What Are the Links Between Housing and Health?

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“Your ZIP code is more important than your genetic code,” said David Erickson, director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco, at Thursday’s “Are Our Neighborhoods Making Us Sick?” webinar.

The event, hosted by the Robert Wood Johnson Foundation, explored the links between public health and community development.

Erickson said that unemployment levels today are practically unchanged from when “The War on Poverty” began. “We just need to do better,” he said. “And we need to evolve.”

Although Erickson said that reining in inflation was the Federal Reserve’s chief obligation, he also said the banks had a duty to do so while maintaining maximum levels of employment. “It does have a dual mandate,” he said.

Erickson said that many social determinants of health are tied directly to community development. Counting up the contributing factors of premature death on the national level, he notes that 15 percent of early deaths in the United States. can be attributed to social circumstances and environmental exposure, with behavioral patterns accounting for almost 40 percent of all premature deaths in the country.

“[These are] things that are outside of medical care or genetics,” he said. “[This is] something community development can influence.”

Erickson considers community developers to be “health care workers on the prevention side.” He examined two heat maps of Los Angeles County, representing the overlay between communities with severe economic hardship index levels and communities with higher prevalence rates for childhood obesity.

Indicating what he considered “the neighborhood nature of health disparities,” Erickson said that when the maps are overlapped, “the same neighborhoods of concern light up.”

He said that developing business models to merge public health and community development goals would require the acquisition of new partners, new ideas and new resources. To successfully knit together the two fields he suggested using new resources – such as redirected existing funds like Medicare and Medicaid – alongside all new resources, including affordable care organizations, social impact bonds and program-related and mission-related investors.

“Safe, vibrant homes are vital to public health,” Erickson said. “Much more than medical care.”

Nancy Andrews, president and CEO of the Low Income Investment Fund (LIIF) financing firm, said that a “paradigm shift” was occurring in the field of community development.

“We are likely to look back at this time and wonder why community development and health were ever separate industries,” she said. Andrews believes the questions of poverty and health are so connected that they should be viewed as pieces of the same puzzle.

If one was to overlay communities with the worst incidents of disease and poor health with hotspots of poverty, “you would find an almost perfect match,” she said.  

Andrews said that LIIF employs a holistic approach, incorporating elements of housing, childcare, education, health and transit-oriented development as part of its financing model. She believes that a focus on “environmental quality and soundness” would lead to an overall system change that would increase resources for community developers.

Andrews said that community development financial institutions (CDFIs) like LIIF serve as “a bridge between poor neighborhoods and Wall Street.”

By providing loans to community projects – such as affordable housing programs, healthier food options and daycare centers, which she said would not be able to profit otherwise – Andrews believes CDFIs are often “a link between major capital flows and distressed communities.”

Her organization has invested more than $1 billion over the last quarter-century, she said, and that in assessing data like graduation rates and improved family income LIIF has generated more than $21 billion in “family and societal benefits.” Capital investments “can literally be the lifeblood” for creating healthier environments in distressed communities, she said.

Assessing the CDFI industry as a whole, Andrews said that there are more than 1,000 such investment firms nationally, which, collectively manage more than $30 billion in capital. She spoke about one of her organization’s most recent projects, the Eddy & Taylor Family Housing unit in San Francisco’s Tenderloin neighborhood -- one of the poorest and most densely populated areas in the city.

With financing from the Bay Area Transit-Oriented Affordable Housing Fund, which she said was a $50 million “public-private partnership,” more than 150 units of affordable housing, complete with a fresh food store, was constructed. She’s optimistic that similar projects can be replicated in other parts of the country.

“If we can find a way to do this, and do this credibly,” she said, “I think we can rock the house.”

Miriam Axel-Lute, editor of Shelterforce and associate director of the National Housing Institute, said that she thinks of “community development very broadly.” To her, perspectives of “prevention and place” are vital to instigating changes in practices regarding affordable housing, foreclosure prevention and urban revitalization programs.

“Environmental justice is crucial to environmentalism as a whole, not peripheral,” she said. “Foreclosures are often caused by, and then cause, health crises.”

Axel-Lute said that many environmental influences, including asthma triggers like mold and pests, are forcing renters to leave their housing units for health reasons. “When landlords were intransigent,” she said, “tenants moved to secure healthier housing conditions.”

She notes that many communities are unequal in both stability and resources. “Some neighborhoods have experienced poor civil displacement,” she said, stating that she would like to change the way that funding streams for things like revitalization programs are “isolated from one another.”

According to Marjorie Paloma, senior policy advisor at the Robert Wood Johnson Foundation, there’s a clear connection between housing and public health.

“What we build is shaping our social behaviors,” she said. “It’s not just the homes in and of themselves.”

She believes that the bonds that bring people together is tied to housing. She examined four communities within Washington D.C., noting that residents that lived in better and healthier housing units had an average life expectancy that was 10 years greater than those living in the neighborhood with the poorest housing conditions. “Small distances can equal these big differences in health,” she said.

Paloma believes partnerships with local health non-profits could be beneficial for community developers.

“We don’t think of housing as just brick and mortar,” she said. “We really think of it as stability, especially for those that are the most vulnerable in society.”

She also said that the use of Health Impact Assessments (HIAs) which factor health outcomes for residents in policymaking processes could help curb some of the “unintended risks” that arise from community divisions, like rezoning and revitalization efforts. The use of HIAs, she believes, could also limit redundancies in housing inspections.

Paloma said that she would like to see housing and community development officials collaborate more frequently.

“Together,” she said, “we can build happy, healthy places for better lives.”