How do housing and health entities build partnerships in the first place?

A version of this post was originally published on How Housing Matters.

Housing organizations and health providers have realized they are natural allies. They serve the same people living in the same places, and are learning that their missions are aligned: improving housing quality and stability can lead to better population health outcomes. A growing emphasis on prevention within the health care sector has housing organizations eager to help. But partnering across sectors can be bumpy.

Last week, we shared best practices for engaging citizens in health and housing interventions discussed at a recent convening cohosted by the Urban Institute and the National League of Cities. But how do housing and health entities build partnerships in the first place? And how does their mutually supportive relationship work?

Community Development for All People

When Nationwide Children’s Hospital approached the city of Columbus, Ohio, for help with infrastructure for a facility expansion, the city brought the nonprofit community development corporation Community Development for All People (CD4AP) to the table to make sure the expansion offered maximum benefits for the surrounding neighborhoods. As Reverend Edgar of CD4AP recounted, the conversations “started small and grew over time as trust emerged, and we gradually realized that there was a lot we could do together that we simply weren’t able to realize independently.”

They discovered that their goals aligned and their resources were complementary. Nationwide Children’s could tap into its funds and leverage business relationships, while CD4AP could apply for government housing funds. That was the start of a 10-year partnership.

Together, they formed a subsidiary corporation owned by CD4AP and funded by the hospital, with a board chaired by Nationwide Children’s chief financial officer but made up of residents, CD4AP staff, and hospital staff. Healthy Homeshas completed the gut rehabilitation and sale of 71 vacant homes, new construction on infill lots, and 150 grants for current homeowners to undertake renovations. The partnership says it has reduced the number of vacant and blighted properties more than 50 percent, and property values have started to rise again—so much so that they are now focusing almost exclusively on providing affordable rental housing. Most recently, they completed a Low-Income Housing Tax Credit development with 2,500 square feet of job training space for the hospital to provide job readiness and skills training just a seven-minute walk from its front door.

Community Development for All People has expanded beyond housing to look at other social determinants of health in partnership with Nationwide Children’s, including neighborhood safety, neighborhood and family well-being, fresh fruit and vegetable distribution, peer health coaches, cooking classes in a demonstration kitchen funded by the hospital, and a social enterprise (a community bike repair shop). They have also launched a major initiative on reducing infant mortality where CD4AP identifies women who are pregnant or have infants and engages them through home visiting, connecting them to other resources for maternal and child health needs.

“It is housing first, absolutely,” said Reverend Edgar. “But in addition,…our priority is not just that the neighborhood looks better, in terms of housing, but that the people feel better…[with] zero displacement, in an opportunity-rich community.”

For other community development organizations, his advice was to start small by talking to the hospitals—not by telling them all the things they should be doing but aren’t, but by finding places where their goals align with yours. Show the value you bring to their work, including your legitimacy as a neighborhood advocate. As a large hospital on a national stage, Nationwide Children’s faces image risks if new programs don’t work right from the start. The partnership with CD4AP gives the hospital more capacity to try new things, especially because CD4AP is more willing to take the blame for failures and shield the hospital from negative feedback.

The Boston Housing Authority + Boston Public Health Commission Partnership

Public housing authorities provide rental housing to vulnerable individuals and families, including those who struggle with health issues. For a health organization, the local housing authority can be a valuable partner for reaching populations with prevention and treatment services. Early partnership efforts, however, should be mindful that housing authorities are often fighting an uphill battle to build a positive image and shed their recurring role as a scapegoat for all manner of neighborhood fears.

Trying to understand the source of health disparities, researchers nearly 20 years ago analyzed housing conditions within properties owned by the Boston Housing Authority (BHA), the largest landlord in Boston. Researchers found pests, mold, and dust contributing to residents’ poor health. But BHA was the subject of research, not a partner in the study. The independent study made the agency feel underappreciated and attacked. As Gail Livingston, deputy administrator for housing programs at BHA, described, “BHA’s first foray into public health issues could have been its last” if partners had not found a way to collaborate more effectively.

Fortunately, BHA cared about the findings and its residents’ health, despite its lack of voice in the initial research. As a key “impartial institutional player with a mission to make things better,” the Boston Public Health Commission (BPHC) got involved alongside BHA to launch follow-up programs and research focused on improving BHA residents’ health, including funding for BHA and the potential to improve operations rather than simply criticize them.

Since then, partners have worked hard together, including BHA, BPHC, and local universities. “Some people think partnerships just happen when you put people together and say ‘here is what you are doing [together],’ but it doesn’t happen like that by a longshot,” remarked Livingston. It takes slow and steady work to identify shared goals, overcome turf issues, build trust, and reach a shared understanding that solving problems together will make everyone’s jobs easier. Each partner brings important resources to the table that can be leveraged to work together, whether it is resources, expertise, or an audience with policymakers.

Just as in the case of CD4AP and Nationwide Children’s, small successes strengthened the partnership and led to larger ones. Livingston noted it started with “everyone want[ing] housing to be better and healthier for the people living there.” What began as a program on integrative pest management in a handful of BHA properties has expanded across its portfolio as part of its standard property management practices. By 2012, another major asthma trigger within its properties was eliminated when BHA adopted a smoke-free policy. The Boston Housing Authority also participates in a local partnership to house the homeless and is working with residents to combat obesity by reducing sugary drink consumption.

Local housing organizations, whether nonprofit community developers such as CD4AP or public housing authorities such as BHA, are critical partners in addressing local health needs. People usually spend more time in their home than anywhere else. If that critical environment doesn’t adequately promote health, the odds may be stacked against some of our most vulnerable neighbors. Though housing organizations have different terminology, different resources (with complicated compliance rules), and different skill sets than health providers, they are a natural ally for improving health and have proven themselves willing partners.

The Columbus and Boston partnerships started small and built on initial wins to sustain and expand their activities for the health of the people they serve. Starting such partnerships is hard work but entirely possible and definitely rewarding.