Safe, stable and healthy housing is foundational to public health, but the housing stock in many communities are met with hazards like lead, mold, pests and insufficient heating. To address housing hazards, municipalities can leverage available and existing partnerships to ensure the greatest impact is achieved. Health systems, like nonprofit hospitals, can play a crucial role in investing in the social determinants of health (SDOH). Partnering with health systems can enable cities to access research, community connections and potentially secure funding to support initiatives such as healthy housing.
Nonprofit Hospitals and Housing from Community Health Needs Assessments
Nearly 50 percent of all hospitals are nonprofit and can be potential partners for increasing local capacity to address the social needs of their communities meaningfully. Every three years, nonprofit hospitals must conduct a Community Health Needs Assessment (CHNA) to address the health needs of the community. Through the CHNA, hospitals can identify housing instability, substandard housing and housing hazards as critical community health issues, opening the door to community benefit investments in healthy housing. Once a need is identified, hospitals may then allocate community benefit funds toward:
- Screening and referring patients for housing needs
- Quality improvements, like remediation of lead, mold and pests
- Collaborating on new and existing affordable housing developments
- Offering rental or utility assistance that supports health
- Policy advocacy and data sharing to expand housing affordability
Following the assessment, to claim the IRS tax credit, nonprofit hospitals must demonstrate a community benefit, which can take the form of a “community health improvement” program. These “activities or programs are subsidized by the health care organization and are carried out for the express purpose of improving community health” (PDF). Through these types of partnerships, cities can leverage existing resources to support local healthy housing goals.
City Examples of City-Health System Partnerships
Columbus, Ohio
After identifying the trend of declining homeownership and increases in poverty, predominantly in African American neighborhoods, Columbus’ Department of Neighborhoods created a resident-driven planning effort to better understand the shared priorities of residents and communities. The process created the Linden Community Plan: One Linden, which outlined the desires of residents for improved housing quality and options for multiple income levels. The Department of Neighborhoods recruited partners, including the Nationwide Children’s Hospital (NCH), which already had a community development initiative titled Healthy Neighborhoods Healthy Families. Through this partnership, the Nationwide Children’s Hospital is committing resources to advance the affordable housing targets identified in the One Linden plan. NCH is positioned to offer support in the form of renovations of existing homes, new builds with energy-efficient and green features and grants to homeowners to make exterior improvements to their homes.
Boston, Mass.
Boston’s comprehensive housing plan, Housing a Changing City: Boston 2030, established a vision that supports “growth and prosperity for all,” including the plans to develop 53,000 new housing units. After reviewing the housing plan and identifying Boston’s growing rates of homelessness and housing instability, the Boston Medical Center (BMC) consulted with the Massachusetts Department of Public Health, the Boston Alliance for Community Health, the Boston Public Health Commission, the Boston Region Metropolitan Planning Organization and local leaders. Through these partnerships, BMC committed $6.5 million to expanding affordable housing opportunities in Boston’s most underserved neighborhoods. Municipalities are well-positioned to be the drivers for hospital engagement and community input can support the decisions to ensure initiatives are targeting areas where they can achieve the greatest impact.
Baltimore, Md.
Baltimore offers a powerful example of how cities and health systems can collaborate to advance healthy housing through mobility programs. Given the connection between health outcomes and housing, the Baltimore Regional Housing Partnership (BHCP) connected with the Green & Healthy Homes Initiative, the Housing Authority and Health Department of Baltimore City and a team of public health researchers from Johns Hopkins University to launch the Healthy Children Voucher Demonstration (HCD) in late 2022. The HCD brings together these partners to offer a comprehensive approach to improving housing situations with a public health lens. Using a referral system, families will gain access to housing search assistance, housing counseling and community health resources provided by the Health Department’s B’more for Healthy Babies initiative, HealthCare Access Maryland and Johns Hopkins Hospital. Families receive targeted support that focuses on their individual situation and will be continuously engaged by BRHP counselors to share additional support resources. An evaluation study conducted by Johns Hopkins School of Public Health measures the efficacy of the community health worker referral process to ensure short and long-term goals are met.
Positioning Cities for Health System Partnerships
A key component for cities considering collaborating with hospitals and health systems is to be proactive in aligning priorities and building trust. Cities should consider the following strategies to support the sustainability of city and health system partnerships.
1. Leverage Community Health Needs Assessment Data
Cities should review these public reports to identify housing-related health priorities like asthma, lead exposure or housing instability and use them as a foundation for partnership proposals.
2. Create a Shared Vision
Frame housing as a health intervention. Demonstrate how preserving existing housing stock, developing new and affordable units and integrating supportive housing can reduce hospital re-admissions and improve community health.
3. Develop Cross-Sector Infrastructure
Establish referral systems or data-sharing platforms that connect housing programs with health providers.
4. Blend Funding Streams
Combine hospital community benefit dollars with city housing funds, federal grants and philanthropic investments to scale projects. Hospitals often seek measurable health outcomes. Cities can provide housing expertise to deliver those results.
5. Pilot and Scale
Start with targeted initiatives in underserved neighborhoods with high health burdens. Use measurable outcomes, like the number of asthma emergency room visits or improved housing quality, to make the case for larger investments.
Cities are uniquely positioned to attract health system investments into housing initiatives that not only improve housing quality but also reduce health disparities and strengthen community well-being.
Explore Housing Supply Accelerator Fact Sheet on Public Private Partnership
These fact sheets explain ways cities can establish public-private partnerships for housing production and preservation. Discover how to leverage these partnerships as a means to fund housing and as a strategy to share resources, align efforts and tackle housing issues in an interdisciplinary manner.
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