The health care industry in the United States is adding its voice to those calling for affordable and safe housing. Why this is happening?
Health care organizations have been investing in supportive housing for some time. These projects typically include permanent housing with support services on site.
Who gets to live in this housing? Efforts to control frequent visits to hospital emergency departments drive health service choice of tenants. People with long histories of homelessness are often at the top of the list.1 And although these initiatives are welcome, they represent small potatoes when compared with the number of people who are homeless and the households that are at risk of becoming homeless.
More recently, health care organizations are speaking up for changes to housing policies at the political level. This represents a significant shift in practice. Health care organizations have been a constant presence in the halls of government. What’s new is their expression of concern for the social factors that contribute to individual health and well-being.
This change mirrors a corresponding shift in the basis for public health care funding. Following passage of the Affordable Care Act,2 public funding to health care systems is increasingly based on community health assessments and improvements in community health outcomes. Funding that has historically been tied to the number of procedures and hospital visits is being determined by new criteria.
The new criteria begins with assessing the factors that drive hospital visits in the first place. Many of those factors are social. More than half the adults in the U.S. have a chronic health condition (think heart disease, diabetes, asthma). Evidence shows that changes to diet, exercise and lowering stress level all help to improve these chronic conditions.
But it’s hard to change your diet, exercise more or have less stress when your housing costs use most of your available income. Housing that is in poor condition and/or crowded also stand in the way of changes to diet, exercising more and lowering stress levels. Health care organizations are gradually acknowledging these key linkages and starting to speak up.
For example, the Robert Wood Johnson Foundation has been leading research and innovation on health and health care since 1952. Safe and affordable housing was the exclusive focus of the Foundation’s president in his annual message in 2019. These concerns were further amplified in Foundation’s dispatches during 2020 as COVID arrived with uneven effects that are linked to housing conditions. Most recently, the Foundation has produced advice to minimize an avalanche of evictions and homelessness for the Biden administration to consider. To read more see: Improving Housing Affordability And Stability To Advance Health Equity
To give an idea of just how much might need to change within health care organizations, here’s an article reflecting on time spent as a hospital resident. The author argues that bringing social considerations into patient treatment in the hospital will mean changes in training and funding for residents, something that is long overdue. Read more in Psychiatric Times: Beneath the Wheel: A Resident Reflects on Burnout and Professional Identity
For advocates who have been calling for changes to housing policies and programs, it should be welcome news to have large health care organizations weighing in to call for changes to housing policy. And it is welcome. Long time housing advocates may chafe at the glacial pace of change as health care organizations test their mettle in this new policy field. But as the author of the Shelterforce article linked below points out, patience up front could pay off in the long run.
For example, the health organizations need to be connected to local community groups to fully understand local issues. In this context, local community groups are experts whose wisdom and experience is valued. They can become strategic allies for the health care organizations.
Health care organizations also have significant financial resources that they can use to build the evidence base demonstrating that affordable and safe housing is a key factor in health and well-being. These resources can be a big boost to community groups that understand the evidence well enough, but lack the resources to organize and present it.
As well, health care organizations have access to officials and politicians at all levels of government. These doors aren’t so easy to open for local community groups. Imagine what could happen to housing policy when there are connections at numerous levels of government, a strong evidence base and the advice of local experts! Read more at Shelterforce: Outside Their Comfort Zone: Health Sector Players Speaking Up for Housing Policy Change and Health Care Institutions Invest in Tenant Protections for Community Health
