The social determinants of health – defined by the World Health Organization as the conditions in which we are born, grow, live, work, and age – significantly influence individuals’ health outcomes. As evidence of this influence mounts, a growing number of hospitals, health systems, and insurance providers are investing “upstream,” in initiatives that address the social determinants of health, in order to improve patient outcomes and reduce expenditures “downstream,” at the clinical level.
Affordable housing is one form of “upstream” investment that is proven to have significant impact on community health. As such, affordable housing and healthcare professionals are increasingly seeking to partner to better serve patients and residents. On February 26, NVAHA and HAND presented “Rx for Building Health and Housing Partnerships,” an event dedicated to exploring the challenges and benefits of cross-sectoral relationships within the greater Washington region. More than 90 housing and healthcare professionals attended the event, which shed light on many important considerations as we continue this conversation and move forward in forming partnerships to address the social determinants of health.
Community Engagement is Key
In her keynote address, Dr. Kamillah Wood, a community pediatrician and public health practitioner, urged healthcare institutions and housing professionals to start by asking their communities, “What do you need?”
Too often, partnerships are formed and programs, facilities, and services are designed by community development professionals who assume they know what residents in the community want. However, residents know best what they need in light of the daily challenges that impact their health and well-being. Authentic engagement begins with designing a community-centered process in which residents lead in developing priorities, programs, and initiatives, building trust and community buy-in.
Community engagement is especially important for partnerships that serve communities of color and other marginalized populations because of the history of systemic, structural racism and discrimination in both the housing and healthcare sectors. Engaging communities of color and other underserved populations is a step toward regaining the trust of these communities, and drawing on their expertise will help ensure the development of programs and services that are needed, desired, and delivered in an effective manner.
Find a Partner Who Shares Your Vision
Not only is trust an essential ingredient for effective community engagement, it is also one of the pillars of a successful partnership. Another pillar is a shared mission and vision. Not all healthcare institutions have embraced the social determinants of health as part of their work. In fact, some institutions feel that their role should not extend beyond the provision of clinical care. Housing and healthcare professionals should seek to align with institutions that share a desire to address the social determinants of health and are prepared to go the distance to promote health equity in their communities.
Utilizing existing tools such as the community health needs assessment (CHNA), can help define a shared vision between housing and healthcare stakeholders. Under the Affordable Care Act, nonprofit hospitals are required to conduct a CHNA every three years to retain tax-exempt status. These assessments are useful for identifying hospitals that recognize housing as a community need and may be looking to invest. A CHNA may also reveal other important considerations. For example, if obesity is identified as a major health concern within the community, access to fresh food and space for physical activity should be considered when planning a new affordable housing development. CHNAs and similar assessments are an asset that many healthcare institutions bring to the table that can be used to guide and inform a partnership.
Communicate Openly
A special break-out session at the event was dedicated to overcoming communication barriers. The healthcare and housing industries each use unique jargon, including ample acronyms – at times identical – which can be confusing for anyone who is not an industry insider. Understanding each other’s terminology and a willingness to ask questions is a critical first step in the ‘getting to know you’ phase of a partnership.
Beyond this phase, partners must agree on what subset of housing need to address. Some hospitals may want to invest in housing for high-needs patients, such as individuals experiencing homelessness while living with a chronic illness, because such an investment is likely to result in cost savings. Examples from case studies presented on Wednesday also showed an interest in investing in housing for hospital employees who could not afford to live near work. The tools and strategies available to a developer are contingent upon who is being served, so substantive discussions on goals are important.
A developer’s decision to use one investment strategy over another also depends on the investment funds and balance sheets of the healthcare partner. Partners may differ in their financial vision for a project, often due to the misconception that all healthcare institutions have deep pockets. Depending on the availability of resources, strategies as varied as land donation, rental subsidies, and loan guarantees may be appropriate. Open communication and the ability to agree to shared expectations are vital to building a sustainable partnership.
Commitment to Ongoing Dialogue
Wednesday’s event brought together diverse stakeholders, some of whom are actively engaged in housing and healthcare partnerships in the greater Washington region and beyond, and some of whom are just beginning this work. NVAHA and HAND were gratified by the enthusiasm of the forum participants and their interest in building upon this event to achieve partnerships that advance community wellness and racial equity in our region.
Nora Daly, Director of Programs and Community Engagement