under the belief that housing is a primary need and it is impossible to expect a homeless person to get a job or overcome addiction.

Although permanent supportive housing may require initial investment, long-term pay-off is substantial and often mitigates program costs. A diverse array of studies and programs, analyzed in Ending Chronic Homelessness: Cost-Effective Opportunities for Interagency Collaboration, demonstrate the success of permanent supportive housing. For example, one study found that 88 percent of those enrolled in a New York City Pathways to Housing permanent supportive housing program remained housed after 5 years, as compared to just 47 percent of the individuals in a linear residential treatment program.

The benefits of permanent supportive housing are not limited to homeless populations. In the aforementioned report Affordable Housing as a Platform for Improving Family Well-Being: Federal Funding and Policy Opportunities, CSSP acknowledges the important role of stable housing as a means for connecting people to services and resources, including quality healthcare and grocery stores. PolicyforResults section on promoting affordable housing provides policy recommendations and best practices for supporting interagency partnerships and co-location of housing and services.

For example, in Vermont, the Support and Services at Home (SASH) program, highlighted in a series of case studies compiled for the recent How Housing Matters Conference, supports the health of elderly and disabled residents who are dually eligible for Medicaid and Medicare. Diverse funding streams include Medicaid and Medicare (public) and various private foundations. To expedite implementation and minimize costs, SASH services are integrated into preexisting affordable multifamily housing developments. Due to the pilot’s success, SASH has been fully integrated into Vermont’s statewide healthcare reform plan, Blueprint for Health, where it is expected to save $40 million in Medicare costs by the fifth year of implementation.

Fortunately, policymakers and funders increasingly support the important connections between housing and health:
Through Choice Neighborhoods, Sustainable Communities Regional Planning Grants, Transportation Investment Generating Economic Recovery (TIGER) II and Community Challenge Planning Grants, the Department of Housing and Urban Development under President Obama is funding innovative, cross-sector initiatives to improve neighborhood resources and infrastructure and promote healthy residents. Additionally, the Neighborhood Revitalization Initiative (NRI), piloted by President Obama’s administration, represents a unique commitment from the Departments of Housing and Urban Development, Education, Justice, Health and Human Services and Treasury, as well as the White House Domestic Policy Council and the White House Office of Urban Affairs to revitalize disinvested communities through interdepartmental collaboration and resident engagement.

A number of private foundations also fund and support (through technical assistance and communities of practice) innovative, cross-sector, place-based neighborhood revitalization and health improvement efforts:

  • Joint Center for Political and Economic Studies: Place Matters: 16 Place Matters teams throughout the country are working to improve health in their communities by addressing social determinants of health, including education, employment and housing. In recognition of each community’s unique needs and characteristics, the Place Matters projects vary significantly.
  • The California Endowment: Building Healthy Communities: Through a generous 10 year grant, 14 sites in California are working to increase school attendance and access to quality healthcare and decrease youth violence and childhood obesity
For more on what policymakers can do to support affordable housing, see PolicyforResults’ coverage of this topic.

For more information, see also PolicyLink Center for Health and Place

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Is your community addressing place-based health disparities?
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