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Housing and Health: Creating Solutions With Communities

By Stacey Barbas and Kate McLaughlin, Kresge Foundation; Jessica Mulcahy, Success Measures; and Vedette R. Gavin, Verge Impact Partners


The following us an excerpt from the article "Housing and Health: Creating Solutions With Communities," and is a part of FHO's Collaboration for Housing Justice series originally published by the Stanford Social Innovation Review. In the series, we share ideas, observations, and lessons from our housing justice efforts, including how and why the work will only move forward if it is systemic, anti-racist, and bridges sectors.


Illustration by Raffi Marhaba, The Dream Collective

The Kresge Foundation wanted to learn with grantees about work at the intersection of housing and health equity. Their takeaway: Fund community-driven solutions and community power.


In vibrant and thriving communities, people have the power and resources to realize their vision of health and well-being. Residents, regardless of zip code or how much money they have, can breathe clean air, eat healthy and culturally appropriate food, and have a safe, affordable place to call home.


However, in far too many places in the United States, that’s not the case. Decades of discriminatory housing, transportation, and land-use policy combined with economic disinvestment have resulted in communities that are residentially segregated by income, race, ethnicity, language, and immigration status. There are inequities in housing quality, stability, and access; and imbalances of power that favor markets, developers, and landlords.


The importance of housing as a social determinant of health has been well-documented by researchers and philanthropies alike. The research finds that housing affects health through three pathways: housing stability, housing affordability, and access to a health-promoting neighborhood. Housing instability—whether through homelessness or frequent evictions and moves—creates chronic, toxic stress and exposes people to traumatic and unhealthy situations. When housing is unaffordable, it leaves little money left over to buy healthy foods and critical medicines. The home you can afford also determines the neighborhood you can live in—a neighborhood with access to public transportation that can connect you with jobs and opportunities, grocery stores with nutritious foods, and safe spaces to exercise or one filled with pollutants, high-traffic roads, and crime, all of which have an impact on health. And when it comes to housing, just having a roof over your head is not enough. Whether it is developing asthma from mold caused by leaky ceilings, dealing with diseases caused by rodent infestations, or suffering from deadly waves of extreme heat when air conditioning units don’t work and don’t get fixed, poor housing conditions directly harm people’s health.


Safe, stable, and affordable housing in many ways is like preventive care, reducing the risk and likelihood of both displacement and poor health. When communities are uprooted and displaced, connections between neighbors, families, and other sources of community support are severed. Separating people from who and what they need causes trauma not just individually, but at the community level, which has negative consequences for people’s health.


 

Learning About Community Power


While approaches to building power varied across grantee organizations, all grantees agreed that building power, which they loosely defined as an ability to cause something “to be or happen” with and for community residents, is central to using housing to advance health equity. In other words, residents’ ability to cause things “to be” in their communities is essential for addressing and remedying systemic housing injustices and improving health.


One grantee explained, “Power exists now with people who make development decisions about neighborhoods or who reinforce enforcement laws that favor landlords. These are the folks that are in power now to determine what the health conditions will be for the Black and Brown people in our community. We want to shift that so that the people most impacted are the ones who have that power to decide what the future of their community will be.”


We learned that among grantees, housing practices that advance health equity and build community power draw on a few common principles and foundational practices.


Recognizing residents as experts and engaging them in decision-making. For example, to help address the housing shortage, Hawaiian Community Assets has partnered with other local nonprofits and community members to create the Affordable Hawaii for All (AHA) Fellows, a program designed to deepen leadership within the Native Hawaiian and Pacific Islander communities and foster community-driven change in the local housing market. The fellows, some of whom do not have homes, are committed to creating a model for affordable communities built by and for the people who will live there. AHA works with community members to build connection and capacity first, and then to engage with the broader housing assembly and policy makers. This shift in power creates housing and community-building efforts like the Pu‘uhonua O Wai‘anae village or “Aloha Lives Here,” a village of approximately 250 unhoused people living on 20 acres of land on the leeward side of the island of Oʻahu, that serves as a refuge for healing from financial disaster, trauma, abuse, addiction, and injury.


Building collective community power by building up individual power. In communities where rents and displacement are rising, residents understood the neighborhood would improve but not for people like them. For Hope Community Inc. in Minneapolis, owning the land is paramount for building power to change things. Its train-the-trainer model supports lower-income renters to become owners of small multi-family dwellings. Given the long-term (two years or more) nature of preparing for homeownership, relationships that Hope is building with residents and the relationships residents are building with one another are at the center of the effort. Residents connect with others who are passionate about their communities, come together as a cohort for training led by other residents, and build collective leadership skills to talk and advocate for themselves. Quality housing directly impacts residents’ overall health and well-being, as well as the feeling of belonging and security in their community.


Fueling narrative change with community power. As part of its long-term strategy to advance health equity through community-driven housing solutions, Miami Workers Center in Florida is building community land trusts to create affordable housing in the Liberty City neighborhood. But that isn’t the end goal. Miami Workers Center is also organizing and using direct action and strategic communication to bring more light and attention to what it actually takes for communities to give people the dignified housing they deserve. Ultimately, it aims to shift the narrative toward understanding that housing is a human right.


 

As one of the founding members of the funder collaborative Funders for Housing and Opportunity (FHO), we value having a space where we can not only share what we learn from our work but learn from other members of the collaborative who care just as deeply about housing and health equity. Our FHO peers and grant-funded partners played an important role in informing some of our early thinking that led to the Advancing Health Equity through Housing initiative. We can achieve more collectively than as individual organizations. Together, we can bring our knowledge to policy makers and align investments to help make change so communities thrive.



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