The Housing-Healthcare Connection
Access to housing is a key social determinant of health, so why are health systems largely ignoring it?
Maslow’s Hierarchy of Needs indicates humans require fulfillment of basic physiological needs (food, water, warmth, and rest) and safety needs (personal security and accessible resources).
This equips the individual to be a productive member of society and work towards the ultimate goal of self-actualization, the fulfillment of the individual’s talent and potential.
For those facing housing instability, these basic needs are unmet.
The housing crisis facing us is also a healthcare crisis — so how are health systems working to address this social determinant of health?
The Necessity of Health Systems Intervention
Research conducted by the Urban Institute examines the motivations, opportunities, and barriers nonprofit hospitals and health systems face when investing in affordable housing development. Nearly every hospital in the study believes housing is a “fundamental resource that can support health and well-being,” and half think the health care sector should be involved in developing housing or providing rental assistance (Reynolds et al., 2019).
Hospitals acknowledge that access to housing is a strong positive social determinant of health, and most provide medical care to people experiencing homelessness and offer clinical services and food assistance at affordable housing sites. Why then are hospitals generally less interested in direct financial investments in housing? These health systems could be using their financial position to enhance credit, lower borrowing risks and costs, provide land, and offer grants and direct loans to cover construction costs.
While many health systems are concerned about the time and resources needed to tackle the housing issue, a few providers are beginning to invest in affordable housing, understanding that stable living conditions can be the best first step in preventative care.
Models for Change
Zip code is often a much more indicative determinant of health than genetic code. So it makes sense health systems are slowly beginning to invest in affordable housing in their communities. In 2019, UMass Memorial Health Care announced their Anchor Mission with the goal of improving the health and welfare of the community beyond the hospital walls.
By leveraging and redirecting the full economic and intellectual power of the organization, UMass can have a much larger impact and encourage other institutions to do the same. Investment in projects that address affordable housing, homelessness, and food insecurity builds trust between the community and while enhancing long-term health outcomes.
This year, The Healthcare Georgia Foundation made a $250,000 investment to expand access to healthy, affordable housing that benefits persons of color, low-income households, seniors, and other vulnerable groups across Georgia. Foundation President, Dr. Gary Nelsons, says this program will “address one of the key social determinants of health (housing) in such a strategic and impactful way.” The Foundation’s vision is “health equity across Georgia,” and in addressing housing inequities, they are starting at the ground level, building a foundation for communities to thrive.
In one of the most innovative projects I have come across, three companies in Louisville, Kentucky are collaborating to develop affordable housing sites with free onsite medical care. Norton Healthcare, LDG Development, and First Source are focusing on primary and preventative care in areas where healthcare has traditionally lacked.
The mobile health care services available will be primarily geared to managing and preventing chronic illnesses common in underserved communities, including diabetes, hypertension, and cardiovascular disease. The services will also focus on women’s health and pediatrics, given that many households in the area are headed by single mothers. This initiative shows that the healthcare coalition is not only addressing the broad issue of access to affordable housing, but focusing in on the specific demographics they serve and what health services are needed.
The same individuals who struggle to find affordable housing are also more likely to face health problems and lack of access to healthcare. This is not a correlative relationship. This is causation. Evidence strongly suggests that addressing housing insecurity can improve individual and population-level physical and mental health and alleviate conditions like respiratory infections, asthma, lead poisoning, mental health conditions, and more.
LDG Development is the country’s largest developer of affordable housing, with more than 17,000 units across the country. They see an opportunity to expand this on-site care model into dozens of other communities. While many health systems hyper-fixate on the bottom line, it may be up to developers to lead the charge in combatting the housing-healthcare crisis. Institutions like UMass Memorial Healthcare and The Healthcare Georgia Foundation have enacted excellent models for others to build on.
Time to Step Up
It may seem idealistic to hope that health systems would take on financial burden out of the goodness of their hearts, but isn’t that the point?
Hospitals used to be run by religious or philanthropic organizations to serve the poor. They provided a public service and generated little if any income. Not-for-profit (NFP) hospitals are entitled to tax exemptions to serve the community, and yet, in 2018, tax-exempt hospitals spent less than 9 percent of their total expenses on community benefit, with less than 0.4 percent for community health improvement services. These hospitals are not providing community benefit equal to the government’s tax expenditure on them.
NFP hospitals and health systems are uniquely situated to be investors in affordable housing development projects. As anchor institutions, they have a stake in the health outcomes of the populations they serve. In addition to the long-term health benefits of stable housing, people turn to ERs when they have nowhere else to go, placing a resource burden on the hospitals. Hospital-provided land or low-interest loans to developers would slash acquisition costs and facilitate the development of low-income housing that would benefit the community, and ultimately the hospitals.
So, what is the delay? If hospitals and health systems see housing as a platform for addressing social determinants of health, and they function based on an assumed community benefit that they aren’t meeting, it’s time to start footing the bill.
Atlas Research’s Health Disparities Working Group is releasing a new series identifying and providing solutions to the complex challenges that underserved Americans face. We look forward to engaging with our readers and driving the conversation on topics such as mental health, Veterans’ health, homelessness, maternal health, economic disparities, racial justice, and more. Opinions expressed are that of the author, and do not necessarily reflect Atlas’ position.
